To obtain credit, you should first read the journal article. After reading the article, you should be able to answer the following, related, multiple-choice questions. To complete the questions and earn continuing medical education (CME) credit, please go to http://cme.medscape.com/viewpublication/30063. Credit cannot be obtained for tests completed on paper, although you may use the worksheet below to keep a record of your answers. You must be a registered user on Medscape.com. If you are not registered on Medscape.com, please click on the New Users: Free Registration link on the left hand side of the website to register. Only one answer is correct for each question. Once you successfully answer all post-test questions you will be able to view and/or print your certificate. For questions regarding the content of this activity, contact the accredited provider, CME@medscape.net. For technical assistance, contact CME@webmd.net. American Medical Association’s Physician’s Recognition Award (AMA PRA) credits are accepted in the US as evidence of participation in CME activities. For further information on this award, please refer to http://www.ama-assn.org/ama/pub/category/2922.html. The AMA has determined that physicians not licensed in the US who participate in this CME activity are eligible for AMA PRA Category 1 Credits™. Through agreements that the AMA has made with agencies in some countries, AMA PRA credit is acceptable as evidence of participation in CME activities. If you are not licensed in the US and want to obtain an AMA PRA CME credit, please complete the questions online, print the certificate and present it to your national medical association.

CME Questions

• You are seeing a 60-year-old woman who was admitted to the hospital for an infected foot ulcer. She has a history of poorly controlled diabetes, congestive heart failure, and stage III chronic kidney disease. Over the last 24 hours, she has developed fever and leukocytosis. Infection is suspected, but the source is not clear. The patient complains of fatigue and chills, but a review of systems is otherwise negative.

Based on data from the current study, which of the following statements regarding the possibility of Clostridium difficile bacteremia (CDB) in this patient is most accurate?

• A. Most CDB is found in young, healthy people

• B. CDB usually develops in association with hospitalizations or stays in chronic care facilities

• C. Abdominal pain is the most common presenting symptom of CDB

• D. CDB does not occur without preceding diarrhea

  • What was the most common source of bacteremia among patients in the current study?

• A. Primary bacteremia

• B. Intra-abdominal infection

• C. Bone and joint infection

• D. Soft tissue infection

  • The patient from question 1 is diagnosed with CDB. According to the current study, what is the best initial choice of antibiotic for her?

• A. Metronidazole

• B. Imipenem

• C. Ertapenem

• D. Clindamycin

  • The patient from question 1 is treated with an appropriate antibiotic. Which of the following statements regarding her prognosis is most accurate?

• A. Mortality is 75% regardless of antibiotic therapy

• B. Use of broad-spectrum antibiotics reduces the risk for mortality to less than 10%

• C. Survivors of CDB usually remain in the hospital for 3–5 days

• D. Treatment with appropriate antibiotics can reduce the risk for mortality to 12.5%