b) 74-year-old man admitted with severe sepsis develops loose stools. Sigmoidoscopy showed yellowish exudates. H/o recurrent episodes of urinary tract infections treated with multiple courses of antimicrobials including cefixime, nitrofurantoin and amoxicillin-clavulanate. Five months prior to this admission he was admitted wor an abdominal abscess with iliac vein thrombosis that was treated with piperacillin-tazobactam and amikacin. In the month preceding his admission, he had sepsis due to extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli that was treated with imipenem. 

The case of a 74-year-old man admitted with severe sepsis who develops loose stools is concerning and requires further evaluation. The patient's history of recurrent urinary tract infections, multiple courses of antimicrobials, and recent admission for an abdominal abscess with iliac vein thrombosis treated with piperacillin-tazobactam and amikacin is suggestive of potential antibiotic-associated diarrhea or Clostridium difficile infection.

Sigmoidoscopy showing yellowish exudates is also consistent with the presence of C. difficile infection. This infection is a common cause of antibiotic-associated diarrhea and can cause severe complications such as pseudomembranous colitis and toxic megacolon. Moreover, the patient's recent history of sepsis due to extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli treated with imipenem raises the possibility of imipenem-resistant infections such as carbapenemase-producing Enterobacteriaceae.

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