1. Lim, Mary Lim, Phoebe Lim, Syndel Lipana, Kirk Liu, Johanna
Case 3
Lim, Mary
Lim, Phoebe
Lim, Syndel
Lipana, Kirk
Liu, Johanna

2. A 38 y/o G3P3 diabetic delivered by Caesarian section due to a big baby. She was non-ambulatory and on indwelling catheter on the first 24 hours post operation.
On the 3rd H.D she experienced fever and chills. Post operative wound was clean.
CBC revealed leucocytosis with predominance of neutrophils and urinalysis with marked pyuria.

3. Salient Features 38 y/o pregnant diabetic female G3P3
Delivered big baby thru caesarean
Non-ambulatory
With indwelling catheter
Post-op wound was clean
On 3rd day of H.D.: fever and chills
CBC: leukocytosis (↑neutrophils)
Urinalysis: Pyuria

4. 1. What is your diagnosis?

5. Urinary Tract Infection
Diagnosis
Urinary Tract Infection

6. Urinary tract infection (UTI)
Characterized by BACTERIURIA and PYURIA
May be symptomatic or asymptomatic
May affect the kidneys (pyelonephritis) or the bladder (cystitis)

7. Etiology
More than 85% - caused by Gram (-) bacilli that are normal inhabitants of the intestinal tract
Most common: Escherichia coli
Other causes: Proteus
Klebsiella
Enterobacter
Streptococcus faecalis

8. 2. What are the factors that predisposed this patient to this infection?

9. Risk factors Indwelling catheterization
The daily risk of bacteriuria with catheterization is 3% to 10%, approaching 100% after 30 days
Other risk factors: female sex, diabetes mellitus, older age, impaired immunity, and lack of antimicrobial exposure

10. PATHOGENESIS 2 ROUTES HEMATOGENOUS - through the bloodstream ASCENDING
- from the lower urinary tract

11. PATHOGENESIS HEMATOGENOUS INFECTION - less common
- results from seeding of the kidneys by bacteria from distant foci in the course of septicemia or infective endocarditis

12. PATHOGENESIS ASCENDING INFECTION
Colonization of the distal urethra and introitus
( in the female) by coliforms
From the urethra to the bladder –urethral catheterization
Urinary tract obstruction and stasis of urine
Vesicoureteral reflux
Intrarenal reflux

14. 3. How do you classify these infections acquired within the institutions?

15. Nosocomial infections
Infections which are a result of treatment in a hospital but not secondary to the patient's original condition.
Appear 48 hours or more after hospital admission or within 30 days after discharge

16. 4. Differentiate these type of infections.

17. Nosocomial Infections
Four most common types of nosocomial infections are:
UTI
SSI
Nosocomial Pneumonia
Nosocomial Bacteremia

18. Urinary Tract Infection
80% associated with the use of indwelling catheters
Associated with less morbidity
Gram-negative enterics, 50%
Fungi, 25%
Enterococci, 10%

19. Surgical Site Infection
Are also frequent – 15%
Presence of purulent discharge around the wound or the insertion site of a drain or –
Presence of cellulites which is emanating from the wound
Patients acquire infection either endogenously or exogenously
Contamination varies with the length of the procedure and the health condition of the patient
Staphylococcus aureus, 20%
Pseudomonads, 16%

20. Nosocomial Pneumonia
About 3% of patients on ventilators acquire pneumonia
The source is often endogenous but may also be exogenous with transfer of an organism from the respiratory equipment

21. Risk factors mechanical ventilation (high risk), elderly, neonates,
severe underlying disease,
immunodeficiency,
depressed sensorium,
cardiopulmonary disease,
recent thoraco-abdominal surgery

22. Pathogens infecting the Respiratory tract
Bacterial pneumonia
Legionnaires' disease
Pulmonary aspergillosis
Mycobacterium tuberculosis
Viral pneumonias
Respiratory Syncytial Virus (RSV)
Influenza

23. Nosocomial Bacteremia
About 5% of nosocomial infections
may occur at the entry site of the intravascular device
sources of infection-causing microorganism for these infections are endogenous
Coagulase-negative staphylococci, 40%
Enterococci, 11.2%
Fungi, 9.65%
Staphylococcus aureus, 9.3%
Enterobacter species, 6.2%
Pseudomonads, 4.9%

24. 5. What are the recommended preventive measures?

25. Prevention
Place bladder catheters only when absolutely needed (e.g. to relieve obstruction).
Use aseptic technique.
Minimize manipulation or opening of drainage systems.
Remove bladder catheters as soon as is feasible.
Healthcare providers clean their hands by washing them with soap and water or using an alcohol-based hand rub before and after touching the catheter.
Avoid disconnecting the catheter and drain tube. This helps to prevent germs from getting into the catheter tube.

26. The catheter is secured to the leg to prevent pulling on the catheter.
Avoid twisting or kinking the catheter.
Keep the bag lower than the bladder to prevent urine from backflowing to the bladder.
Empty the bag regularly. The drainage spout should not touch any­thing while emptying the bag

27. 6. What are other organisms that cause pulmonary, gastrointestinal and post surgical wound infections?

28. Microorganism
Infections caused
Staphylococcus aureus, Coagulase negative Staphylococci, Enterococci
Surgical wound infections, Pneumonia, Septicemia, Urinary Tract Infections
Escherichia coli, Pseudomonas aeruginosa, Enterobacter spp. And Klebsiella Pnemoniae
Pneumonia and surgical wound infections
Clostridium difficile
Causes nearly half of nosocomial diarrhea
Candida Albicans
Urinary tract infections and Septicemia
Acinetobacter, Citrobacter, Haemophilus
Urinary tract infections and surgical wound infections

29. Hospital acquired: Pulmonary
Pseudomonas aeruginosa
most common MDR Gram-negative bacterium causing Ventilator-associated pneumonia
Methicillin-resistant Staphylococcus aureus
is an increasing cause of VAP
Ventilator-associated pneumonia
 people who are on mechanical ventilation through an endotracheal or tracheostomy

30. Hospital acquired: Gastrointestinal
Clostridium difficile
Causes pseudomembranous colitis
offensive-smelling diarrhea, fever, and abdominal pain
life-threatening complications can develop
Ex: Toxic megacolon
Clindamycin
causes the alteration of the normal bacterial flora of the bowel

31. Hospital acquired: Surgical wound
Most common causes of surgical site infection:
Staphylococcus aureus - wounds and incisions
Staphylococcus epidermidis - nosocomial bacteremia
Bacteroides fragilis - anaerobic isolate from surgical infection
Example: Surgical site infection
Those that occur as a result of a surgical procedure or those that require surgical intervention as part of their treatment
S. Aureus because it is the most common normal flora of the skin
B. Fragilis because it is a common normal flora of the gi

32. THANK YOU!