Case Study Analysis: Wound Care, Antibiotics, and Infection Control

This case study analyzes a patient's wound, exploring the physiological basis of observations such as pain, redness, and swelling, which are linked to the body's inflammatory response and potential bacterial infection. It delves into the sources and modes of contamination, distinguishing between endogenous and exogenous factors. The case provides a rationale for the selection of specific antibiotics, including ceftriaxone, cephalexin, and dicloxacillin, considering their administration routes and mechanisms of action. It also addresses potential adverse reactions to dicloxacillin. Finally, the case outlines the process of wound healing, emphasizing the roles of antibiotic therapy, potential surgical interventions, and appropriate wound care procedures, including cleaning, dressing, and the use of advanced techniques like VAC therapy.

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1. Physiological basis of the wound observations (Total: 10 marks)
A wound is defined as the injury to the body which includes damage or laceration to the
membrane. Wound drainage is basically the fluid or exudate that comes out of the wound in
order to heal the damaged part or as a result of infection. The wounds that remain open for a
while, exhibit various types of exudate or drainage such as serious, purulent, and
serosanguineous. The purulent drainage is milky or yellowish in appearance. These types of
wounds indicate that the wound is infected. The color and thickness are of the fluid change due
to the dead cell count and white blood cells present in the fluid. Mary has been suffering from
extreme pain, worm, red and swollen wound. Normally the pain is decreased with the time but
if it increases continuously it indicates the clear sign of infection (Craft & Gordon, 2015). As
mentioned in the case study the patient has used a handkerchief to prevent the bleeding from
the wound area. This might be the reason behind bacterial infection of the wound. Redness
may be appeared due to the body's natural inflammatory process try to heal the wound.
Sometimes the wound takes more time to reduce the redness and pain due to the bacterial
infection which keeps growing with the time. Swelling is also like redness which takes place at
initial stages of the wound healing. Sometimes the wound also feels somewhat warm, this is
because the body's immune system is under process to kill the pathogen that causes infection.
The heat near the wound is generated due to the secretion of vasoactive chemicals that results
in increased blood flow to the affects area (Marieb & Hoehn, 2016). In response the body’s
defense mechanism produce more heat and sends lymphocytes to generate more antibodies to

kill the microorganism, this is called phagocytosis (Bullock & Manias, 2017).
2. Possible sources of contamination and modes of transmission (Total: 10 marks)
2.1 Name one endogenous source of contamination and discuss the mode of
transmission from the source to the new host. (5 marks)
In the endogenous type of infection, the patient is infected by a type of microorganisms
such as virus, bacteria, and fungi. The microbes are generally present on the human skin, one
of the studies conducted by Reichman and Greenberg stated that nearly 3 million pathogens
per square centimeter on the skin are always there. Staphylococcus and Escherichia species are
the most common cause of wound infection. The pathogens are not infectious while present on
the skin, but once they enter inside the skin, may cause infection. The mode of transmission of
these microbes takes place when there is a breakdown of a barrier between the non-sterile and
sterile tissues. When the body’s resistance is impaired these pathogens invade and cause
infection (Grabe et al., 2012).
2.2 Name one exogenous source of contamination and discuss the mode of
transmission from the source to the new host. (5 marks)
The exogenous sources of wound contamination are the sources from which the
patient’s damaged body part infected by the infectious agents. The microbes can easily
become dislodged and pass from one part to the other part of the body and result in
exogenous infection. The microorganisms like Staphylococcus aureus are able to transfer
from one location to another via direct, indirect or airborne routes. Indirect mode of
transmission of the most common such as handshakes. A single scale of staphylococcus
carrier can transmit around hundred bacteria to a new host. This single scale is then become
airborne and reaches to the wound. The life cycle of a microorganism includes a stage in
which the insect vector is used to transfer the pathogen from the uninfected area to the wound
(Randall, Gupta, Jackson, Busse & O'neill, 2015).
3. Rationale for choices of antibiotics (Total 10 Marks)

