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8845NRS Assignment Trimester 1 2019

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  • Course Code: 8845NRS
  • University: Griffith University
  • Country: Australia

Question:

1.Using contemporary literature as a basis, create a report that:

a.Briefly describes the morphology of the pathogen and the epidemiology of infection with this pathogen.

b.Describes the pathophysiology of infection with this pathogen and uses this information to explain the classical clinical presentation of this infection.

c.Outlines the provisional and definitive diagnoses including laboratory methods for diagnosis.

d.Discusses contemporary approaches to treatment of the infection and provides a rationale from the literature on why these are recommended.

e.Describes best practice approaches to infection prevention and control in relation to this pathogen.

f.Lists any other important considerations including legislative reporting requirements.

  • Briefly describes the morphology of the pathogen and the epidemiology of infection with this pathogen.
  • Describes the pathophysiology of infection with this pathogen and uses this information to explain the classical clinical presentation of this infection.
  • Outlines the provisional and definitive diagnoses including laboratory methods for diagnosis.
  • Discusses contemporary approaches to treatment of the infection and provides a rationale from the literature on why these are recommended.
  • Describes best practice approaches to infection prevention and control.
  • Lists any other important considerations including legislative reporting requirements.

Uses scholarly literature appropriately to support the discussion

 

Answer:

Introduction

Clostridium difficile often called C. difficile or C. diff is a microorganism that can cause serious issues ranging from diarrhoea to severe swelling of the colon. Infection from C. difficile often affects older people in a hospital setting or in clinical care amenities and naturally occurs after the use of antibiotic medicines (Brandt et al., 2012). However, studies reported cumulative rates of this infection among individuals traditionally not measured high threat (Leffler, & Lamont, 2015). In this particular scientific report the morphology, epidemiology, pathophysiology, diagnosis, treatment approaches, prevention, and important considerations will be discussed.

Morphology 

It is a rod-shaped gram-positive, spore-forming anaerobic bacterium. It is 3 to 4 µm in length. It reproduces by using binary fusion and has one circular chromosome, which contains 4,290,252 base pairs. It can move with the help of peritrichous flagella (Paredes-Sabja, Shen, & Sorg, 2014).

Epidemiology

Between 2011 and 2016, the regular rate of Clostridium difficile (CD) contamination related analyses in Australian community hospitals was 4.0 detects per 10,000 patient days.  The degree of CD linked detects peaked in initial 2012 (5.0 detects per 10,000 patient days) and all over again in late 2012 (4.9 establishes per 10,000 diseased person days) (Australian Commission on safety and quality in Health care, 2018). It is reported that this nearly 112 cases of serious disorders and 45 expiries from severe clostridium difficile infection in Australia in 2015 (Australian Commission on safety and quality in Health care, 2018).

 

Pathophysiology 

The main cause of transmission in patients is symptomatic infection in hospital a setting. These individuals shed large amounts of C. difficile spores and bacterium in the faeces, subsequent in widespread infection of their skin area, bed linen, and adjacent environmental exteriors. The bacterial spores are resilient to drying and the normal chemical washing agents, and can consequently stay in the atmosphere for some weeks or months. Microorganisms can then be taken upon the patient’s and healthcare worker’s hands (Polage, Solnick, & Cohen, 2012).

Diagnosis 

Diagnosis is done by laboratory analysis of faeces from persons with diarrhoea. The common examination for C. difficile contaminant does not differentiate between the strains (Surawicz, Brandt, Binion, Ananthakrishnan, Curry, Gilligan, & Zuckerbraun, 2013). Specific assessments (such as PCR or polymerase chain reaction examinations in a pathology test site) are necessary to identify the epidemic straining thought to be accountable for sickness that is more serious. If a doctor doubts that the patient has this contamination, he or shell perhaps recommend one or additional stool examinations including; enzyme immunoassay, polymerase chain reaction, and GDH/EIA.  The tests like X-rays or a CT scan of your intestines might also be recommended (Surawicz et al., 2013).

Treatment 

Antibiotics

Metronidazole and vancomycin are mostly recommended and have been the mainstay management choices for CDI. For minor to reasonable contamination, clinicians usually suggest metronidazole (Flagyl), provided by mouth. An alternative oral antibiotic, fidaxomicin (Dificid), are also approved to manage C. difficile (Surawicz, et a., 2013). 

Surgery

Surgery is the therapeutic choice for management of fulminant colitis or persons who are not getting improved by medicinal therapy (Mattila et al., 2012). Among patients who do not react to optimal medicinal therapy, it is consequently suggested to do a surgical session earlier. In initial fulminant colitis cases, any postponement in the surgery can lead to expiry or death. CT scan of the stomach might provide valued data in identifying the sickness severity (Cammarota, Ianiro, & Gasbarrini, 2014). 

Fecal microbiota transplant (FMT) moreover known as the stool transfer, FMT is developing as the alternative approach for handling recurring C. difficile contaminations. However not yet accepted by the FDA, scientific studies of FMT are presently underway (Mattila et al., 2012).

Prevention 

Probiotics 

Probiotics are microorganisms, like bacteria and yeast, which aid reinstate vigorous stability to the colonic tract. Yeast named Saccharomyces boulardii, in combination with antibiotics can assist to stop further repeated C. difficile contaminations (Hell, Bernhofer, Stalzer, Kern, & Claassen, 2013).

Vaccine

The toxoids A and B are considered as the best aspirants for C. difficile injection and they are capable to apply admirable serum antibody reactions in health adults. Some of the studies of the DNA vaccine directing C. difficile contaminants clarified that the receptor-linking domain of C. difficile contaminant A, that is capable to induce well resistant responses in rats and defend them from expiry (Foglia, Shah, Luxemburger, & Pietrobon, 2012).

