Clinical History

 Joneth Maglasang
 31 years old/ Female
 Banaybanay dvo. Or.

Date of admission

September 6, 2009

History prior to admission:

On the day prior to admission, the patient was stabbed by a knife at her anterior neck.
Chief complaint: Severe bleeding.

Laboratory findings:
 Laboratory result in Bacteriology
 Sample: Endotracheal aspirate (ETA)
 Planted in:

Media Result
 MacConkey agar - Moderate growth of LLF colonies
 Blood Agar - Heavy growth white of non hemolytic & B-
Hemolytic colonies
 Chocolate agar - Heavy growth of white colonies
 TSB - Cloudy

FOLLOW-UP TESTS

Gram stain result:

 Pus cells- +++
 Gm (-) cocci in clusters & pairs
 Gm (-) rods +

Catalase test for Staphylococcus aureus

Result: Positive

Coagulase test for Staphylococcus aureus

Result: Positive

Biochemical test reading: Klebsiella species:

 TSI- Acid /Acid, Gas(+), H2s (-)
LIA- Deam -, Decarb -
Citrate- +
Urease- +
SIM- Non-motile, S (-), Indole (-)

Sensitivity Test for Klebsiella and S. aureus

Klebsiella rhinoscleromatis Staphylococcus aureus

Antibiotic Zone of Interpretation Zone of inhibition Interpretation

inhibition

Amikacin 20 S Ciprofloxacin 30 S

Ampicillin 12 R Clindamycin 6 R

Aztreonam 6 R Cefaclor 16 I

Amoxicillin 7 R Erythromycin 16 I

Cephalothin 6 R Gentamycin 18 S

Cefriaxone 18 I Ofloxacin 31 S

Ceftazidime 22 S Oxacillin 6 R

Cefuroxime 6 R Tazobactam 21 S

Ciprofloxacin 30 S Penicillin 13 R

Cefaclor 17 I Rifampin 22 S

Gentamycin 17 S Tobramycin 18 S

Impemen 20 S Vancomycin 18 S

Netilmicin 18 S

Nitrofurantoin 6 R

Ofloxaicin 30 S
Tazobactam 30 S

Tobramycin 15 S

Moxifloxacin 25 S

Bacterial Growth in Different culture media

MacConkey media Blood agar media

(Moderate growth of LLF) (Heavy growth
white of non hemolytic & B-
Hemolytic
colonies)

Chocolate agar media

(Heavy growth of white
colonies)

Biochemical Test

Sensitivity Testing using Mueller Hinton Media

Enterobacteriaceae panel
 Antibiotic disc Zone of Inhibition Antibiotic Disc

Staphylococcus panel

Antibiotic Disc Zone of Inhibition Antibiotic Disc

Physical Examination

Vital signs: BP = 100/70

PR = 76/ min
RR = 24/min.
 TEMP.= 37°C
Unconscious
Fever
Patient’s impression or Diagnosis

Primary Diagnosis: Stab wound on anterior neck

Principal Diagnosis: Bacterial Infection Secondary to Stab Wound

Discussion

1. Explain how these bacteria infect the stab wound. What are the factors that contribute their
colonization?

2.) How significant are the biochemical tests in the specification of the organisms?

3.) Explain the pathophysiology of the condition.

4.) What is meant by nosocomial infection and what predisposing factors that may lead patients to
acquire the infection?