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Knowledge At MET

Knowledge At MET

Nosocomial Infections - Pneumonia: A Case Study

In every nation, health care systems are one of the few sectors where a very high working efficiency of all medical and paramedical professionals is expected. Our nation with a vast population, financial inabilities, improper infrastructure and lack of hygiene lags behind significantly in the health care scenario. Following is a case which focuses how a small private hospital fails to provide appropriate medical care.

Patient details and History:

A 42 year old female, previous history of childhood asthma, operated upon thrice during a span of 23 years (Three

caesarean sections, Hysterectomy, Oophoerctomy (surgical removal ovaries))

Initial Symptom before 1st hospitalisation: Shooting pain in the lower back, Throat itching, Fever, weakness, burning sensation in the urine)

Patient was hospitalised and advised to be kept under supervision for one night and check for condition next morning.

Initial Treatment: Metronidazole, Pheniramine, Ciprofloxacin, Hydrocortisone, Pantaprazole, ondansetron, Paracetamol, Ranitidine.

Second day treatment: Piperacillin/ Tazobactum, Artesunate, Ceftriaxone, Paracetamol injection, Amikacin Sulphate, Ibuprofen and Rantidine.

Patient did not respond to treatment for the 1st three days. By the third day, extreme chills, high fever, problem in breathing and inability to swallow food was reported. Doctors were unable to alleviate symptoms, and there was no change in line of treatment. Infection of the urinary tract did not decrease but instead flared up. A family decision was taken to shift the patient to another renowned corporate private hospital.

The initial patient admission report read as follows:

Diagnosis: Pyelonephritis with LTRI

Case history: Patient came with complaints of fever with chills, burning micturition, cough with expectoration and breathlessness since 4-5 days. Admitted to a private nursing home and diagnosed as UTI with renal calculi and possible septicemica. History of heamturia. Patient referred for further management. Past history - bilateral renal stones.

Patient was admitted and retained into Intensive Care Unit for 5 days. Catheter was passed through subclavian and patient is put on electrolytes for stabilisation. Doctor confirmed pooling of water in the lungs, pneumonia, declares it as a hospital acquired infection, septicaemia.

Treatment given in the ICU: Clarithromycin, Paracetamol-lignocaine, Frusemide, Salbutamol sulphate + Ipratropium Bromide, Ondansetron, Piperacilin + Tazobactam, Esomeprazole, Levofloxacin, Meropenem.

A very rigorous schedule for medication, doctor visits and hygiene was followed which lead to positive response from the patient. After 5 days patient was shifted to a separate ward and was discharged after 11 days when her condition was stable.

Course in the ward: Patient transferred here from private nursing home in v/o breathlessness/ desaturation. She was admitted in ICU and found to have pyelonephiritis and lTRI. She was managed conservatively in the ICU. Chest physician opinion was taken and patient responded well to the treatment.

Follow up therapy: Clarithromycin- 5days, Esomeprazole- 5days, Nitrofurantoin- 10days, Ambroxol syrup. Follow up with physician after 1 week with CBC/ ESR / Urine report.

This is one case out of hundreds which happen on a regular basis because of lack of care or the hospital cleanliness and administration. The total cost of two hospitalisations came up to Rs. 2 lakh which could have been considerably lower if the initial treatment and hospitalisation was safe and effective.

Mustafa Mithaiwala (Final Y B Pharm)

Tags: MET Institute of Pharmacy