Gastrointestinal Tract Infection Case Study
1) The 83yr old man has had a history of hypertension and chronic renal failure, which may have factored in his cause of Urinary Tract Infection (UTI) after undertaking is aortic valve replacement. The case study states that Staphylococcus, a bacterium that is normally found in the gastrointestinal tract and is one of the common bacteria in most UTI, was isolated from the patient’s blood cultures. It is also common that a bladder infection is a symptom of any underlying disorder, such as the patient’s history of hypertension and chronic renal failure. Subjects who are at higher risk of developing UTI are elder adults and the use of using a catheter; that may have been used in the subject’s surgery.
The initial administration of Tiacarillin Clavulanate was used to reduce the number of the patients’ drug-resistant bacteria and maintain …show more content…
the effectiveness of antibacterial drugs. Tiacarillin clavulanate should only be used to prevent infections that are proven or strongly suspected to be caused by bacteria .
2) The administration of Tiacarillin Clavulanate may have been the main factor for the Clostridium difficile Infection (CDI) in the patient, as the exposure to antibiotics has accounted for roughly 95% of development of CDI. This is the most important risk factor in the development of CDI. “The disruption of the normal flora caused by antibiotics allows C. difficile to colonize and overgrow within the gastrointestinal tract. Nearly every antibiotic has been implicated in leading to CDI, however broad spectrum antibiotics with1 anti-anaerobic activity appear to cause the greatest risk”.
Secondly, the CDI was most likely predisposed by the man’s advanced age . Production of antitoxin antibody by the patient protects against CDI; however, the ability to mount this immune response decreases with age, which would account for the severity and recurrence of CDI in the elderly.
Other known risk factors, such as duration of hospital stay or exposition to proton-pump inhibitor might be discarded in our patient, since the CDI was diagnosed only after his 5th day as inpatient, and no proton-pump inhibitors were administered.
3) In order for an infectious disease to spread, it must complete the so-called Chain of Infection, which is made of 6 parts: an infectious agent, a reservoir, a portal of exit, a mode of transmission, a portal of entry and a susceptible host. If only one of the parts is missing, the disease cannot spread.
Colonization of Clostridium difficile occurs through the ingestion of spores and it may be caused by the direct contact by an infected persons feces, contact with a contaminated environment such as hospital beds, rails or hospital beds and from a health care worker with contaminated hands.
The patient could have been could have been infected from two different sources and these may include the room the patient was in or either the health care workers looking after him. The health care worker may have not followed the proper procedures to maintain proper prevention and control. C. difficile transmission from one person to another is more prevalent than in contact with environmental spores . In hospitals wards and intensive care units 49% of sites contained C. difficile and 29% of sites occupied by asymptomatic carriers.
4) The primary means of transmission in Clostridium difficile is from person to person via fecal – oral route, the environment contamination and hand hygiene throughout the hospital. These may include direct contact by toilets, bed rails, towel racks and door knobs. Patients who experience diarrhea with CDI spread spores into the hospital, and these spores are usually resistant to disinfectants that are commonly used in the hospital. Environmental contamination shows that the higher the levels of contamination, the higher the prevalence of C. difficile. Nearly all hospitals rely on alcohol-based cleansers for hand hygiene and infection control but C.difficile are thought to be resistant to alcohol. This also may help promote more spore formation. They can survive on dry surfaces for weeks and months on any environmental surface in a patient’s room or special care. In order to kill spores a chlorine bleach concentration of 1:10 is the only agent that effectively kills C. difficile on environmental surfaces.
5) There are many infection control strategies the hospital can introduce to help prevent the start of Clostridium difficile.
First step would be to prevent the ingestions of C.difficile spores from the environment, cleaning hospitals in the correct regime, vaccinate animals and to prevent CDI if spores are ingested. If CDI has occurred you could also maintain the level of antibiotics induced, as this is the one of the major risk factors affecting CDI. In order for prevention control, health care workers need to follow the correct procedure for prevention control such as washing hand frequently with soap. This may physically help remove spores. This is also includes patients water scrubbing is essential to maintain infection. Any patients with diarrhea should not prepare foods for others and if it is possible to use separate toilets. Hypochlorite-based solution appears to be the best agent to clean patient’s rooms so this agent must be used before and after patients leave. All health care workers should wear gloves and a gown before seeing each patient and disposing of the gloves appropriately so this can also infection control
.
6) Vancomycin and metronidazole are the two essential anti-infection agents utilized as a part of the medication of C difficile infection.
Metronidazole is taken preferably as an oral; it is readily absorbed in the upper gastrointestinal tract and is usually well tolerated by the body with general side effects. Possible side effects include nausea, vomiting, diarrhea, rashes, dizziness, unpleasant metallic taste and abdominal pain.
