American Board of Internal Medicine (ABIM) Certification Practice Exam

What might be a possible indication for a second recurrence of Clostridium difficile infection?

1. Persistent fever without other symptoms

2. History of previous antibiotic use

3. Severe abdominal pain

4. Uncontrolled diabetes

The correct answer is: History of previous antibiotic use

A history of previous antibiotic use is a significant indication for a second recurrence of Clostridium difficile infection (CDI). Antibiotics disrupt the normal gastrointestinal flora, which can lead to an overgrowth of C. difficile if it is present in the gut. This disruption can create an environment conducive to CDI due to the lack of competing bacteria that normally help keep pathogenic organisms in check. When treatment with antibiotics is used, it not only treats the initial infection but can also eliminate beneficial bacteria. In patients with a prior history of CDI, repeated antibiotic use is a strong risk factor for recurrence. Thus, recognizing the association between past antibiotic therapy and the likelihood of CDI return is critical for management and prevention strategies. Other options presented do not have a direct and established link to the risk of recurrent CDI in the same way that prior antibiotic use does. Persistent fever may indicate an ongoing infection but is not specific to CDI. Severe abdominal pain is a symptom that could arise from various gastrointestinal issues, not necessarily indicative of a recurrent CDI without other supporting symptoms. Uncontrolled diabetes can lead to various complications in infections but is not a recognized direct risk factor for the recurrence of CDI.