Lecture 40 - Nosocomila Diarrhoea Flashcards
Senario
- patient had large bowl resection
- develops fever, abdominal pain, has not opened bowels since surgery
- IV canular in arem, one in foot
- has urinary catheter
- high heat rate, low bP, temp high, breathing rapidly
given IV analgesia, and antibiotics
IV sites not inflamed, surgical wound is healing well
- remember however this is a superifical laparotomy healing and also where bowel is sewen together (small amounts of fecal material could have leaked and infect here)
- IV cannulas could be infected
- could have UTI from urinary catheter
- catheter shows a high WBC count
CT scan - showed a large collection in region of her bowel anastomosis
-pus here
- most likely to have fecal peritonitis
- can ignore urinary catheter response
CA-UTI
- caused by catheter
- bacteria easily to get up here
- presence of bacteria in urine is very common
- 10% of people with catheters
- risk factors - duration of catheters, women, poor care
Symptoms
- flank pain
- fever, confusion, lethargy
- presnece of wbcs in catheter is not diagnostic of infection
- culture - just one pathogen - probably more meaningful
How to avoid these
-avoid using catheters e.g use condom catheters
Candida albergans
- trush
- invasive infections
- causes many species
- colonises on mucosal surfaces
63 year old women, recovering after a hemi-colectomy. Developed high fever, tachycardia.
Has an inflammation surroudngin a cannula in right arm
small amount of purulence at exit site
-urine sample tken and has candida albicans
c. take swab of purulent material, blood culture, remove cannula and start with flucloxacillin
do start stuff, then remove cannula and urinary catheter
How do bacteria cause infection on catheter
- Build a biofilm
- bacteria float through blood stream, and make a slimy mask and can stick to things
- stick to catheter, in thick layered structures
- then can be released and go off to infect antoher site
Factors responsible for building these biofilms
bacteria factors - some bacteria can do this better
- staph aureus
- e.coli - adhesive factors, polysaccharide slime layer
devide factors
-material
host factors - affect the bindign e.g fibronectin
-immune response
future complicaitons
- can get cellulities
- staph aureus was the cause
Prevention
do they actually need the catheter
-need to be very sterile with way you do it
Treatment
- remove cannula (may need replacement)
- flucloxacilin
- may need to get lab to test if mrsa strain
Women in hospital, recovering
- water, bloodless diarrhoea
- infection with clostridium difficilie is suspected
sdfds
Likely mode of transmission
- Clostridium difficle os part of normal flora in GI tract
- spread from person to person, by toilet (diarrhoea contaminates things )
- is an obligate anerobe, however endospores cna allow it to live with oxygen
People most at risk
People in hospital receiving broad spectrum antibiotics
- changes flora, and then can get clostridium outcompete flora
- c. difficle grows to high numbers where i starts making toxins
- survive because of its endospores
- survive until can germinate again
