Decision-IQ: Managing Recurrent Clostridioides Difficile Infection in a Patient With Ulcerative Colitis

Decision-IQ: Managing Recurrent Clostridioides Difficile Infection in a Patient With Ulcerative Colitis is organized by Med-IQ. 

Initial Release Date: September 4, 2019
Expiration Date: September 3, 2020

Target Audience:
This activity is intended for gastroenterologists.

Accreditation:
Med-IQ designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Overview:
In this brief, case-based activity, meet a 35-year-old man with a history of ulcerative colitis (UC) who has been admitted to the hospital. Approximately 2 weeks ago, he began experiencing a symptom flare-up with numerous loose stools per day with small amounts of blood and mucus, low-grade fevers, and abdominal pain.

As you move through this activity, you will:
• Be directed to useful resources to help you make diagnostic and management decisions for this patient
• See how your answers compare with your peers’
• Receive insights from gastroenterologist, Amy Barto, MD, on identifying and managing Clostridioides difficile infection (formerly known as Clostridium difficile) in a patient with UC

Statement of Need:
Patients with inflammatory bowel disease (IBD), especially ulcerative colitis (UC), have an increased risk of Clostridioides difficile infection (CDI, formerly known as Clostridium difficile) and recurrent CDI in particular. In patients with UC, CDI is associated with an increased risk of hospitalization, surgery, and morbidity. Furthermore, the diagnosis of CDI in an individual with UC is challenging as it is difficult to distinguish it from an IBD flare-up. Management challenges include choosing an appropriate antibiotic therapy, determining the optimal timing of antibiotic initiation, adjusting immunosuppressive therapy (if needed), and assessing candidacy for fecal microbiota transplantation. As the incidence of CDI in the general population is increasing—with even greater increases seen in patients with IBD—gastroenterologists must be able to overcome the unique diagnostic and management challenges presented by CDI in UC.

Learning Objective:
Upon completion, participants should be able to:
• Describe strategies to identify and manage Clostridioides difficile infection in patients with UC