Infection prevention and control

• Patient A is a 64-y.o. man who was intubated by paramedics at the scene of a road traffic accident and admitted to ICU after operative internal fixation of femoral and tibial fractures. Cefuroxime was administered intra-operatively and continued for 24 hours. He failed extubation and, on day seven, developed signs of a ventilator associated pneumonia (VAP) and microbiology work-up has grown multi-resistant Klebsiella spp. from sputum, blood cultures and perineal swabs...
• A 63-y.o. lady, Patient B, with two previous ICU admissions for COPD has now been readmitted, from the ward after seven days, with deteriorating respiratory function, purulent sputum, pyrexia, leukocytosis and hypotension. You start resuscitation, diagnose nosocomial pneumonia and, after taking sputum and blood cultures, commence antibiotic therapy...
• Patient C is identified as having an ESBL-Klebsiella. She is a 64 y.o. with inflammatory bowel disease who is admitted to the ICU following laparotomy for perforated bowel on day 17, in septic shock. Klebsiella is grown from blood cultures and CVC cultures taken on day 18, and from sputum taken on day 19. Catheters are changed and meropenem started but she deteriorates...
• Patient D is a 59 y.o. male with end-stage renal failure (ESRF) receiving intermittent haemodialysis. He was admitted to the ICU following resuscitation from an out of hospital cardiac arrest and, after some days, a tracheostomy is performed. On day 17, the microbiologist informs you that he is colonised with MRSA in his perineum, nose and tracheostomy site. You apply mupirocin to his external nares and tracheostomy, and a chlorhexidine body wash. You are informed on day 20 that a Gram-negative bacillus has been cultured in his sputum specimen. You suspect it is probably Klebsiella and contact infection control...