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Case #2

Video of Bill Jenkin's case #2
7.5
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.
24.4
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.
74.2
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 prostate surgery. Unfortunately, though Mr. Jenkins did remained unwell. His temperatures were high, and he had little energy. Cultures were ordered, and specimens were taken from his catheter and his bloods done but there was 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. There were lots of men in the same bay, all like Bill.
127.9
They all had catheters. And looking back, there’s just so many ways he could have picked up that other infection.
137.8
I just thought it’d be OK 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 he 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 is relying on them to perform his operation.

Watch this video in which Bill Jenkins’s clinical presentation is described.

With the information provided in the video, consider the following questions:

  • What type of infection does Bill have?
  • Which are the most likely causative microorganisms?
  • Should you consider the possibility of antibiotic resistant GNB when deciding antimicrobial therapy to treat Bill’s infection? Why or why not? 

Share your thoughts with your fellow learners in the comments.

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Challenges in Antibiotic Resistance: Gram Negative Bacteria

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