Vancomycin is only reserved for severe or life threatening cases of C.difficle infection. It is for patients who are unable to tolerate Metronidazole. Vancomycin is taken orally but is not properly absorbed in the body so it is secreted in the stool, which is an ideal treatment for C.difficile infection. In conclusion Metronidazole and Vancomycin are equally as effective for the treatment of CDI, but Vancomycin is superior for treating patients with severe CDI and for patients who fail therapy with metronidazole.
7) Nineteen days after the patient’s surgery, his condition deteriorated further. His temperature was 39.2’ and the leukocyte count was 31.2 × 109/l. Clostridium difficile causes toxin-mediated colitis. There are Pathogenic strains of C. difficile and they produce two protein exotoxins: toxin A and toxin B. These toxins injure the lining of the colon that can cause diarhhrea, and inflammation. Toxin A activates macrophages and mast cells (two different sub-types of white cells). The activation of these cells causes the production of inflammatory mediators. Toxin B has little enterotoxic activity but is extremely toxic. C. difficile toxins also cause leukocyte chemotaxis and the up regulation of cytokines and other inflammatory mediators . Consequently, there is a profound colonic inflammatory response, which would explain the high leukocyte count. The patient’s high temperature would be caused by toxin A. There are chemicals being released from the injured cells, which are being carried from the bloodstream into your brain thus explaining high temperatures.
Works Cited
Antranik. (2012, March 25). Inflammation and the Pathophysiology of Fever . Retrieved September` 22, 2013, from The Inflammatory Response (aka the Non-Specific Immune Reaction) : http://antranik.org/inflammation-and-the-pathophysiology-of-fever/
David J. Riddle, M. a. (2010, September 1). NIH. Retrieved September 18, 2013, from Clostridium difficile Infection in the Intensive Care Unit: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726831/
Gerding DN, J. S. (2008). Clostridium difficile associated diarrhea and collitis, Infect Control Hosp Epidemol.
Harvard Medical School. (2010, June). Harvard Health Publications. Retrieved September 17, 2013, from Clostridium difficile: An intestinal infection on the rise: http://www.health.harvard.edu/newsletters/Harvard_Mens_Health_Watch/2010/June/clostridium-difficile-an-intestinal-infection-on-the-rise medicinenet. (2013). MedicineNet. Retrieved September 20, 2013, from Heart Disease and Cardiac Catheterization: http://www.medicinenet.com/cardiac_catheterization/article.htm
Pharm, P. (2006). Clostridium difficile. Virginia: Childrens medical centre.
RXList. (n.d.). Retrieved from Timinten: http://www.rxlist.com/timentin-drug.htm
SCHROEDER, M. S. (n.d.). American Academy of Family Physicians. Retrieved September 20, 2013 , from Clostridium difficile–Associated Diarrhea: http://www.aafp.org/afp/2005/0301/p921.html
The initial administration of Tiacarillin Clavulanate was used to reduce the number of the patients’ drug-resistant bacteria and maintain …show more content…
the effectiveness of antibacterial drugs. Tiacarillin clavulanate should only be used to prevent infections that are proven or strongly suspected to be caused by bacteria .
2) The administration of Tiacarillin Clavulanate may have been the main factor for the Clostridium difficile Infection (CDI) in the patient, as the exposure to antibiotics has accounted for roughly 95% of development of CDI. This is the most important risk factor in the development of CDI. “The disruption of the normal flora caused by antibiotics allows C. difficile to colonize and overgrow within the gastrointestinal tract. Nearly every antibiotic has been implicated in leading to CDI, however broad spectrum antibiotics with1 anti-anaerobic activity appear to cause the greatest risk”.
Secondly, the CDI was most likely predisposed by the man’s advanced age . Production of antitoxin antibody by the patient protects against CDI; however, the ability to mount this immune response decreases with age, which would account for the severity and recurrence of CDI in the elderly.
Other known risk factors, such as duration of hospital stay or exposition to proton-pump inhibitor might be discarded in our patient, since the CDI was diagnosed only after his 5th day as inpatient, and no proton-pump inhibitors were administered.
3) In order for an infectious disease to spread, it must complete the so-called Chain of Infection, which is made of 6 parts: an infectious agent, a reservoir, a portal of exit, a mode of transmission, a portal of entry and a susceptible host. If only one of the parts is missing, the disease cannot spread.
Colonization of Clostridium difficile occurs through the ingestion of spores and it may be caused by the direct contact by an infected persons feces, contact with a contaminated environment such as hospital beds, rails or hospital beds and from a health care worker with contaminated hands.
The patient could have been could have been infected from two different sources and these may include the room the patient was in or either the health care workers looking after him. The health care worker may have not followed the proper procedures to maintain proper prevention and control. C. difficile transmission from one person to another is more prevalent than in contact with environmental spores . In hospitals wards and intensive care units 49% of sites contained C. difficile and 29% of sites occupied by asymptomatic carriers.
