CASE STUDY Essay Example

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Analysis of Clostridium difficile Ribotype 027

Question 1 Explain how the patient might have developed urinary tract infection and justify initial administration of Ticarcillin Clavulanate

One of the factors that might have led to the development of urinary tract infection is the indwelling catheter used to drain urine from the patient’s bladder. Prolonged use of indwelling catheter post operatively provides a medium for growth of bacteria (Escherichia coli) responsible for causing urinary tract infection (In Soule et al. 2012). Prolonged retention of urine might have contributed to the infection. Urine provides media for bacterial growth hence, infection. Infection might have occurred due to inability of healthcare providers to follow sterile procedures during catheter insertion leading to contamination, hence infection. Ticarcillin Clavulanate is an antibiotic administered to treat UTI’s as it inhibits bacterial wall synthesis. The drug is administered to prevent and treat uncomplicated and complicated urinary tract infections and intra-abdominal infections after surgery. The infections are caused by beta-lactamase producing strains of Escherichia coli. Additionally, the drug treats UTI’s caused by Klebbsiella spp, Citrobacter spp. And S. aureus
(Herz, 2011).

Question 2 Discuss two of the most likely predisposing factors for this man’s Clostridium difficile infection

One of the risk factors that might have contributed to the patient acquiring Clostridium difficile infection is his advancing age. Surawicz et al. 2013 states that people aged 65 years and above are at high risk of acquiring Clostridium difficile infection than those aged below 65 years. The rate of Clostridium difficile infection in older patients is thrice that of those aged below 65 years. Old age is associated with infection contributing factors such as the lowered immune system. The patient in the above case is aged 85 years and is at a risk of acquiring the infection. Secondly, patients who have undergone surgery are at a high risk of being affected by this infection. Surgery predisposes one to infections since one depends on antibiotics that increase the risks of being infected by the bacteria. Other factors contributing to the above infection as stated by Hedge et al. 2008 include prolonged use of anti-ulcer medication, conditions that suppress the immune system and serious underlying pathologies.

Question 3 Explain how the Clostridium difficile infection may have developed in the patient’s gut starting from two different sources of contamination

One of the main sources of Clostridium difficile infection tothe patient is from contaminated surfaces, patient’s beddings, infected skin and clothing. The Clostridium difficile is shed by the infected patients in form of spores in stool contaminating the above Medias which transmits the infection the other patients. Surawicz et al. 2013 states that healthcare health care providers can also act as a great source of Clostridium difficile infection to the patient population.This mainly occurs through them coming in contact with the contaminated surfaces and equipment. Consequently, the healthcare providers transmit the infection to the patients when they come in close contact. Clostridium difficile infection development in the gut is mediated by exotoxins A and B (Herz, 2011). Bacteria receptor mediated endocytosis occur leading to endosomal acidification that activates the toxins in the cytosol. The activated exotoxins A and B disrupt actin cytoskeleton of the gut by altering intracellular signaling mechanisms. Actin disruption results to catastrophic impairment of cellular function. This leads to gut inflammation secondary to initiation inflammation neurogenic stimuli. Inflammation results to increase membrane permeability and fluid accumulation leading to great tissue damage hence, the pathology (Weston, 2008).

Question 4 Why is Clostridium difficile difficult to eradicate from the hospital environment

One of the main reasons as to why it is difficult to eradicate Clostridium difficile in the hospital environmentis the ability of its spores to resist heat and chemicals used for disinfection purposes. Spores of Clostridium difficile are highly resistant to various chemicals used for disinfecting hospital contaminated equipment. Spores resistance to the effects of extreme heat and chemical agents make it difficult to eradicate the infection. Hospital environment is characterized with frequent spread of different hospital acquired infections (Herz, 2011). Additionally, Clostridium difficile have undergone mutation to develop strains that are resistant to antibiotics used for managing the infection. Most of the hospitals environment has poor standards of hygiene. The ever increasing population of the old in the society makes the eradication process difficult as they are highly affected by the infection. Hospital set up has high incidences of overcrowding on daily basis. This creates multiple sources of Clostridium difficile infections in the hospital making prevention of the disease a problem (Hedge et al. 2008).

