Case Study Example

Scenario:

Joe is in his 80s and has been receiving outpatient chemotherapy for cancer. He fell in his apartment and broke his hip, so he ended up in the hospital for 2 weeks. Towards the end of his stay, he began experiencing a fever and rapid heart rate. He had stomach pain and terrible watery diarrhea many times throughout the day. He became severely dehydrated. It was hard for him to manage the nausea. His doctor took a stool sample and noticed an anaerobic Gram positive bacteria.

This case is an 80-year-old cancer patient, named Joe, who acquired an in-hospital infection while being treated for a hip fracture secondary to cancer. Joe is currently undergoing cancer treatment with chemotherapeutic drugs. Hospital acquired infections are a serious matter within our healthcare system; so much so that in 2014 the CDC did a study and determined that about 4% of hospitalized patient’s suffered from a hospital acquired infection (Monegro et al., 2020). To put that number into perspective we look at local, nationally ranked Johns Hopkins Hospital. Johns Hopkins has roughly 107,000 inpatient admissions annually, using the 4% number mentioned previously, that equates to 4,280 patients in one hospital system in one year that suffered from a hospital acquired infection (Fast Facts: Johns Hopkins Medicine, 2020).

Based on the information provided in this case study I have determined that Joe is suffering from a common hospital acquired infection, Clostridium difficile. Joe’s compromised immune system, his abdominal pain, fever and watery stool are all classical indicators of a Clostridium difficile infection. Clostridium difficile (C. difficile) is a spore-forming, gram positive anaerobic bacillus (Clinical C. Diff Q & A, 2020). C. difficile is a common cause of antibiotic associated diarrhea and currently accounts for 15-25% of all episodes of antibiotic associated diarrhea (Clinical C. Diff Q & A, 2020). C. difficile is often caused by specific antibiotics that wipe out the “good bacteria” within a patient’s GI tract, other patients at risk are those with compromised immune systems (Clinical C. Diff Q & A, 2020).

C. difficile has some key characteristics that make it easy to spread within a hospital environment; for one, it has a protective outer coating that potentially allows it to live for months if not years on surfaces and in the soil (Prevent the Spread of C. Diff (Deadly Diarrhea)., 2019). Second, C. difficile requires the use of soap and water to prevent the spread of germs, with the increase in usage of alchol based hand sanitizers like Purell in the hospital environment, which is not effective at killing C. difficile, it is easier for hospital staff to unintentionally spread the disease (Prevent the Spread of C. Diff (Deadly Diarrhea)., 2019). Third, C. difficile requires cleaning beyond the traditional norm within the hospital environment, a bleach solution is required in order to kill C. difficile spores, this is a higher level of cleaning than is what is typically used for most room turnovers within a hospital environment (Prevent the Spread of C. Diff (Deadly Diarrhea)., 2019). Finally, it is important to note that various studies have shown that C. difficile has been present in anywhere from 2%-15% of the healthcare workers sampled, while this is a relatively low number, it could provide a substantial source of potential infection to the immunocompromised patient’s that C. difficile infects so readily (Prevalence of Clostridium Difficile Colonization among Healthcare Workers, 2013). C. difficile is shed through GI tract and out of the body through feces and can be transferred with any surface contact of infected materials (Clinical C. Diff Q & A, 2020). In the hospital setting modes of transmission could include any number of items: hospital beds, rectal thermometers, sheets, toilets or hospital employees’ hands just to name a few. While surface contact is the most common mode of transmission, a 2010 study suggests that C. difficile is also transmittible through the air and notes that individual rooms are the safest option for preventing the spread of C. difficile (Adalja, 2019).

Despite its virulence, C. difficile generally responds well to treatments. About 20% of patients who acquire C. difficile will see it resolve with just the discontinuation of the antibiotics they were previously prescribed (Clinical C. Diff Q & A, 2020). The remaining patients will often see improvement with a change to a more appropriate antibiotic, usually Vancomycin for Fidaxomicin (Clinical C. Diff Q & A, 2020). Other treatments will include replacement of fluids to prevent the dehydration that is commonly associated with diarrhea. It is important to treat C. difficile early as it can lead to serious conditions such as dehydration, sepsis, toxic megacolon and in rare cases death (Clostridium Difficile: Epidemiology, Diagnostic and Therapeutic Possibilities—a Systematic Review, 2013).

If left untreated, C. difficile can cause a number of different symptoms, the most common of which are watery diarrhea, fever, loss of appetite, abdominal pain or tenderness and nausea (Clinical C. Diff Q & A, 2020). While those symptoms might sound minor, in totality they can ultimately lead to dehydration, a perforated colon (which is a life threatening condition that will require surgery) or a very serious condition called sepsis which is characterized by high fever, high heart rate and severe low blood pressure which can ultimately be fatal.

According to the Cleveland Clinic, with treatment, the prognosis for C. difficile is usually positive, they state that with proper antibiotics the fever will subside within two days and the diarrhea within two to four days (C. Diff (Clostridioides Difficile) Infection Outlook / Prognosis, n.d.). They do report that 10-20% of patients may see a re-emergence of symptoms within one to two weeks (C. Diff (Clostridioides Difficile) Infection Outlook / Prognosis, n.d.). More serious complications like a perforated colon, dehydration or sepsis could require longer hospital stays to treat appropriately.

In conclusion, our patient Joe, is suffering from a Clostridium difficile infection acquired during his hospital stay for his broken hip. His immunocompromised system, caused by his cancer treatments, places him at an increased risk for hospital acquired infections. With quick identification and rapid treatment with appropriate antibiotics, Joe has a good chance of overcoming his C. difficile infection and getting discharged to rehab to continue healing from his hip fracture.

Works Cited

Adalja, A. A. (2019, January 29). Airborne Spread of Clostridium difficile | 05-14-2010 | CBN article. Clinicians’ Biosecurity News | Johns Hopkins Center for Health Security. https://www.centerforhealthsecurity.org/cbn/2010/cbnreport_05142010.htmlThis source is a world-renowned hospital that is consistently ranked as a “top hospital” within the United States.

C. diff (Clostridioides difficile) Infection Outlook / Prognosis. (n.d.). Cleveland Clinic. Retrieved November 8, 2020, from https://my.clevelandclinic.org/health/diseases/15548-c-diff-clostridioides-difficile-infection/outlook–prognosisThis source is a world-renowned hospital that is consistently ranked as a “top hospital” within the United States.

Clinical C. diff Q & A. (2020, March 27). Centers for Disease Control and Prevention. https://www.cdc.gov/cdiff/clinicians/faq.html#anchor_1529601781962This source is a federal government agency.

Clostridium difficile: epidemiology, diagnostic and therapeutic possibilities—a systematic review. (2013, November 1). PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3950610/This source is a peer reviewed medical journal.

Fast Facts: Johns Hopkins Medicine. (2020, January 1). [Graph]. Hopkins Medicine. https://www.hopkinsmedicine.org/about/_downloads/JHM-Fast-Facts.pdfThis source is a world-renowned hospital that is consistently ranked as a “top hospital” within the United States.

Monegro, A. F., Muppidi, V., & Regunath, H. (2020, September 3). Hospital Acquired Infections. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/books/NBK441857/This source is a peer reviewed medical journal.

Prevalence of Clostridium difficile colonization among healthcare workers. (2013, October 4). PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3850636/This source is a peer reviewed medical journal.

Prevent the spread of C. diff (deadly diarrhea). (2019, November 4). Centers for Disease Control and Prevention. https://www.cdc.gov/cdiff/prevent.htmlThis source is a federal government agency.