Case study Essay Example

  • Category:
    Nursing
  • Document type:
    Case Study
  • Level:
    Undergraduate
  • Page:
    3
  • Words:
    1758

9CASE STUDY

CASE STUDY

Introduction

Clostridium difficult infection is a common healthcare setting acquired illness and is a frequent cause of mortality and morbidity amid elderly hospitalized individuals. Clostridium difficile inhabits intestinal tract of humans after indigenous gut flora is destroyed by antibiotic treatment and is the organism that causes antibiotic connected pseudomembranous colitis. This case study looks at the causes of Clostridium difficile infection in an 83 year old hospitalized man, its causes and measures that are used to prevent and control the infection.

Question 1

How the patient might have developed urinary tract infection

The patient might have developed urinary tract infection due to invasion of the urinary tract by bacteria. According to Craft et( 2011) Majority of urinary tract infections are as a of infection by the result of infection by the digestive system bacteria and a urinary tract infection may occur when gastro intestinal bacteria move and multiply from anus to urethra. A urinary tract infection occurs when microorganism get into the urinary tract, causing damage of tissues in the urethra, kidneys or bladder. Experiencing stress and weakened immune system are predisposing factors to urinary tract infection (Marieb, & Hoehn, 2013).

Ticarcillin Clavulanate Was initially administered because it an antibacterial that acts against bacteria. Ticarcillun Clavulanate offers extensive spectrum penicillin having a beta lactamase inhibitor and is highly effective in the treatment of severe bacterial infections as a result of susceptible microorganisms. The drug is utilized to cure different bacterial infections such as joint and bone infections, skin infections and urinary tract infections (Bullock & Manias, 2011).

Question 2

Predisposing factors to Clostridium defficile infection

The two most predisposing factors to the patient’s clostridium difficult infection in the patient are old age and his stay in a health care setting. According to Owens (2009) majority of Clostridium difficile infections come about in and after exposure of a person to health care environment such as nursing homes and hospitals where microorganism spread easily and quickly, there is widespread utilization of antibiotics and individuals are particularly susceptible to infection. Old age is another factor risk factor to the eighty three years old man clostridium difficile infection Old age is a predominant predisposing factor to infection by clostridium difficile and People who are 65 years and older are greatly exposed to the infection than younger people because their immune system is weak (Owens ,2009).

Question 3

How Clostridium difficult infection may have developed in the patient’s gut

Use of antibiotics to treat urinary tract infection might have been the cause of Clostridium difficult infection in the gut of the patient. According Bullock and Manias (2011) use of antibiotics to treat infections and kill their causal bacteria kills several non- detrimental bacteria that reside in the gut. Clostridium difficile is not damaged by several forms of antibiotics and when other undamaging bacteria are destroyed, C. Difficile is given a chance to greatly multiply and produce poisons that may cause damage and inflammation of the inner inning of the colon and consequent antibiotic associated diarrhea. Therefore, because the patient was under antibiotics and he had clostridium difficile bacteria in his gut, these bacteria thrived and caused infection.

Antimicrobial treatment plays a core part in pathogenesis of the clostridium difficile contagion. The assumed schemes through which antibiotics stimulate clostridium difficile infection are via interruption of the local colon’s microflora, thus permitting the bacteria and thrive to greater concentrations and produce toxins. There are many strains of Clostridium difficult and majority has the capability of causing more severe infections than others. The seriousness of the clostridium difficile infection or illness may differ and prototype 027generates more poisons than other strains and has a high likelihood of causing serious illness (Kyne et al, 2009).

Question 4

Why Clostridium difficile is difficult to eradicate from a hospital setting

It is difficult to eradicate Clostridium difficile in a hospital because the bacteria spreads majorly on hands from one person to another and on bedside tables , sinks toilets , stethoscopes, toilets and sinks. Majority of clostridium difficile infections occur as a result of cross infection from one patient to another, patient health care staff contact, or via contamination within the immediate health care setting environment. In addition, patients who have this infection release a huge amount of Clostridium difficile bacteria spores in their stool. These spores have the capability of surviving for a very long time and therefore if a patient, hospital staff or visitor touches a surface that has been infected by the spores, they may be ingested by accident or be passed to patients and other individuals in the facility (Dubberke et al, 2010).

Dubberke et al, (2010), argues that the main method of transmission for clostridium difficile in a healthcare setting, entailing hospitals is through individual to individual vial oral fecal route. The hand s of the hospital staff, which may be contaminated with the clostridium difficile spores, together with environmental contagion play a significant role in transmission of the bacteria in a hospital. In comparison to other hospital associated bacterial microbes, environment pollution around clostridium difficile illness is a relatively important factor in spread of the microorganism to others. This is attributed by the fact that the bacteria forms spores and perseveres in the atmosphere for a long time whilst resisting routine disinfection procedures more than organisms without the capability to form spores (Leffler & Lamont, 2009).