Question 5 Describe infection control measures that the hospital could introduce in a case such as this

One of the infection prevention and control measures that should be adopted in the hospital set up is proper hand washing after every procedure and patient contact. Hand washing minimizes spread of bacteria causing the infection (Weston, 2008). Healthcare providers should wear protective gowns such as gloves when handling the patients and their beddings. This minimizes risks of disease spread between the healthcare providers and the patients. Lidded toilets and flushing of toilets prior to closing of the lid minimizes infection spread. The Clostridium difficile infection rates in the hospital set up can also be reduced by using hydrogen peroxide vapor to sterilize the patients’ rooms before their discharge (Sabja et al. 2009). Other prevention and control measures that can be adopted in the hospitals include controlling the use of antibiotics, cleaning the hospital environment, isolating all patients suffering from diarrhea with unconfirmed diagnosis, adhering to disinfection policies and controlling future outbreaks through proper surveillance and monitoring of case outbreaks (Hacker et al. 2009).

Question 6 Discuss the rationale for the combination of Vancomycin and Metronidazole in the treatment

Vancomycin is an antibiotic that acts by inhibiting the cell wall synthesis in the Gram-positive bacteria (Hickson, 2011). Metronidazole acts by inhibiting enzyme action in anaerobic bacteria through formation of unstable compounds through the impairment of the normal DNA functioning by the metronidazole metabolites. Metronidazole is the first line drug for managing the infection while Vancomycin is the second line of drug for managing the infection. However, both drugs combination can be used in managing the infection. This is to increase these drugs in vivo activity against the Clostridium difficile (In Soule et al. 2012). Additionally, the drugs are given in combination to minimize the recurrence of the infection among the treated population. The combined drug regimen eliminates Clostridium difficile vegetative spores and bacteria. Consequently, the normal colonic flora is restored. The restoration of the normal colonic flora reduces patient’s susceptibility to recurrent Clostridium difficile infections. Drug combination reduces bacteria effectiveness through binding on exotoxin A. impairing bacterial functioning (Hacker et al. 2009).

Question 7 Nineteen days after surgery, the patient’s condition deteriorated further. His temperature was 39.2 C, his leukocyte count was 31.2 x 10 9 /L Explain this response in the patient

The high temperature and high white blood cell count are some of the evidences of Clostridium difficile infection recurrence. The changes are caused by the breakdown of the flora barrier found in the colon after a period of antibiotic treatment (Sabja et al. 2009). Vancomycin and metronidazole kills only the vegetative forms of the bacteria and do not kill the bacterial spores. These spores germinate after some time to produce toxins. These toxins invade the gut walls causing inflammation and damage to the tissues. The body responds to the presence of the toxins by increasing the production of white blood cells from the bone marrow to aid in eliminating the toxins from the body. Additionally, high fever indicates the presence of severe recurrence of Clostridium difficile infection and physiological response to the bacterial toxins present in the body (Herz, 2011).


.Hacker, M. P., Messer, W. S., & Bachmann, K. A. (2009). Pharmacology: Principles and practice. Amsterdam: Academic Press/Elsevier.

Hedge H. D, Strain J. D, Heins J. R, & Farver D. K. (2008). New Advances in the treatment of Clostridium difficile infection (CDI). Ther Clin Risk Management. Vol. 4 (5), p. 949- 964.

Herz, C. (2011). Pharmacology: A novel. Las Vegas, NV: AmazonEncore

Hickson M. (2011). Probiotics in the prevention of antibiotics-associated diarrhea and Clostridium difficile infection. Therap Adv Gastroenterol. Vol. 4 (3), p. 185-197.

In Soule, B. M., In Memish, Z. A., & In Malani, P. N. (2012). Best practices in infection prevention and control: An international perspective.

Sabja D. P., Bond C, Carman R. J, & Sarker M. R. (2009). Germination of spores of Clostridium difficile strains, including isolates from a hospital outbreak of Clostridium difficile- associated disease (CDAD).
.MicrobiologyVol. 154(Pt 8):2241-50. doi: 10.1099/mic.0.2008/016592-0

Surawicz C. M, Lawrence J, David G. B, Ananthakrishnan A. N, Curry S. C. & Zucherbraun B. S. (2013). Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol. Vol. 108 p. 478-498.

Weston, D. (2008). Infection prevention and control: Theory and clinical practice for healthcare professionals. Chichester, England: John Wiley & Sons.