Tuesday, March 04, 2008

Wind, wound, water, and walk*

This is the little mnemonic that medical students use when searching for the source of a post-operative fever. It's coming in handy this day, years past med school, as I think through why a certain old lady might be running a temp near 102. I'll add colitis to the list as she's been on antibiotics for her arm wound (which is much improved, so that's not where the fever is coming from).

Antibiotics can cause a dangerous shift in the body's resident bacteria. While a little diarrhea might be a small price to pay for the treatment of a serious infection, one antibiotic-related bowel infection--Clostridium difficile-- is a bad actor that you do not want in your intestinal tract. The last time Mom did battle with that little hummer, she became septic (the bacteria was released into her bloodstream, causing a systemic infection) and nearly died.

You don't have to be a frail little old lady to get a c. diff infection. I've had two otherwise healthy adults get c. diff colitis after a course of oral antibiotics for no-big-deal infections. While neither one was seriously ill, they had some serious diarrhea for a long time and required yet another antibiotic to clear this microbe out of their colons. All the more reason to skip antibiotics if possible through the flu season.
*Wind = Respiratory infection or pulmonary embolus
Wound = Surgical site or any opening in the skin from injury or ulceration
Water = Urinary tract infection
Walk = Deep venous thrombosis or clot


Laura in L.A. said...

Your poor Mom's medical file is reading like the Book of Job! I am so sorry she is having all these complications, and I am praying for her.

Mauigirl said...

So sorry your mom got this. My aunt had it after she had an operation and had been on antibiotics. If it isn't one thing, it's another...

janemariemd said...

Great post, and so timely!! This is one of my recent pet issues; I've seen 3 patients with SEVERE c.diff, 2 hospitalized for it, one ended up in the ICU with dehydration, acute renal failure, and got it because she'd taken some antibiotics on her own (you know, they were lying around the house) for respiratory symptoms. I have one patient who seems to be permanently colonized--she's still on po vancomycin 8 months after the initial infection.

I find keeping these vignettes in my mind helps me maintain my resolve not to give antibiotics for minor URIs.

kenju said...

A favorite neighbor of mine died from c. diff she got in the hospital, after being treated for heart trouble and scleroderma.