Question

Mary is a 72-year-old nursing home resident, who is admitted to the hospital for pneumonia. She is treated with azithromycin and ceftriaxone and responds well to therapy.

Mary develops the diarrhea on day five of antibiotic treatment for pneumonia, but since her pneumonia is clinically improved,she is discharged back to the nursing home with an order for Imodium and a repeat lab draw for a complete blood cell count in one week.

Her diarrhea is somewhat controlled on admission to the nursing home, but she needs the Imodium at least three times a day. No one questions this as abnormal. After her blood count shows a significant leukocytosis (after one week), her stool is checked for Clostridium difficile. The sample is positive, and she is treated.

Answer 1

A 72-year-old woman in a nursing home develops diarrhea after receiving antibiotics, diagnosed with Clostridium difficile upon leucocytosis, and adequately treated. Detection of a C. difficile infection in elderly patients following antibiotic use is critical for their recovery.

Step-by-step explanation:

Clostridium difficile Infection in the Elderly

A 72-year-old resident of a nursing home develops diarrhea after antibiotic treatment for pneumonia. The symptom onset on the fifth day and persistent necessity for Imodium, an antidiarrheal medication, were seemingly unalarming until a significant leukocytosis was noticed. Subsequently, a stool test confirms a Clostridium difficile infection, for which she receives appropriate treatment.

Clostridium difficile, a gram-positive rod bacterium, typically becomes pathogenic when the normal gut microbiota is disrupted by antibiotics. This disruption can lead to an overgrowth of C. difficile and potentially result in antibiotic-associated diarrhea, a condition that can be particularly dangerous in an elderly population in health care settings such as a nursing home.

Detection of a C. difficile infection is crucial and often involves a Nucleic Acid Amplification Test (NAAT) to find the genetic material of the pathogen. Once the infection is confirmed, treatment with appropriate antibiotics, such as vancomycin, can be started to clear the infection. Proper diagnosis and management are essential, especially in vulnerable populations like the elderly.