Skip to content

2024/09

Treatment of CRAB

Source

  • The use of high-dose ampicillin-sulbactam (total daily dose of 6–9 g of the sulbactam component) in combination with at least 1 other agent is suggested for the treatment of CRAB infections.

Key Opportunities to Improve Antibiotic Use

Source

狀況 診斷考量 經驗治療 根據培養結果調整最終療法並確定治療時長，包括出院處方
社區性肺炎 治療開始後複查病例以確認肺炎診斷或排除非感染性病因。 除非有臨床指徵，避免經驗性使用抗綠膿桿菌β-lactam類藥物和/或抗MRSA藥物。 大多數無併發症的成年肺炎病例可在患者迅速臨床反應的情況下進行5天治療。數據也顯示，MRSA鼻腔移生檢測結果為陰性可幫助指導停用MRSA肺炎的經驗性治療
泌尿道感染 實施尿液培養開立標準，以確保陽性培養更可能代表感染而非膀胱移生。例如：
僅在患者出現符合UTI的徵兆和症狀時訂開立培養，如尿急、頻尿、排尿困難、耻骨上疼痛、側腹疼痛、骨盆不適或急性血尿。
對於使用導尿管的患者，若無UTI的徵兆和症狀，避免僅因尿液外觀混濁或氣味難聞而進行尿液培養。
譫妄、噁心和嘔吐等非特異性徵兆和症狀應謹慎解讀，因為單獨這些徵兆對UTI的特異性較低。		 建立標準以區分無症狀和有症狀的菌尿症。除非在某些臨床情況下需要治療（如妊娠婦女和進行侵入性泌尿生殖手術的患者），否則應避免對無症狀菌尿症進行抗生素治療。 使用臨床適宜的最短抗生素治療時長。
皮膚和軟組織感染 制定診斷標準以區分化膿性和非化膿性感染，以及疾病的嚴重程度（即輕度、中度和重度），以便根據指南適當管理皮膚和軟組織感染。 除非有臨床指徵，避免經驗性使用抗綠膿桿菌β-lactam類藥物和/或抗厭氧菌藥物。對於無併發症的非化膿性蜂窩織炎，可能不需要使用特別針對MRSA的治療。 大多數無併發症的細菌性蜂窩織炎病例可在患者迅速臨床反應的情況下進行5天治療。
  • in medicine
  • 3 min read

Urinary tract infection

source: Pocket Medicine, 2022
UTI_zh

Definitions

  • Asymptomatic bacteriuria: presence of bacteria in urine without signs or symptoms of infection
  • Uncomplicated: confined to bladder. No upper tract or systemic infection signs.
  • Complicated:
    • extends beyond bladder (pyelonephritis, renal/perinephric abscess, prostatitis) with symptoms of fever, rigors, malaise, flank pain, CVA tenderness or pelvic/perineal pain.
    • More likely to develop bacteremia or sepsis.
    • Men, those w/ nephrolithiasis, strictures, stents, urinary diversions, immunosupp, DM, are not automatically complicated.
    • Pregnant & renal transplant are considered complicated.
  • in medicine
  • 3 min read

Sepsis and Shock

source: Pocket Medicine, 2022

Shock

  • Tissue hypoxia due to ↓ tissue perfusion and hence ↓ tissue O2 delivery and/or ↑ O2 consumption or inadequate O2 utilization
  • Typical signs include HoTN (SBP <90 mmHg or drop in SBP >40 mmHg), tachycardia, oliguria (UOP <0.5 cc/kg/h), Δ mentation, metabolic acidosis ± ↑ lactate
  • Hard to diagnose as ↑ SVR can maintain SBP, but tissue perfusion poor; shock index (HR/SBP) >0.9 and pulse pressure [(SBP - DBP)/SBP] <25% clues to significant shock
  • in medicine
  • 7 min read

BACTEREMIA

Definitions

  • Primary bacteremia: bloodstream infection due to direct inoculation of the blood
  • Central line associated bloodstream infection (CLABSI): bacteremia in which the same organism is growing from peripheral and catheter cultures (CID 2009;49:1)
  • Secondary bacteremia: infection of another site (eg, UTI, pneumonia, colitis, etc.) spreading to blood
  • Contaminant: bacteria growing in a blood culture that does not represent a true infection