Antimicrobial Stewardship

Appropriate treatment of Clostridium difficile infection (CDI) is significant for inhibiting complications and decreasing the threat of transmission (Nathwani, Sneddon, Patton, & Malcolm, 2012). The Antimicrobial stewardship interventions for individuals with CDI can upsurge the use of suitable therapy and progressive adherence to standard recommendations. Usual goals are enlightening adherence to the CDI management recommendations, decreasing the implementation of empiric treatment in individuals with low medical suspicion for CDI, reducing the risks of repeated infection and enhancing patient results (Nathwani, Sneddon, Patton, & Malcolm, 2012).

Reduction of Transmission

Difficile commonly transmitted via spores either by an unintentional interaction with a contaminated surface or by direct contact with an infected person (persons in the clinic, apparently via their infected hands). Contaminations of different surfaces and devices play a key role in the C. difficile contamination among patients (Leffler, & Lamont, 2015). It has been assumed that certain of the bacterial strains shows higher capacity of sporulation than other different strains. Using sodium hypochlorite, chlorine solutions and chlorine dioxide products has been established to be effective in preventing C. difficile spores transmission (Surawicz et al., 2013).

Important considerations

  • Using gloves and dress (gown) in the patient zone when in direct physical contact
  • using single-use devices or recyclable equipment that is devoted to the exaggerated patient and experiences appropriate reusing among patients
  • Preferably, a patient suspected with CD infection must be transferred to a personal room with private bathroom services (Trubiano, Cheng, Korman, Roder, Campbell, May, & Athan, 2016)
  • The patients should be prohibited to visit other areas of healthcare setting as it can spread the infection among health people.
  • Increased incidence of cleaning the environment including everyday cleaning with cleaner and decontaminator, of regularly touched areas and substances
  • Investigation of CDI in services must be done as per the guidelines of the Australian Commission on Safety and Quality in Healthcare
  • It is suggested that all clinics review investigation data on a consistent basis to understand if there has been an upsurge in cases
  • All guests should do hand hygiene earlier to enter and after exit the patient’s room (Trubiano et al., 2016).

Conclusion

Clostridium difficile is the microorganism that can cause different health issues among the affected people. It is a rod-shaped, spore generating bacterium, which is 3-4 µm long. There nearly 336,600 people hospitalized that includes this infection. The bacterial transmission takes place by direct contact and cause different issues like diarrhea. It can be diagnosed by laboratory testing, stool tests such as enzyme immunoassay, polymerase chain reaction and GDH and intestinal X-rays or CT scan. The treatment includes antibiotic use and surgery. The infection can be prevented by using probiotics, antimicrobial stewardship, and reduction of transmission. The important considerations that should be followed are using gloves, gowns, sterilized equipment's, and terminal cleaning of a patient room in the health care setting.

 

References

Australian Commission on safety and quality in Health care (2018). Clostridium difficile infection; a model to improve the management and control of clostridium difficile in Australia. Retrieved from: https://www.safetyandquality.gov.au/wp-content/uploads/2015/05/Model-to-improve-prevention-and-control-of-CDI-in-Australia.pdf

Brandt, L. J., Aroniadis, O. C., Mellow, M., Kanatzar, A., Kelly, C., Park, T., & Surawicz, C. (2012). Long-term follow-up of colonoscopic fecal microbiota transplant for recurrent Clostridium difficile infection. The American journal of Gastroenterology, 107(7), 1079.

Cammarota, G., Ianiro, G., & Gasbarrini, A. (2014). Fecal microbiota transplantation for the treatment of Clostridium difficile infection: a systematic review. Journal of clinical gastroenterology, 48(8), 693-702.

Foglia, G., Shah, S., Luxemburger, C., & Pietrobon, P. J. F. (2012). Clostridium difficile: development of a novel candidate vaccine. Vaccine, 30(29), 4307-4309.

Hell, M., Bernhofer, C., Stalzer, P., Kern, J. M., & Claassen, E. (2013). Probiotics in Clostridium difficile infection: reviewing the need for a multistrain probiotic. Beneficial Microbes, 4(1), 39-51.

Leffler, D. A., & Lamont, J. T. (2015). Clostridium difficile infection. New England Journal of Medicine, 372(16), 1539-1548.

Mattila, E., Uusitalo–Seppälä, R., Wuorela, M., Lehtola, L., Nurmi, H., Ristikankare, M., & Anttila, V. J. (2012). Fecal transplantation, through colonoscopy, is an effective therapy for recurrent Clostridium difficile infection. Gastroenterology, 142(3), 490-496.

Nathwani, D., Sneddon, J., Patton, A., & Malcolm, W. (2012). Antimicrobial stewardship in Scotland: impact of a national programme. Antimicrobial resistance and infection control, 1(1), 7.

Paredes-Sabja, D., Shen, A., & Sorg, J. A. (2014). Clostridium difficile spore biology: sporulation, germination, and spore structural proteins. Trends in microbiology, 22(7), 406-416.

Polage, C. R., Solnick, J. V., & Cohen, S. H. (2012). Nosocomial diarrhea: evaluation and treatment of causes other than Clostridium difficile. Clinical Infectious Diseases, 55(7), 982-989.

Surawicz, C. M., Brandt, L. J., Binion, D. G., Ananthakrishnan, A. N., Curry, S. R., Gilligan, P. H., & Zuckerbraun, B. S. (2013). Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. The American journal of Gastroenterology, 108(4), 478.

Trubiano, J. A., Cheng, A. C., Korman, T. M., Roder, C., Campbell, A., May, M. L. A., & Athan, E. (2016). Australasian Society of Infectious Diseases updated guidelines for the management of Clostridium difficile infection in adults and children in Australia and New Zealand. Internal medicine journal, 46(4), 479-493.

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