An 85-year-old male who was recently treated for an upper respiratory tract infection presented 2 days ago with abdominal pain. On abdominal examination, he has tenderness to palpation with mild distention but no signs of peritonitis. On admission, the WBC was 25 cell/mL and now it is 18 cell/mL. Urinalysis does show bacteria and the initial diagnosis is a UTI. Cultures have been sent. Chest X-ray does not show any evidence of pneumonia. He starts to develop hypotension on the floor with oliguria requiring 2 L of crystalloid. A request is made to transfer the patient to the ICU. The nurse notes that in the past 24 hours, he has had four episodes of diarrhea. Stool was sent for GDH (glutamate dehydrogenase) and Toxin A and B. GDH was negative, but the Toxin A/B was positive. She asked the intern on the floor to start IV Flagyl for a presumed Clostridium difficile infection, but the intern has not started it yet. Aside from the sepsis guidelines and ICU care, what is the NEXT step to address a possible C. difficile infection?
A. Hydration, bowel rest, continuing current empiric antibiotics, and monitoring her symptoms Wrong Choice!
B. Start IV Flagyl because the patient is positive for Toxins and obtain a KUB Wrong Choice!
C. Send stool for nucleic acid amplification testing then start IV Flagyl and obtain a KUB Correct Choice
D. Start IV Flagyl and PO Vancomycin and obtain a KUB Wrong Choice!
Answer:C
An 85-year-old male who was recently treated for an upper respiratory tract infection presented 2 days ago with abdominal pain. On abdominal examination, he has tenderness to palpation with mild distention but no signs of peritonitis. On admission, the WBC was 25 cell/mL and now it is 18 cell/mL. Urinalysis does show bacteria and the initial diagnosis is a UTI. Cultures have been sent. Chest X-ray does not show any evidence of pneumonia. He starts to develop hypotension on the floor with oliguria requiring 2 L of crystalloid. A request is made to transfer the patient to the ICU. The nurse notes that in the past 24 hours, he has had four episodes of diarrhea. Stool was sent for GDH (glutamate dehydrogenase) and Toxin A and B. GDH was negative, but the Toxin A/B was positive. She asked the intern on the floor to start IV Flagyl for a presumed Clostridium difficile infection, but the intern has not started it yet. Aside from the sepsis guidelines and ICU care, what is the NEXT step to address a possible C. difficile infection?
A. Hydration, bowel rest, continuing current empiric antibiotics, and monitoring her symptoms Wrong Choice! B. Start IV Flagyl because the patient is positive for Toxins and obtain a KUB Wrong Choice! C. Send stool for nucleic acid amplification testing then start IV Flagyl and obtain a KUB Correct Choice D. Start IV Flagyl and PO Vancomycin and obtain a KUB Wrong Choice!