Continuing Medical Education Questions: April 2013DeVault, Kenneth R MD, FACG; Gómez, Victoria MD; Ngamruengphong, Saowanee MDAmerican Journal of Gastroenterology: April 2013 - Volume 108 - Issue 4 - p 499 doi: 10.1038/ajg.2013.86 Practice Guidelines Free Author InformationAuthors Article OutlineOutline Article MetricsMetrics If you wish to receive credit for this activity, please refer to the Web site:http://acgjournalcme.gi.org/. Article Title: Guidelines for Diagnosis, Treatment, and Prevention ofClostridium difficileInfections Questions: Back to Top | Article Outline Questions: 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. 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. 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.