CDI Cases Flashcards
SH is a 50yo man who presents with fever and watery stools. He had 5 episodes of watery stools the previous day. He mentions that he is experiencing abdominal cramps and is hunching over in pain. NKDA His temperature is 39.0ºC
Dx: Acute Infectious Diarrhea
His stool culture has been sent for testing. Meanwhile, suggest a treatment for this patient
Ceftriaxone 2g IV q24h for 3-5d
or cipro 500mg PO BD 3-5d
MT is a 78yo woman who recently undergone kidney transplant. She presents with fever and watery stools. She mentioned that she had diarrhea 4 times the previous day. Her stools are not bloody, and does not have mucus. Her temperature is 38.2ºC and she is feeling very lethargic. She is allergic to macrolides (rashes).
Dx: Acute infectious Diarrhea
Do you treat this patient? Why or why not? If yes, suggest treatment for this patient
Yes treat, because patient is immunocompromised, and fever is a sign of infection
Treatment: IV Ceftriaxone 2g q24h for 3-5 days
(or cipro 500mg PO BD 3-5d)
NU is a 50yo man who presents with diarrhea, fever and abdominal cramps. He mentioned that his diarrhea lasted for 1 week, with at least 5 episodes each day. He was discharged from a severe pneumonia 1 month ago. His GDH and Toxin tests are both posittive for C.difficle and toxins. He had no history of CDI. NKDA
Vitals: WBC 14.8, sCr 100, T 38.2ºC, RR23, HR 78, BP 110/69
Radiological imaging: No abnormalities
Suggest treatment for this patient
CDI: Non-severe
Treatment options available:
- PO Vancomycin 125mg q6h 10d
- PO Metronidazole 400mg PO q8h 10d
- PO FDX 200mg q12h 10d (not registered in SG)
ABC is a 49yo man who was recently treated for pneumonia with a 7-day course of levofloxacin presents with dirrhea. Stool testing confirms CDI and she has no history of CDI. NKDA
Vitals: WBC 18, sCr 98, T 38.9ºC, RR20, HR 88, BP 101/62
Radiological imaging: No abnormalities
Suggest treatment for this patient
Case: Initial episode of severe CDI (WBC ≥15 x10^9)
Treatment: Similar as initial, non-severe CDI
- PO Vancomycin 125mg q6h 10d
- PO FDX 200mg q12h 10d (not registered in SG)
(Metronidazole is NOT appropriate since it has shown high failure rate in severe CDI)
XJ is a 43yo woman was treated with a 7-day course of clindamycin for cellulitis. SHe presented with new onset of diarrhea. Stool testing confirmed CDI. She has prior diagnosis of CDI in the last 1 year. NKDA
Vitals: T 39.3ºC, HR 91, RR 22, BP 103/67, WBC 18 x 10^9
Histological findings show pseudomembranous colitis
Ileus is confirmed
Recommend treatment for this patient
Case: Fulminant CDI with ileus
(Pseudomembranous colitis is a complication hence fulminant)
Recommended treatment:
- PO Vancomycin 500mg q6h
- PR Vancomycin 500mg in 100mL NS q6h
- IV Metronidazole 500mg q8h
Treatment duration: 10d (usually patient will show improvement within 10d)
Mew is a 37yo woman presented with new onset of diarrhea. Stool testing confirmed CDI. She last received medications for CDI 7 weeks ago and her treatment was Vancomycin 125mg for 10 days. He had no other episodes of CDI prior to the one mentioned. NKDA
Vitals: T 38.7ºC, HR 81, RR 21, BP 111/77, WBC 14 x 10^9
Xray shows no abnormalities
Histological investigations shows no abnormalities
Recommend treatment for this patient
Case: Recurrent CDI: First recurrence
Treatment: Prolonged tapered/pulsed Vancomycin regimen
- PO 125mg q6h for 10-14d then
- PO 125mg q12h for 7d then
- PO 125mg q24h for 7d then
- PO 125mg every 2-3d for 2-8 weeks
OR
- PO Fidaxomicin 200mg q12h for 10d
Mewtwo is a 41yo man presented with new onset of diarrhea. GDH test and NAAT tests were positive for C.difficle and its toxins. He last received medications for CDI 8 weeks ago and his treatment was Vancomycin 125mg for 10 days. He also had another episode of CDI 15 weeks ago and his treatment was Metronidazole 400mg for 10 days. NKDA
Vitals: T 39.1ºC, HR 76, RR 19, BP 111/77, WBC 17 x 10^9
Xray shows no abnormalities
Histological investigations shows no abnormalities
Recommend treatment for this patient
Case: Second or subsequent recurrence
Possible treatment options:
1) Tapered/pulsed vancomycin regimen
2) PO VAN 125mg q6h 10d, then PO Rifaximin 400mg q8h 20d
3) PO FDX 200mg q12h for 10d
If there are any further failed therapy:
- Fecal microbiota transplantation
Mjiau is a 50yo man who was treated for CDI 2 weeks ago with PO Vancomycin 125mg q6h for 10days. He is afebrile, and his diarrhea has stopped. His vitals have also returned to normal. NKDA
The doctor ordered for GDH EIA test and NAAT tests and found that both tests were still positive. He suggested to continue the CDI treatment with PO Metronidazole 400mg q8h for 10 more days. Do you agree with the doctor?
Do not agree with the doctor
- Tests remains positive even after treatment and asymptomatic
- Hence, patient is fine and does not require any further treatment for now, unless his diarrhea returns
Woofers is a 32yo F who presents with a new onset of diarrhea. Her stool is positive for CDI. She had a previous CDI 10 weeks ago, which was treated with Metronidazole 400mg for 10 days. She is currently taking Omeprazole 20mg OD for Gastro-Esophageal Reflux Disease (GERD) which was diagnosed 13 days ago. NKDA
Vitals: T 37.9ºC, RR 17, WBC 12, sCr 100 mmol/dL, BP 120/80, HR 65
X-ray shows no abnormalities
Suggest treatment for this patient. Suggest modifications to any of her current medications if necessary
Case: Initial, non-severe CDI
(note her episode is 10 weeks ago, which is beyond 2-8 weeks to be classified as recurrent CDI)
Treatment:
- PO Vancomycin 125mg q6h for 10d OR
- PO Metronidazole 400mg q8h for 10d OR
- PO Fidaxomicin 200mg q12h for 10d
Although PPI is a risk factor for CDI, her omeprazole should not be deprescribed (For GERD, treatment duration is 4-8 weeks)
Booper is a 67yo F who presents with a new onset of diarrhea. The GDH and Toxin test of her stool sample is positive for C.difficle. She had a previous episode of CDI 6 weeks ago which was treated with Metronidazole 400mg q8h for 10 days. She also had an earlier episode of CDI which was 20 weeks ago and was treated with Vancomycin 125mg for 10 days. NKDA.
Vitals: T37.8ºC, RR 18, HR 80, BP 110/79, sCr 99 mmol/dL, WBC 14.9 x 10^9
Recommend treatment for this patient
Case: First recurrence of CDI
Treatment option:
- PO Vancomycin 125mg q6h for 10d
(no need tapered/pulsed vancomycin since her previous episode of cdi was treated with metronidazole)
