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Gastroenterology


Answer 1
  1. Send stool samples for C. difficile toxin analysis. This patient has several risk factors for C. difficile diarrhea, including ongoing antibiotic use and prolonged hospitalization, and his clinical picture is highly suggestive of this infection. Enzyme immunoassay of 3 stool samples to look for C. difficile toxin A or B is usually sufficient to make the diagnosis. Although a colonoscopy may confirm the presence of pseudomembranes, a stool assay is easier and safer to obtain. Initiation of empiric antibiotic therapy for diarrhea presumed to be due to C. difficile should wait until the etiology of the infection is known. Given this patient’s significant symptoms and comorbid illness, observation is inadequate.

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