Beruflich Dokumente
Kultur Dokumente
AND MANAGEMENT
SITI NUR BAITI BINTI SHAIK
KHAMARUDIN
OUTLINE
Monomicrobial vs Polymicrobial
Selecting and initiating antibiotic regimen
Factors influencing antibiotic choice
Antimicrobial combination
Host factors
Duration
Oral vs Intravenous therapy
Misuse
Monomicrobial infections
Nosocomial which occurred in postoperative
patients, e.g. UTI, pneumonia, catheterrelated infection, bacteremia
Culture and sensitivity tests
Polymicrobial infections
culture results less helpful
POLYMICROBIAL
Antibiotic regimen should not be modified in the
basis of culture.
E.g., patient who undergoes appendectomy for
gangrenous perforated appendicitis/bowel resection
for intestinal perforation should receive antibiotic for
3-5 days occasionally longer.
If he regains bowel function during this time,
convert from IV to oral which is safer, earlier
discharge.
Empiric therapy
should be initiated
immediately after or
concurrently with
collection of
specimen.
E.g.: septic shock,
febrile neutropenic,
bacterial meningitis.
Stable
Hospital-acquired infection
Related to invasive devices and procedures
Intravascular catheter-associated bacteremia,
ventilator-associated pneumonia and
catheter-associated UTI.
Drug-resistant gram-positive (MRSA) and
gram-negative bacteria (Pseudomonas
aeruginosa)
FACTORS INFLUENCING
ANTIBIOTIC CHOICE
1) Site of infection & organisms likely to
colonize
Antibiograms
ANTIMICROBIAL
COMBINATIONS
When to use?
1. Agents exhibit synergistic activity against
microorganisms
Penicillin and gentamicin to treat endocarditis caused
by Enterococcus spp.
Penicillin +gentamycin
HOST FACTORS
Renal & hepatic function
Concerned with dose reduction to prevent
accumulation and toxicity
Age/conditons
Pediatrics: dose guided by weight
Geriatrics: depends on age and weight, not
creatinine clearance solely for kidney function
Obese: depends on fat percentage
Genetic variation
Susceptibility to drug ADR
Glucose-6-phosphate dehydrogenase (G6PD) deficiency
Avoid certain antimicrobials like dapsone, primaquine and
nitrofurantoin.
Result in hemolysis.
DURATION
If cultures are negative, empirical
antibiotic therapy should be stopped 48
to 72 hours.
Unnecessity
MONOMICROBIAL
Standard guideline:
3-5 days for UTI
7-10 days for pneumonia
7-14 days for bacteremia
Longer course do not result in improved care
and associated with increase risk of
superinfection by resistant microorganism.
POLYMICROBIAL
Studies focused on patients with peritonitis.
Satisfactory outcomes:
12 to 24 hours for penetrating gestrointestinal trauma
with absence of extensive contamination
3 to 5 days for perforated/gangrenous appendicitis
5 to 7 days for peritoneal soilage due to perforated viscus
with moderate contamination.
7 to 14 days for adjunct therapy of extensive peritoneal
soilage (feculent peritonitis) or that of in
immunosuppressed host.
ORAL VS INTRAVEOUS
THERAPY
Patients hospitalized with infections always
treated with intravenous abx
Prompted by severity of infection
MISUSE
Scenarios:
Prolonged empiric therapy without clear
evidence of infection,
Failure to narrow antimicrobial therapy
when causative organism is identified.
Data available narrowest for continuation
REFERENCE
Mayo Clinic article http
://www.ncbi.nlm.nih.gov/pmc/articles/PMC3031442/
Schwartzs Principles of Surgery, Tenth Edition
Sabiston Textbook of Surgery, 19th Edition