Clinical Scenario
A 75-year-old patient underwent cystocele repair 10 days ago. Her urine culture showed >100,000 CFU/mL of E. coli, sensitive to all tested antibiotics, and she was treated with oral cephalexin for 7 days post-op. Ten days later, she developed diarrhea, with loose stools, cramps, and vomiting but no blood. Vital signs included a pulse of 95/min, respiration of 25/min, temperature of 39°C, and BP of 117/54 mm Hg. WBC count was normal with 54% immature polymorphonuclear cells. Electrolytes, lipase, liver enzymes, and examination were normal. Cultures for Salmonella, Shigella, Yersinia, and Campylobacter spp. were negative.
Identifying the Microbe Responsible for the Patient’s Diarrhea
Scenarios of bacterial infections leading to diarrhea, fever, and other symptoms can have many causes. In the present case, it is likely that the patient’s condition is caused by Clostridioides (Clostridium) difficile (C. diff). This microbe is one of the most widespread causes of nosocomial diseases related to antibiotic use (Mada and Alam). Based on the patient’s presentation and circumstances, this bacterium fits the description.
Predisposing Factors and Susceptibility to Infection in the Patient
The patient has many factors that increase the risks of C. diff-related diarrhea. First, individuals over 60 have a higher risk of being susceptible to pathogens (Mada and Alam). Second, the patient recently underwent surgery and was exposed to a hospital setting, surgical equipment, and treatment by staff (Makajeva et al.). Third, the woman entered the clinic with an infection with a certain E.coli strain and took antibiotics, further weakening her immune system. These factors created conditions for C. diff to affect her health and develop diarrhea.
The Problematic Nature of This Microbe as a Nosocomial Pathogen
Nosocomial pathogens – microbes acquired during hospital stay – are problematic for patients. Compared to other settings, healthcare facilities expose infectious organisms to various antibiotic medications. As a result, pathogens in this environment are more likely to be drug-resistant (Kollef et al. 170). Therefore, treating hospital-acquired infections is much more challenging than other types. This factor also increases the risk of high mortality and severe symptoms in patients.
Virulence Factors Produced by the Organism and Their Role in Disease Pathogenesis
C. diff bacteria have two virulent factors that play a role in their pathogenesis. Toxins A and B (TcdA and TcdB) are responsible for binding to the surface of organism cells and displacing cytosols, leading to cell death (Mada and Alam). As an outcome, the patient develops related symptoms, such as diarrhea, pain, nausea, and more. Some C. diff strains may produce only toxin B, but both are dangerous.
Therapeutic Strategies for Treating the Infection
Treatment of C. diff infections requires considering the patient’s use of medications and their environment. One strategy is to discontinue antibiotics that contribute to the condition (Mada and Alam). Next, the patient should take a new type of antibiotic to which C. diff bacteria respond, such as fidaxomicin or vancomycin (Mada and Alam). Apart from pharmacological approaches, the patient may undergo surgery or be given a fecal transplant to reduce the risk of reoccurring infections (Mada and Alam). However, these strategies are only applicable to severe cases where the bacteria repeatedly cause symptoms.
Works Cited
Kollef, Marin H., et al. “Nosocomial Infection.” Critical Care Medicine, vol. 49, no. 2, 2021, pp. 169-187. Web.
Mada, Pradeep Kumar, and Mohammed U. Alam. “Clostridioides Difficile Infection.” StatPearls. 2023. Web.
Makajeva, Julija., et al. “Cystocele.” StatPearls. 2022. Web.