Question 5

Infection control measures that the hospital could introduce

The hospital can control the infection through the introduction of effective infection prevention and control measures to minimize the incidence of infection and severity of illness. This can be achieved through measures that will prevent ingestion of the microorganism along with its spores by hospital staff and patients and minimizing the likelihood of the development of the infection just in case the pathogen is ingested. Leffler and Lamont, (2009) argues that Ingestion of the microbe can be prevented through the use of convention infection regulation schemes that will target the hospital environment barrier methods and personal hygiene, whilst schemes for minimizing infection can be focused on the elimination or minimization of antimicrobial hygiene. The hospital can dynamically monitor the rate and severity of the infection acquired within its setting as a portion of its infection regulation and prevention program so as to establish if the rate of infection is acceptable and swiftly identify if there are increases in incidences of Clostridium difficile infection (Leffler, & Lamont, 2009).

Hand hygiene and environmental disinfection is an important measure that the hospital can use to prevent and control infection. According to Lee and Bishop (2013) hand washing using water and soap and disinfection of surfaces with bleach is effective in the reduction of environmental contamination within patient rooms as well as the reduction of rates of infection within hospital units with high rates of infection. Promptly identification of individuals with Clostridium difficile infection can also be used to prevent infection. These patients can be timely isolated and put under treatment therefore reducing environmental burden linked with diarrhea.

Question 6

Combination of Vancomycin and metronidazole in the treatment of Clostridium difficile infection

Clostridium difficile infection is treated using antibiotics which deters the bacteria from multiplying and growing and which treats diarrhea along with colon complications caused by the infection. According to Leffler and Lamont (2009) therapy for mild to moderate clostridium difficile infection comprises of or oral metronidazole. Metronidazole is effective against anaerobic bacteria and is an inexpensive antibiotic with a higher positive rate of response. Metronidazole is usually alternated with Vancomycin in the treatment of the infection since the drug is an effective against severe Clostridium difficult infection. When the drug is administered through the mouth, it’s not absorbed in the bloodstream but it stays with the intestines, permitting it to prevent growth of clostridium difficile (Leffler & Lamont, 2009).

According to Craft et al (2009) Vancomycin is effective in treatment of recurrent infection. The utilization of alternating antibiotic treatment is based upon the assumption that reversion may occur as a result of the existence of unrelenting spores which endure antibiotic treatment. Intermittent therapy permits the spores to sprout when the use of antibiotic is withdrawn and once they have grown into their functional toxin geberating forms, they are vulnerable to killing once antibiotics are administered again.

Question 7

Causes of patient’s deterioration after surgery

The patient’s condition may have deteriorated due recurrence of the Clostridium difficile infection. According to Owens, (2009) recurrent clostridium difficile infection is common and is usually occurs as a result of reinfection with a similar or another strain of clostridium difficile. Recurrence happens in majority of patients treated with vancomycin and metronidazole and they might experience many incidents of intermittent colitis. Majority of recurrences occur after one to three weeks after the discontinuation of antibiotic therapy.

The patient’s condition deteriorated after nineteen days due to intermittent administration of metronidazole and Vancomycin and recurrence was severe due to a weakened immune system as a result of old age. Predisposing factors for the recurrence of Clostridium difficult infection are old age, severe underlying therapeutic disorders and the requirement for a continuing treatment with associated antibiotics during control for Clostridium difficile infection (Kyne et al 2009).

Conclusion

Clostridium difficile infection is a serious health problem that occurs when the normal intestinal flora is damaged by antibiotics. The infection mostly occurs in hospitalized individuals due to cross transmission amongst patients and hospital staff and patients are at greater risk for mortality and morbidity from this microbe. The infection can be treated through use of antibiotics like metronidazole and vancomycin and through use of preventive and control measures such hand hygiene and disinfection of surfaces.

References

Bullock, S., & Manias, E., (2011). Fundamentals of pharmacology, 6th edition. Frechs Forest, NSW: Pearson Australia.

Craft, J., Gordon, C., Heuther, S., & Rote, N., (2011). Understanding pathophysiology. Chatswood, NSW: Elsevier.

Lee, G., & Bishop P., (2013). Microbiology and infection control for health professionals( 5th ed.). Frenchs Forest, NSW: Pearson.

Marieb, N., & Hoehn, K., (2013). Human anatomy and physiology. (9th ed.). Bostonm MA; Pearson.

Kyne, L., Hu, Y., Katchar., et al. (2009). Prospective derivation and validation of a clinical prediction rule for recurrent Clostridium difficile infection, Gastroenterology, 136, 1206.

Leffler, A.,& Lamont, T., (2009). Treatment of Clostridium difficile –associated disease. Gastroenterology, 136, 1899.

Dubberke E, Gerding N, Classen D, et al., 2010 Strategies to prevent Clostridium difficile infections in acute care hospitals. Infect Control Hosp Epidemiol;29:81-92.

Owens, C., (2009) Clostridium difficile-associated disease: an emerging threat to patient safety: insights from the Society of Infectious Diseases Pharmacists. Pharmacotherapy
26:299- 311.