Patient 5: Wong Wei Hong (2nd entry)

Wong Wei Hong
Male, 67 years old
Fever, chills, bladder distension; on indwelling catheter

The patient is an elderly man whose prostate is enlarged. This happens to all men as they grow older. As the gland grows, it presses on the urethra, the tube through which urine passes out of the body and causes urination and bladder problems, in this case, bladder distension.

As a treatment, catheter is inserted into the urethra to drain the urine as the patient has trouble emptying his bladder. The catheter, during it’s insertion through the urethra, might have displaced some of the normal flora into the bladder, causing urinary tract infection (pyelonephritis), the condition the patient is in now.

The suspected microorganisms are:
Escherichia coli (gram-negative bacilli)[1]
Klebsiella pneumoniae (gram-negative bacilli)[2]
Proteus mirabilis (gram-negative bacilli)[3]

A clean-catch urine should be collected for laboratory investigations. Urine should be cultured on a Columbia agar with 5% Sheep Blood (general purpose medium) and MacConkey agar (selective and differential medium used for the isolation of gram-negative organisms).[4]

[1]http://medinfo.ufl.edu/year2/mmid/bms5300/bugs/esccoli.html
[2]http://medinfo.ufl.edu/year2/mmid/bms5300/bugs/klebpne.html
[3]http://medinfo.ufl.edu/year2/mmid/bms5300/bugs/promirab.html
[4]www.nlm.nih.gov/medlineplus/ency/article/000522.htm