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Continuing Medical Education Questions: April 2013

DeVault, Kenneth R MD, FACG; Gómez, Victoria MD; Ngamruengphong, Saowanee MD

American Journal of Gastroenterology: April 2013 - Volume 108 - Issue 4 - p 499
doi: 10.1038/ajg.2013.86
Practice Guidelines

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Article Title: Guidelines for Diagnosis, Treatment, and Prevention ofClostridium difficileInfections

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  1. Which one of the following definitions of severe Clostridium difficile infection (CDI) do the authors propose?
    • A. CDI with at least one of the following: hypotension with or without use of vasopressor therapy; white blood cell count (WBC) ≥35,000 cells/mm3 or <2,000 cells/mm3; or sepsis and organ dysfunction.
    • B. CDI with hypoalbuminemia (serum albumin <3 g/dL) and either a WBC ≥15,000 cells/mm3 or abdominal tenderness without criteria of complicated disease.
    • C. WBC ≥15,000 cells/mm3 or serum creatinine level ≥1.5 times the premorbid level.
    • D. CDI with diarrhea in patients older than 60 years.
  2. Which one of the following statements is true?
    • A. Asymptomatic carriers of Clostridium difficile are rare, making up less than 1% of healthy adults. Therefore, antimicrobial therapy to eradicate asymptomatic carriage of B. Clostridium difficile in hospitalized patients is recommended to prevent horizontal spread within an institution.
    • B. Nucleic acid amplification tests (NAATs) such as polymerase chain reaction (PCR) for Clostridium difficile toxin genes are superior to toxin A + B enzyme immunoassay (EIA) as a standard diagnostic test for CDI.
    • C. Repeat testing can increase the sensitivity and negative predictive values of NAATs for toxigenic Clostridium difficile.
    • D. Testing for cure aft er treatment of CDI can be used to evaluate the need for a longer course of anti-Clostridium difficile therapy.
  3. In the following clinical scenarios, which treatment recommendation is most appropriate for anti-Clostridium difficile therapy?
    • A. For mild-to-moderate CDI in pregnant or breastfeeding women, metronidazole 500 mg taken orally three times per day for 10 days is the first-line therapy.
    • B. In patients with mild-to-moderate CDI who fail to respond to metronidazole therapy within 7 days, metronidazole therapy should be continued for an additional 14 days.
    • C. Patients with severe CDI should be treated with fidaxomicin 200 mg orally 2 times per day for 10 days.
    • D. In patients with CDI in whom oral antibiotics cannot reach a segment of the colon—such as patients with Hartman's pouch, ileostomy, or colon diversion—vancomycin therapy delivered via enema should be added to standard treatments until the patient improves.
© The American College of Gastroenterology 2013. All Rights Reserved.