Infectious Diseases I

Patient Cases

(38.8°C), WBC 27 x 103 cells/mm3, heart rate 125 beats/minute, and mean arterial pressure 57 mm Hg. An

abdominal CT scan reveals a large amount of intestinal air, suggestive of ileus and moderate transverse and

sigmoid colonic inflammation. On review of the patient’s history, it is learned that K.L. recently completed

a 4-week course of broad-spectrum antibiotic therapy for a postoperative osteomyelitis after repair of right

comminuted femur fracture, increasing the suggestion of CDI. Which regimen would be best for empiric

management of a suspected CDI in K.L.?

intravenously every 8 hours, and intracolonic vancomycin 500 mg instilled every 8 hours.

nasogastric tube every 6 hours.

Questions 15 and 16 pertain to the following case.

E.A. is a 79-year-old man admitted to the MICU for severe pneumonia. On day 5 of treatment with broad-spec-

trum antibiotic therapy despite negative culture, E.A. is noted to have several liquid bowel movements requiring

a rectal pouch (around 1.6 L of stool in past 24 hours), a low-grade fever, elevation of WBC at 27 x 103 cells/mm3,

heart rate 124 beats/minute, MAP 67 mm Hg, lactate 1.6 mmol/L, and SCr 1.5 mg/dL. A stool sample is sent for

a suspected C. difficile infection (CDI).

every 8 hours.

nasogastric tube every 6 hours.

would be best for E.A.?