Critical Thinking

A patient in the hospital has an intravenous catheter inserted to allow for the delivery of medications, fluids, and electrolytes. Four days after the catheter is inserted, the patient develops a fever and an infection in the skin around the catheter. Blood cultures reveal that the patient has a blood-borne infection. Tests in the clinical laboratory identify the blood-borne pathogen as Staphylococcus epidermidis, and antibiotic susceptibility tests are performed to provide doctors with essential information for selecting the best drug for treatment of the infection. Antibacterial chemotherapy is initiated and delivered through the intravenous catheter that was originally inserted into the patient. Within 7 days, the skin infection is gone, blood cultures are negative for S. epidermidis, and the antibacterial chemotherapy is discontinued. However, 2 days after discontinuing the antibacterial chemotherapy, the patient develops another fever and skin infection and the blood cultures are positive for the same strain of S. epidermidis that had been isolated the previous week. This time, doctors remove the intravenous catheter and administer oral antibiotics, which successfully treat both the skin and blood-borne infection caused by S. epidermidis. Furthermore, the infection does not return after discontinuing the oral antibacterial chemotherapy. What are some possible reasons why intravenous chemotherapy failed to completely cure the patient despite laboratory tests showing the bacterial strain was susceptible to the prescribed antibiotic? Why might the second round of antibiotic therapy have been more successful? Justify your answers.

Why are autoinducers small molecules?

Refer to Figure B1 in Appendix B. If the results from a pond water sample were recorded as 3, 2, 1, what would be the MPN of bacteria in 100 mL of pond water?

Refer to Figure 9.15. Why does turbidity lose reliability at high cell concentrations when the culture reaches the stationary phase?

A microbiology instructor prepares cultures for a gram-staining practical laboratory by inoculating growth medium with a gram-positive coccus (nonmotile) and a gram-negative rod (motile). The goal is to demonstrate staining of a mixed culture. The flask is incubated at 35 °C for 24 hours without aeration. A sample is stained and reveals only gram-negative rods. Both cultures are known facultative anaerobes. Give a likely reason for success of the gram-negative rod. Assume that the cultures have comparable intrinsic growth rates.

People who use proton pumps inhibitors or antacids are more prone to infections of the gastrointestinal tract. Can you explain the observation in light of what you have learned?

The bacterium that causes Hansen’s disease (leprosy), Mycobacterium leprae, infects mostly the extremities of the body: hands, feet, and nose. Can you make an educated guess as to its optimum temperature of growth?

Refer to Figure 9.29. Some hyperthermophiles can survive autoclaving temperatures. Are they a concern in health care?

Haemophilus, influenzae grows best at 35–37 °C with ~5% CO₂ (or in a candle-jar) and requires hemin (X factor) and nicotinamide-adenine-dinucleotide (NAD, also known as V factor) for growth. (Centers for Disease Control and Prevention, World Health Organization. “CDC Laboratory Methods for the Diagnosis of Meningitis Caused by Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenza. WHO Manual, 2nd edition.” 2011. http://www.cdc.gov/meningitis/lab-manual/full-manual.pdf) Using the vocabulary learned in this chapter, describe H. influenzae.