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Diagnosing the cause of Bill’s infections

Revisiting Bill's case
5.4
I’d been unwell for some time and after loads of visits and antibiotic tests for urine infection. The doctor told me I had prostate cancer.
22.2
We decided together that Bill should have the operation. And we wanted to get it over with as quickly as we could. You see, Bill hasn’t been well for about five months, since we were on the cruise. He had a chest infection and was given lots of different antibiotics from the GP. And then he got, what the GP said was another urine infection. for which he also got antibiotics. And then our GP put him on a pill at night to try and stop these infections. We were worried, weren’t we, because he didn’t get better. And in fact he had diarrhoea and sickness twice. And the GP sent him along for stool tests because he was worried about that nasty C. diff.
72
As far as we were concerned, this was a routine elective operation and standard procedures were followed preoperatively. Usually patients start to recover well one or two days after prostrate surgery. Unfortunately though Mr. Jenkins did remain unwell, his temperatures were high and he had little energy. Cultures were ordered, and specimens were taken from his catheter and his bloods done. There were still no major concerns at this point. The nurses and staff on the ward didn’t seem worried about hygiene. I didn’t see them washing their hands. And the doctor who put the catheter in wasn’t very hygienic either. She took three attempts, and Bill was in agony.
121.6
Lots of men, in the same bay, all like Bill, they all had catheters. And looking back, there’s just so many ways he could’ve picked up that other infection.
135.3
I just thought he’d be okay and protected, because, well, like I mentioned earlier to you– four months ago he had antibiotics when he got ill on the cruise in the Med. So I just thought he’d be immune and OK by the time you got into hospital. I suppose I should have said something, really. But you don’t like to, do you? Consultants know best, and I don’t want to upset anyone, especially when Bill’s relying on them to perform his operation.
171.2
We do have lots of quite poorly patients on the ward. And elderly, in particular, can take some time to recover and can get secondary infections. So when the results came back, it wasn’t good news. It wasn’t anything to be too concerned about. The microbiologists said he has a resistant infection. The consultant decided on IV antibiotics– not the treatment that microbiologists had actually recommended, but blockbuster antibiotics he normally uses for such cases. He normally says about 14 to 28 days– frequently likes to use them to prevent such infections. Also, although it’s not on our policy, his wife was understandably concerned and not very happy. But after a long time on IV antibiotics, Bill began to improve.
221.4
In fact, prior to discharge, he was able to entertain and to help other patients in the ward.
Watch Bill’s clinical scenario (or read the transcript in downloads below) and address these three questions:
  • Do you think that getting to know which micro organisms are causing Bill’s symptoms is relevant?
  • Why?
  • What, in his past medical history and in his clinical presentation, makes it more important to find the etiology of Bill’s infection?
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Antimicrobial Stewardship: Managing Antibiotic Resistance

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