Clinical Ques: Post Op Infection

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Specializes in Psych.

Pt J has an artifical heart valve replacement and is sent home. Within a few days, seems to be doing ok, but takes a turn. Some watery stool, stomach pain. No swelling or redness or fever.

Goes to ER, where it is discovered that fluid is around the heart, and WBCs are 22.2. C-diff test is negative at this point but s/he is put on contact isolation. Surgery is scheduled again for the morning to drain the fluid from around his/her heart and put in chest tube.

Is contact isolation a broad precaution, or does it mean they know the bacteria with which s/he is infected?

Is the development of this infection so soon after surgery an indication of HAI?

If the infection is in the abdominal cavity and the surgery was in the chest cavity, could it have migrated somehow, and be flourishing in the gut?

Thanks for your theories.

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Specializes in Med/Surg, Ortho, ASC.

We would welcome your theories.

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Specializes in Emergency.

I especially welcome the theory on how that c-diff result came back so fast assuming it wasn't based on smell....

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Specializes in Psych.
I especially welcome the theory on how that c-diff result came back so fast assuming it wasn't based on smell....

How long does it take for c-diff to colonize in the lab? They said they wanted to repeat. BTW, this is not a pt of mine, and I'm not sure if the heart valve surgery was done via minimally invasive procedure through groin or open heart.

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Specializes in Med/Surg, Academics.
I especially welcome the theory on how that c-diff result came back so fast assuming it wasn't based on smell....

Cdiff by PCR comes back very quickly. It's not a culture; it detects the presence of a cdiff toxin.

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Specializes in Med/Surg, Academics.
How long does it take for c-diff to colonize in the lab? They said they wanted to repeat. BTW, this is not a pt of mine, and I'm not sure if the heart valve surgery was done via minimally invasive procedure through groin or open heart.

Minimum elapsed time for a repeat is 7 days.

cdiff may be routinely tested when presenting with watery stool, abdominal pain, fever, and recent antibiotic use. For sure, the patient received antibiotics as a SCIP measure before and after the Valve replacement.

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