How did THAT get there???!?!!!

1. Had a patient recently who had a deep, productive cough x several days. Docs asked for a sputum culture, so night shift sent off 1st sputum of the morning last week.
   
   Got the C&S back and had a few of the 'usual suspects' ie haemophilus influenze pneumonia and strep..... and..... wait for it...
   
   E. Coli!!!
   
   How in the name of all things good did E coli end up in this patients' lungs?
   
   Bit of history, was initially admitted for "weakness, pre-syncope" and found to have a rapid heart rate. Somewhat obese pt with history of OSA (obstructive sleep apnea) requiring c-pap at rest.
   
   I'm wondering if the c-pap might have had something to do with it?

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2. 10 Comments

   Comment
3. 
   Jun 18, '13

   CPAP + poor hand hygiene = e. coli in the lungs
4. 
   Jun 18, '13

   Yikes.. poor pt
5. 
   Jun 18, '13

   Wow.. Reminder about the importance of handwashing!!!!!
6. 
   Jun 19, '13

   Could also be that the person handling the equip contaminated the specimen via the equip. I would guess that lots of cultures are falsely positive due to poor technique.
   
   Like maybe the person who handled the lab equip had dirty hands?!?
7. 
   Jun 19, '13

   anything that went into her mouth, should be suspect as well. Is she a snacker? with sleep apnea that pull in of air that happens after the brain calls "hard" enough for air, is quit forceful. Good hand hygiene, all persons, including dietary, should be checked.
8. 
   Jun 19, '13

   E. Coli is everywhere all the time, not just our poop. It's resident bacteria that even proper handwashing wont always scrub away.
9. 
   Jun 19, '13

   Poor hand hygeine. Too close to the toilet when flushing. Not ideal functioning for peri care secondary to obesity. I wouldn't rule out a UTI either.
   
   Patient could benefit from some occupational therapy to assist in personal care. And respitory therapy to teach her how and when to change all of the gadgets on her CPAP.
10. 
    Jun 19, '13

    Here's another thought.... Does the patient have pets? Household pets are known carriers of E. coli
    
    Many people think nothing of having their pets around no matter what they are doing. I had a patient that had an E. coli wound infection. The odor from that wound was quite impressive. His wife had been changing his dressings and used less than clean technique. They were astonished that their dog can carry it.
    
    I'm not too familiar with the mechanical configuration of a CPAP, but I would assume that there is an air intake filter. It would probably be well advised to make sure that it is changed and/or even the whole machine sanitized before the patient continues using it.
    
    Just a thought.
11. 
    Jun 19, '13

    Boy, there are some REALLY good investigative possibilities out here. We all are GOOD!
12. 
    Jun 19, '13

    Where does the patient work? W/o getting into specifics, I once had a patient who grew out E. coli from a very surprising place, who worked in wastewater treatment.

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