Q: 49 year old male with previous history of crohn's disease with colectomy is admitted to ICU from floor due to hypotension and severe diarrhea. What should be the first concern?


Answer: C. Diff.

C. difficile infection in patients with Inflammatory Bowel Disease with previous surgery is very common and can get fatal without treatment. Oral vancomycin is said to be better than metronidazole.




References:

1. Issa M, Vijayapal A, Graham MB, et al. Impact of Clostridium difficile on inflammatory bowel disease. Clin Gastroenterol Hepatol 2007; 5:345. 

2. Horton HA, Dezfoli S, Berel D, et al. Antibiotics for Treatment of Clostridium difficile Infection in Hospitalized Patients with Inflammatory Bowel Disease. Antimicrob Agents Chemother 2014; 58:5054.