Infectious Diseases I

J.E. is a 67-year-old woman admitted to the MICU

for severe metabolic acidosis secondary to uninten-

tional metformin overdosage. Her ICU stay has been

complicated by a femoral vein CLABSI and related

severe sepsis caused by pan-sensitive E. coli. J.E.

received a 3-day course of empiric piperacillin/tazo-

bactam, removal of her central line, and 11 days of

ceftriaxone as definitive therapy with resolution of

sepsis. Starting yesterday, it was noted that J.E. had

nine loose bowel movements and new leukocytosis

of 14,500 cells/mm3, which suggests Clostridioides

difficile infection (CDI). J.E. continues to tolerate

enteral nutrition. Per the 2021 IDSA focused guide-

line update, which is the most appropriate regimen

for J.E.’s suspected CDI?

hours

8 hours

hours

hours

J.S. is a 42-year-old man admitted to the SICU after

an open total colectomy with ileostomy for ischemic

colitis. On postoperative day 4, the surgery resident

on your interdisciplinary ICU team notes moderate

erythema (3 cm) and purulent drainage from the

wound. The resident subsequently opens the skin

portion of the wound and finds infected material just

above the unaffected fascia. No systemic signs and

symptoms are noted. Which intervention is most

appropriate?

dressing

changes

and

patient

assessment.

wound infection.

against skin and colonic flora.

suspected necrotizing fasciitis.

tension who presents to the ED with altered mental

status and acute kidney injury. T.F. was seen at an

outside hospital 5 days ago, where he tested positive

for novel severe acute respiratory syndrome corona-

virus 2 (SARS-CoV-2). On initial assessment, T.F.

is hemodynamically stable with an oxygen satura-

tion (SaO2) of 87% on room air, which has worsened

over the past 4 hours. T.F. now requires 5 L of high-

flow nasal cannula to maintain an SaO2 above 92%.

Chest radiography is notable for bilateral opacities

consistent with viral pneumonia. Initial laboratory

tests indicate alanine aminotransferase 23 U/L and

estimated creatinine clearance 31 mL/minute (base-

line 68 mL/minute). Which agent is considered

first-line therapy in hospitalized patients with coro-

navirus disease 2019 (COVID-19) and increasing

oxygen requirement?