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?