Tags: Cefepime

Pseudomonas Aeruginosa

The genus Pseudomonas consists of a number of human pathogens, the most important of which is Pseudomonas aeruginosa. P aeruginosa is an opportunistic pathogen found widely in soil, water, and organic material, reflecting its limited nutritional requirements. A moist environment is favored. Human colonization in the community is rare, and, when it occurs, the skin, gut, and upper or lower airway are colonized.

Infection in Patients With Aids

Paeruginosa infections may occur in patients with AIDS. Risk factors for infection include a CD4 count of < 100 cells/mL3, neutropenia or functional neutrophil defects, intravascular catheterization, hospitalization, and prior use of antibiotics including ciprofloxacin or trimethoprim-sulfamethoxazole. Many cases are community acquired. Bacteremia is common, and the lung or an intravenous catheter is the most frequent portal of entry.

Order Metronidazole (Flagyl) No Prescription 200/400mg

Central nervous system symptoms can occur with standard doses of metronidazole, but they are mainly seen with high doses and especially when such doses are given for a long time. Under the latter conditions, there was a 25% incidence of such symptoms as headaches, dizziness, tremor, ataxia, and confusion.

Intravascular Catheter-Related Infections

Can be life-threatening. Often prolong hospital stay, and can be complicated by metastatic lesions and bacterial endocarditis. A 53-year-old white woman was admitted to the hospital with complaints of severe shaking during infusion of her hyperalimentation solution. She had been receiving intravenous hyperalimentation for 16years for a severe dumping syndrome that prevented eating by mouth.

Meningitis

Bacterial meningitis remains one of the most feared and dangerous infectious diseases that a physician can encounter. This form of meningitis constitutes a true infectious disease emergency. It is important that the physician quickly make the appropriate diagnosis and initiate antibiotic therapy.

Central Nervous System Abscess

Brain abscess is an uncommon disease, found in about 1 in 10,000 general hospital admissions. Infection of the cerebral cortex can result from the direct spread of bacteria from another focus of infection (accounts for 20% to 60% of cases) or from hematogenous seeding.

Deciding On Hospital Admission In Acute Pneumonia

The Pneumonia Patient Outcome Research Team developed useful criteria called the pneumonia severity index for assessing pneumonia severity; however, that index proved to be complex and difficult to use. A simpler index called the CURB-65 (confusion, urea nitrogen, respiratory rate, blood pressure, age 65 years or older) has been shown to have sensitivity and specificity nearly equal to that of the pneumonia severity index. Both indexes can be used to guide decisions on admission to a hospital ward or intensive care unit. As shown in Figure 4.5, patients with a score of 0 or 1 can be treated as outpatients; those with a score of 2 or more warrant hospitalization.

Specific Causes Of Acute Community-Acquired Pneumonia

Great overlap occurs among the clinical manifestations of the pathogens associated with acute community-acquired pneumonia. However, constellations of symptoms, signs, and laboratory findings serve to narrow the possibilities. By developing an ability to focus on a few pathogens or to identify a specific pathogen, clinicians can better predict the clinical course of pneumonia and can narrow antibiotic coverage. Pathogenic strains of S. pneumoniae have a thick capsule that prevents PMN binding and that blocks phagocytosis.

Anti-Infective Therapy

Despite dire warnings that we are approaching the end of the antibiotic era, the incidence of antibiotic-resistant bacteria continues to rise. The proportions of penicillin-resistant Streptococcus pneumoniae, hospital-acquired methicillin-resistant Staphylococcus aureus, and vancomycin-resistant Enterococcus strains continue to increase. Community-acquired methicillin-resistant Staphylococcus aureus is now common throughout the world.

Anti-Infective Agent Dosing

The characteristics that need to be considered when administering antibiotics include absorption (when dealing with oral antibiotics), volume of distribution, metabolism, and excretion. These factors determine the dose of each drug and the time interval of administration. To effectively clear a bacterial infection, serum levels of the antibiotic need to be maintained above the minimum inhibitory concentration for a significant period. For each pathogen, the minimum inhibitory concentration is determined by serially diluting the antibiotic into liquid medium containing 104 bacteria per millihter.

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