Infectious Disease Expert Evaluates Fatally Delayed C. Difficile Infection Diagnosis

Case Overview

This case involves an elderly male patient in New Jersey who was killed by an acute C. difficile infection. The patient first presented to his primary care doctor with complaints of a high fever and lethargy. Upon examination, the doctor diagnosed the man with pneumonia, despite the fact that the patient did not have a cough. The patient was sent home with a prescription for antibiotics and instructions to follow up in a week. Over the next few weeks the patient’s condition continued to deteriorate until he was eventually admitted to the hospital. There, he was diagnosed with an advanced C. Difficle infection, which eventually proved fatal.

Questions to the Infectious Disease and Communicable Disease expert and their responses

Do you routinely treat patients similar to the one described in this case?

I routinely see geriatric patients with C. difficile infections. They are the group at highest risk of infection, and most cases are associated with antibiotic use.

How could the patient's outcome be avoided in this case?

If antibiotic use was unnecessary (as it often is) this case could have been avoided by no antibiotics. Also at the point of evaluating for fever, many patients like this will have a very limited workup that doesn't identify the true cause, as appears to have been the case here. Being treated for pneumonia when having C. difficile would make the C. difficile worse (as most antibiotics make C. difficile worse).

About the expert

This highly qualified expert is board certified in both Infectious Diseases and Internal Medicine and completed his fellowship training at The Weill Medical College of Cornell University. He is a member of The Infectious Disease Society of America, International Society of Infectious Diseases and Society for Hospital Medicine. He formally acted as a consultant for the U.S. Navy on Infection Control. Currently this expert is an Infectious Disease physician and Chief Hospital Epidemiologist at a university affiliated hospital and an Associate Professor a major university. He earned his BS at Reed College, MS in Clinical Research at the University of Maryland School of Medicine, and his MD at the University of Rochester.

E-009394

Specialties:

Infectious Disease and Communicable Disease