4) The primary means of transmission in Clostridium difficile is from person to person via fecal – oral route, the environment contamination and hand hygiene throughout the hospital. These may include direct contact by toilets, bed rails, towel racks and door knobs. Patients who experience diarrhea with CDI spread spores into the hospital, and these spores are usually resistant to disinfectants that are commonly used in the hospital. Environmental contamination shows that the higher the levels of contamination, the higher the prevalence of C. difficile. Nearly all hospitals rely on alcohol-based cleansers for hand hygiene and infection control but C.difficile are thought to be resistant to alcohol. This also may help promote more spore formation. They can survive on dry surfaces for weeks and months on any environmental surface in a patient’s room or special care. In order to kill spores a chlorine bleach concentration of 1:10 is the only agent that effectively kills C. difficile on environmental surfaces.
5) There are many infection control strategies the hospital can introduce to help prevent the start of Clostridium difficile.
First step would be to prevent the ingestions of C.difficile spores from the environment, cleaning hospitals in the correct regime, vaccinate animals and to prevent CDI if spores are ingested. If CDI has occurred you could also maintain the level of antibiotics induced, as this is the one of the major risk factors affecting CDI. In order for prevention control, health care workers need to follow the correct procedure for prevention control such as washing hand frequently with soap. This may physically help remove spores. This is also includes patients water scrubbing is essential to maintain infection. Any patients with diarrhea should not prepare foods for others and if it is possible to use separate toilets. Hypochlorite-based solution appears to be the best agent to clean patient’s rooms so this agent must be used before and after patients leave. All health care workers should wear gloves and a gown before seeing each patient and disposing of the gloves appropriately so this can also infection control
.
6) Vancomycin and metronidazole are the two essential anti-infection agents utilized as a part of the medication of C difficile infection.
Metronidazole is taken preferably as an oral; it is readily absorbed in the upper gastrointestinal tract and is usually well tolerated by the body with general side effects. Possible side effects include nausea, vomiting, diarrhea, rashes, dizziness, unpleasant metallic taste and abdominal pain.
Vancomycin is only reserved for severe or life threatening cases of C.difficle infection. It is for patients who are unable to tolerate Metronidazole. Vancomycin is taken orally but is not properly absorbed in the body so it is secreted in the stool, which is an ideal treatment for C.difficile infection. In conclusion Metronidazole and Vancomycin are equally as effective for the treatment of CDI, but Vancomycin is superior for treating patients with severe CDI and for patients who fail therapy with metronidazole.
7) Nineteen days after the patient’s surgery, his condition deteriorated further. His temperature was 39.2’ and the leukocyte count was 31.2 × 109/l. Clostridium difficile causes toxin-mediated colitis. There are Pathogenic strains of C. difficile and they produce two protein exotoxins: toxin A and toxin B. These toxins injure the lining of the colon that can cause diarhhrea, and inflammation. Toxin A activates macrophages and mast cells (two different sub-types of white cells). The activation of these cells causes the production of inflammatory mediators. Toxin B has little enterotoxic activity but is extremely toxic. C. difficile toxins also cause leukocyte chemotaxis and the up regulation of cytokines and other inflammatory mediators . Consequently, there is a profound colonic inflammatory response, which would explain the high leukocyte count. The patient’s high temperature would be caused by toxin A. There are chemicals being released from the injured cells, which are being carried from the bloodstream into your brain thus explaining high temperatures.
Works Cited
Antranik. (2012, March 25). Inflammation and the Pathophysiology of Fever . Retrieved September` 22, 2013, from The Inflammatory Response (aka the Non-Specific Immune Reaction) : http://antranik.org/inflammation-and-the-pathophysiology-of-fever/
David J. Riddle, M. a. (2010, September 1). NIH. Retrieved September 18, 2013, from Clostridium difficile Infection in the Intensive Care Unit: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726831/
Gerding DN, J. S. (2008). Clostridium difficile associated diarrhea and collitis, Infect Control Hosp Epidemol.
Harvard Medical School. (2010, June). Harvard Health Publications. Retrieved September 17, 2013, from Clostridium difficile: An intestinal infection on the rise: http://www.health.harvard.edu/newsletters/Harvard_Mens_Health_Watch/2010/June/clostridium-difficile-an-intestinal-infection-on-the-rise medicinenet. (2013). MedicineNet. Retrieved September 20, 2013, from Heart Disease and Cardiac Catheterization: http://www.medicinenet.com/cardiac_catheterization/article.htm
Pharm, P. (2006). Clostridium difficile. Virginia: Childrens medical centre.
RXList. (n.d.). Retrieved from Timinten: http://www.rxlist.com/timentin-drug.htm
SCHROEDER, M. S. (n.d.). American Academy of Family Physicians. Retrieved September 20, 2013 , from Clostridium difficile–Associated Diarrhea: http://www.aafp.org/afp/2005/0301/p921.html