Clostridioides difficile Infection
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Management of Clostridioides difficile Infection (2021)
Clostridioides difficile Infection- Key Concepts
- Fecal Microbiota Transplant (FMT)
- References
- Introduction
- Epidemiology
- Clinical Risk Factors
- Advanced Age
- Antibiotic Treatment
- Contact with a Healthcare Facility
- Immunocompromised States
- Inflammatory Bowel Disease
- Perioperative Prophylactic Antibiotics and Mechanical Bowel Preparation
- Proton Pump Inhibitors
- Nomenclature and Genetics of C. difficile Infection
- Diagnosis of C. difficile Infection
- Clinical Measures of Severity
- Antibiotic Therapy for CDI
- Surgery for CDI
Benign Disease- A 55-year-old man presents with severe refractory ulcerative colitis. He was admitted to the hospital and placed on parenteral steroids. He is now receiving salvage therapy with infliximab, but is not responding. The best next step in management is to:
- A 43-year-old man is seen on an inpatient consultation basis for ulcerative colitis that has been recalcitrant to medical management for the past 2 weeks. He has worsening abdominal pain, persistent diarrhea, rectal bleeding, and intermittent fevers. He was given empiric broad-spectrum antibiotics for elevated leukocytosis. Colonoscopy revealed pancolitis consistent with findings of ulcerative colitis. Although his pain improves, he continues to have 15 to 20 watery bowel movements per day. What is the most appropriate next step in management?
- A 56-year-old woman with a history of recurrent urinary tract infections presents to the emergency department with tachycardia (heart rate 124 beats/min), hypotension (blood pressure 85/38 mm Hg), diffuse abdominal pain, and frequent watery diarrhea following a course of oral antibiotics. Her abdomen is distended and diffusely tender. Her white blood cell count is 25,000/L (25109/L) and her hemoglobin is 15.0 g/dL (150 g/L). The patient is positive for Clostridioides difficile and is not responding to treatment with 125 mg of oral vancomycin. What is the next best option for this patient?
- A 68-year-old woman developed crampy abdominal pain with diarrhea after taking antibiotics for a dental procedure. She was treated for Clostridioides difficile infection (CDI) with oral vancomycin. Three weeks later, she developed similar symptoms and is treated for a relapse of CDI with vancomycin for 2 weeks. She now presents with her third episode of CDI 8 weeks after her initial infection. She is hemodynamically stable with minimal abdominal discomfort. She does not want to have surgery and would like to know other alternatives. What is the best next step in management?
- A 66-year-old woman presents to the emergency department with loose, watery stools for 3 days, after completing a 10-day course of oral antibiotics for a sinus infection. The patient denies nausea or vomiting. A stool sample is positive for Clostridioides difficile toxin. Examination reveals soft, nondistended, and mild lower abdominal tenderness. The best next step in management is:
- A 23-year-old man with a history of ulcerative colitis is admitted to the hospital with bloody diarrhea. His white blood cell count is 13,000/L (13109/L) and hemoglobin is 8.3 g/dL (83 g/L). He is hemodynamically stable. After hospital admission and initiation of intravenous (IV) steroids and infliximab, he undergoes flexible sigmoidoscopy with biopsy. He continues to have 10 to 12 bloody bowel movements daily. Endoscopic and pathologic findings are shown (Figures 1 and 2). What is the best next step in management?
Benign Disease- A 55-year-old otherwise healthy woman presents with tachycardia, abdominal pain, and diarrhea after taking antibiotics. Computed tomography (CT) shows pancolitis. Infectious workup is positive for Clostridioides difficile (C. diff). She has never had C. diff colitis. What is the initial therapy recommended for her?
- A 26-year-old patient who was admitted to the hospital with ulcerative colitis (UC) continues to have frequent bloody bowel movements and tachycardia despite intravenous (IV) steroids and cyclosporine. Which is the most appropriate next step?
- A 38-year-old man returns from a 1-week trip to Africa, where he had sampled the local cuisine and drank the water. On his return, he develops fever and bloody diarrhea. Other symptoms included abdominal pain, nausea and vomiting. His symptoms did resolve independently over the course of the next week. Within a few days of gastrointestinal symptom resolution, the patient developed neurologic symptoms consistent with Guillan-Barre syndrome. Which of the following gastrointestinal illnesses is he most likely to have contracted?
- A 78-year-old woman is diagnosed with Clostridioides difficile colitis, intially presenting with frequent diarrhea and mild abdominal pain. Despite appropriate antibiotic therapy with oral vancomycin and fluid resuscitation, she develops progressive hypotension, tachycardia, worsening abdominal pain, and altered mental status. The best next step in management is
- A 42-year-old previously healthy woman presents to the emergency department with 2 weeks of right lower quadrant abdominal pain and diarrhea. Computed tomography (CT) of the abdomen and pelvis shows terminal ileitis and associated enlarged mesenteric lymph nodes. Serologic testing for which of the following should be performed?
- Infectious Colitides
- Ulcerative Colitis: Surgical Management
- Perioperative
- Surgical Management of Ulcerative Colitis (2021)