3.1 Rationale for the stat dose of ceftriaxone administered IVI immediately. (3 marks)
A discussed in the case study the patient had an injury and suffering form extreme
pain. Before examining the wound clinically it was not clear that the wound is infected, but
possibilities were there. Therefore she has been administered Cefrtriaxone via IVI route for
fast absorption of the drug. Administration of this medicine Intravenously can exhibit better
results. According to Jin et al. (2015), IV ceftriaxone can provide higher C max (Peak) and
shorter Tmax (time at which Cmax is observed) values than subcutaneous treatment. The results
of this medication occur immediately after intravenous routes of administration. The effects
of this drug last for nearly 24 hours (Kokai-Kun et al., 2017).
3.2 Rationale for the oral cephalexin. (2 marks)
The patient is commenced with Oral Cephalexin as it is not possible for them to inject
medicine via IV r SC route, because the patient is already in extreme pain. The rationale of
prescribing this medicine is because this drug works by killing the bacteria. This medicine is
used to treat a wide variety of bacterial infection (Medicine plus, 2018). ORAL route is the
easy way to deliver the drug into the patient’s body. It is used to treat different verities of
bacterial infection such as respiratory tract infection, otitis media, bone infection and skin,
and skin structure infections by inhibiting their growth (Kokai-Kun et al., 2017).
3.3 The rationale for the change to oral dicloxacillin. (4 marks)
The cephalexin is used for infection, UTI and Ear infection on the other hand
dicloxacillin is used for only bacterial infection. As the patient has been diagnosed with
staphylococcal infection dicloxacillin might be a good effect to kill that kind of bacteria.
Onset of action of action of dicloxcillin is another reason for prescribing this medicine to the
patient for immediate effect on pathogen (Treato, 2018). This drug exhibit effects in thirty
minutes of administration. Cephalexin takes nearly one hour to exhibit its beneficial effects
in case of bacterial infection. The effects of dicloxacillin antibiotic last for 6 hours after
injecting into the body. On the other hand, cephalexin remains effective for four to five hours

only (Pottegård, Henriksen, Madsen, Hellfritzsch, Damkier, & Stage, 2015).
3.4 State two adverse reactions to dicloxacillin. (1 mark)
1. It may cause breathing issues like shortness of breathing
2. One of the most common adverse reactions is Diarrhoea (Alpatova, Davies, &
Masten, 2013).
4. Process by which Mary’s wound will heal (Total: 5 marks)
To treat Mary's wound three processes can be included that are using antibiotics,
invasive surgery treatment, and caring for the wound. In this case, scenario antibiotics like
dicloxacillin may play a crucial and vital role to kill the microorganisms. For Mary, the time
of antibiotic therapy should be more as she is infected for a while. It may take 7 to 8 days to
kill the pathogen. If the wound still has infections than invasive surgery can be used to
remove the infected part. The wound care procedure includes cleaning of the wound on the
regular basis and dressing two times a day. After the removal of the bandages, the wound
should be cleaned, only after the new bandage should be used. VAC or Vacuum-assisted
closure dressing can be used which help to increase the blood to the affected area. The
transparent dressing is the new type of dressing that is useful for treating the wound while the
health professionals want to examine the wound healing. This type of dressing cover the
wound with the clear firm and make infection easier to spot (Lee & Bishop 2016).

References
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Bullock, S., & Manias, E. (2017). Fundamentals of Pharmacology (8th ed.). Frenchs Forest,
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Grabe, M., Botto, H., Cek, M., Tenke, P., Wagenlehner, F. M., Naber, K. G., & Johansen, T. E. B.
(2012). Preoperative assessment of the patient and risk factors for infectious complications
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Jin, J. F., Zhu, L. L., Chen, M., Xu, H. M., Wang, H. F., Feng, X. Q., & Zhou, Q. (2015). The
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Kokai-Kun, J. F., Roberts, T., Coughlin, O., Sicard, E., Rufiange, M., Fedorak, R., & Sliman, J.
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Lee, G., & Bishop, P. (Eds.). (2016). Microbiology and infection control for health professionals.
(6th ed.). Melbourne, Victoria: Pearson Australia.
Marieb, E.N., & Hoehn, K. (2016). Human anatomy & physiology (10th ed.). Harlow, United
Kingdom: Pearson Education.

Medicien Plus (2018). Cephalexin. Retrieved from:
https://medlineplus.gov/druginfo/meds/a682733.html
Pottegård, A., Henriksen, D. P., Madsen, K. G., Hellfritzsch, M., Damkier, P., & Stage, T. B. (2015).
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Randall, C. P., Gupta, A., Jackson, N., Busse, D., & O'neill, A. J. (2015). Silver resistance in Gram-
negative bacteria: a dissection of endogenous and exogenous mechanisms. Journal of
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Treato (2018). Cephalexin vs dicloxacillin. Retrieved from:
https://treato.com/Cephalexin,Dicloxacillin/?a=s