Question

Reza is a 23-year-old male who was involved in a motor vehicle accident. After the accident, he told the paramedics he felt extreme pain under his rib cage. He was transported by ambulance to the hospital, and the attending physician determined Reza had ruptured his spleen during the accident. He was scheduled for emergency splenectomy. Due to the severity of the injury, Reza had to have “open surgery” to remove his spleen.

The surgery was a success. Reza was given prophylactic antibiotics to prevent a surgical site infection. Because Reza had an open surgery, the doctor told him he’d need to stay in the hospital up to 6 days, depending on his recovery.

By the fourth day, Reza, who was young and otherwise healthy, was looking forward to being discharged from the hospital. But that morning, he woke up experiencing severe abdominal cramps. He slowly tried to get up to go to the bathroom, but he quickly realized he wasn’t moving fast enough. Panicked, he immediately pressed the nurse call button. By the time, the nurse got to Reza, there was stool all over him, the bed, and the floor. Reza was horrified, but the nurse comforted him, helped him up, and got him into the shower. The hospital housekeeping staff was called to clean the room.

After he was cleaned up, the nurse assessed Reza. His vital signs were recorded as follows:

• Temperature = 39.4°C [102.9°F]
• Pulse = 118 bpm
• Respiration = 20 breaths/minute
• BP = 92/52 millimeter Hg

While taking Reza’s vital signs, the nurse noticed he was pale and appeared dehydrated. He also seemed confused and disoriented. Reza kept trying to leave his hospital room, and he had repeat episodes of profuse diarrhea that had to be cleaned off him, the linens, and the floor. The nurse noticed the stool appeared yellow in color, seemed to contain pus, and had an especially foul odor.

The type of infection and the causative pathogen must be identified based on the patient’s signs and symptoms and laboratory results. Then a treatment plan is developed.

1.Identify the signs, symptoms, and potential risk factors.

2.Determine the causative pathogen (make a diagnosis).

3.Evaluate diagnostic laboratory results.

4.Suggest treatment

Diagnostic laboratory results: The colonoscopy showed Reza’s colon was severely inflamed. Also visible were raised and purulent yellow nodules (or plaques), erosion of the mucosal wall, and fibrin deposition and debris in the lumen of the bowel. The endoscopy report concluded Reza has “pseudomembranous colitis.”

Which of the following would be recommended for a patient with Clostridium difficile diarrhea?  

• Discontinue offending antibiotic (if possible)
• Manage dehydration
• Put patient on isolation precautions
• Completely stop antibiotic therapy
• Consider treatment with vancomycin
• Microbiota replacement therapy

Which one would you not recommend?

Group of answer choices

Completely stop antibiotic therapy

Put patient on isolation precautions

Manage dehydration

Consider treatment with vancomycin

Microbiota replacement therapy

Discontinue offending antibiotic (if possible)

Answer 1

Clostridium difficile associated diarrhoea is the most common cause of antibiotic associated diarrhoea in hospital

Therapy for patients with C difficile associated diarrhoea comprises:

1. Supportive measures (adequate fluid and electrolyte replacement).
2. Withdrawal of current antibiotic therapy if possible.
3. Antibiotic treatment to eradicate C difficile. Oral metronidazole 400 mg three times a day and vancomycin 125 mg four times a day are the treatments of choice. You should usually continue treatment until symptoms stop.
4. Probiotics may be useful for preventing recurrence.
5. Patients must be isolated in single or double bedded rooms or cohort bays to prevent other patients developing it.

Which of the following would be recommended for a patient with Clostridium difficile diarrhea?  

· Discontinue offending antibiotic (if possible)

· Manage dehydration

· Put patient on isolation precautions

· Completely stop antibiotic therapy

· Consider treatment with vancomycin

· Microbiota replacement therapy

Ans: Recomanded all treatment except Completely stop antibiotic therapy

Which one would you not recommend?

Completely stop antibiotic therapy

Put patient on isolation precautions

Manage dehydration

Consider treatment with vancomycin

Microbiota replacement therapy

Discontinue offending antibiotic (if possible)

Ans: Completely stop antibiotic therapy not recommend