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LEARNING OBJECTIVES

After completing this case study, the reader should be able to:

  • Identify signs and symptoms of Clostridioides difficile infection (CDI).

  • Discuss CDI complications and prevention strategies.

  • Evaluate treatment options and develop an optimal patient-specific treatment plan for initial and recurrent CDI, including drug, dose, frequency, route of administration, and duration of therapy.

  • Develop a pertinent monitoring plan for a CDI regimen from a therapeutic and toxic standpoint.

PATIENT PRESENTATION

Chief Complaint

“I have been having to go to the bathroom a lot more frequently, and my stomach hurts a lot.”

HPI

Bernice Cooper, a 68-year-old woman, is transferred to your medical team from the MICU after being admitted for sepsis secondary to a urinary tract infection and hypotension requiring pressor support. Over the past 2 days, she has been complaining of frequent foul-smelling stools. One week prior to being transferred to your team, she was admitted to the hospital complaining of urinary frequency and urgency for 3 days, nausea, vomiting, and left-sided flank pain, as well as light-headedness and dizziness. In the ED, the patient was hypotensive (BP 92/63 mm Hg) and tachycardic (HR 112–124 bpm), with an elevated lactate level and leukocytosis. She was transferred to the MICU for pressor support and started on an empiric regimen of cefepime and vancomycin 1 g IV Q 12 H for suspected urosepsis. Urine (×2) and blood (×3) cultures were subsequently found to be growing Escherichia coli and enteric gram-negative rods, respectively, and antibiotic coverage was narrowed to ceftriaxone 2 g IV daily on day 5. The patient’s blood pressure was stabilized, no ileus was detected, and she was transferred to the internal medicine service on day 7 of hospitalization. She is now complaining of new-onset diarrhea and abdominal pain.

PMH

CDI 2 months ago

Hyperlipidemia

HTN

s/p MI 2003

SH

Lives at home alone, lifetime smoker (half pack per day for 54 years), drinks alcohol socially

Medications

Metoprolol XL 100 mg PO once daily

Lisinopril 10 mg PO once daily

Atorvastatin 10 mg PO once daily

Pantoprazole 40 mg PO once daily

All

NKDA

Physical Examination

Gen

Patient is overweight and complains of abdominal discomfort.

VS

BP 149/85, P 98, RR 20, T 38.8°C; Ht 5′8″, Wt 87.2 kg

Skin

Warm and moist secondary to ...

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