Infectious Diseases I

and guideline recommendations do not support prophy-

lactic antibiotic therapy for preventing infection of the

necrotic tissue (Answer D is incorrect). The mainstay of

therapy for this patient is volume resuscitation and con-

sideration of surgical debridement of pancreatic necrosis

if persistent SIRS is evident (Answer C is incorrect).

Answer: A

Metronidazole orally or through a feeding tube is not

recommended for management of an initial-episode

CDI (Answer B is incorrect). Intravenous metronida-

zole is indicated for fulminant CDI in combination with

vancomycin (Answer C is incorrect) In the absence of

fulminant CDI (i.e., shock, megacolon, ileus), the 2021

IDSA focused guideline update recommends fidaxomi-

cin over oral/enteral vancomycin for first-episode CDI

to increase the likelihood of complete clinical response

(Answer A is correct; Answer D is incorrect). If fidax-

omicin is unavailable or cost-prohibitive, oral/enteral

vancomycin is an acceptable alternative.

Answer: A

This patient has a superficial incisional wound infec-

tion requiring opening and the local debridement of

infected material. Lack of systemic signs of infection

and no involvement of the fascia suggest that no anti-

biotic therapy is necessary at this time (Answer A is

correct; Answers B–D are incorrect). If the infection

extends to include these features or worsened erythema

consistent with cellulitis, empiric antibiotic therapy may

be warranted.

The RECOVERY trial showed that dexamethasone

decreases 28-day mortality compared with usual care in

hospitalized patients with COVID-19 requiring supple-

mental oxygen or MV. A meta-analysis of available trials

also supports corticosteroid use (Answer A is correct).

Hydroxychloroquine has limited to no benefit in patients

hospitalized with COVID-19 (Answer B is incorrect).

Evidence from the ACTT study showed that remdesi-

vir may shorten the duration to clinical recovery, but it

has no difference on mortality compared with placebo.

Non-controlled, aggregated data have suggested an

association with lower mortality, but this has not been

confirmed in controlled trials; therefore, remdesivir

should be considered in addition to dexamethasone rather

than monotherapy in patients with increasing oxygen

requirement (Answer C is incorrect). Tocilizumab, an

anti–IL-6 monoclonal antibody, can be considered in

addition to dexamethasone with or without remdesi-

vir in patients recently hospitalized and demonstrating

rapid decline in oxygenation and systemic inflammation.

(Answer D is incorrect).