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抗生素(英文).ppt

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抗生素(英文)

Coventry and Warwickshire Treatment Guidelines (Hospital) UTI Usually Gram-negatives as a cause E.coli Other coliforms (proteus, klebsiella) Less commonly enterococci, staphylococci Pseudomonas Mainly in catheterised patients or those with underlying urinary tract disorders Case 4 Stephen, 17 years old Admitted through AE Lethargic, drowsy, unwell High fever Photophobia stiff neck No allergies Coventry and Warwickshire Treatment Guidelines (Hospital) Meningitis Neisseria menigitidis (meningococcus) Strep. pneumoniae (pneumococcus) Haemophilus influenzae (HiB) Listeria (extremes of age, immunocompromise) Need IV therapy Need antibiotics with good meningeal penetration Case 5 Albert, 82 years old Had total hip replacement 5 days ago On review today, unwell, coughing mucky sputum Poor Oxygen sats, febrile WCC 18, CRP 280 CXR – widespread opacity No allergies, no previous microbiology samples Coventry and Warwickshire Treatment Guidelines (Hospital) Case 6 Ivy, 82 year old #neck of femur Had a DHS 3 days ago. Now has some erythema around the wound Tender and wound feels hot. Well otherwise Determined to be non-severe wound infection Recent MRSA screen negative Penicillin allergic (previous rash) Coventry and Warwickshire Treatment Guidelines (Hospital) Case 7 Rose, 75 year old Has been on medical ward for 2 weeks Diabetic, hypertensive Catheterised to measure urine output Today, unwell, high temperature, hypotensive, MEWS score = 7. No obvious cause – chest OK, abdo normal. No known allergies Coventry and Warwickshire Treatment Guidelines (Hospital) Blood cultures are returned positive: MRSA grown after 24 hours Flucloxacillin Resistant Erythromycin Resistant Gentamicin Sensitive Vancomycin Sensitive Rifampicin Sensitive On careful examination, a cannula site is found to be very inflamed and other sources are excluded clinically. Should the antibiotics be changed? Sepsis Wide variety of causes May be clear cause e.g. urosepsis or unclear Needs to be tre

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