The Bugs
Enterococci
E. Faecalis
E. Faecium
facultative anaerobes
Enterobacteriaceae
E. Coli
Protes
Klebsiella
Citrobacter
Salmonella
Shigella
Yersinea
Urine
Morganella
E. Aerogenes
E. Cloacae
Anaerobes
Clostridia
Non-Fermentative Gram Neg Rods
Pseudomonas Aeruginosa
A. Baumannii
Candida
Albicans
Krusei
Glabrata
candida colonizes the gi tract
any candida in the blood requires removal of all lines and treatment
in the urine without other sites, remove catheter and reculture
treat:
2 sites
vascular cath tip
c. tropicalis
resistant funguria
deep issue culture
fluconazole 400-800 mg/day
early yeast infection: consider gastric perf
Group B strep is strep A galactiae
S
UPER BUGS UNLEASHED IN YOUR EMERGENCY DEPARTMENT—
Peter DeBlieux, MD, Professor of Clinical Medicine, Louisiana
State University School of Medicine, New Orleans
Epidemiology:
gram-positive sepsis has overtaken gram-negative
sepsis; common gram-positive bacteria include
Staphylococcus
aureus,
coagulase-negative staphylococci, enterococci,
and streptococci; most common gram-negative pathogens are
Escherichia coli
, Klebsiella, and Pseudomonas; incidence of
fungal sepsis has tripled due to transplant patients and those on
immunosuppressive therapy (accounts for only 5% of all cases
of sepsis); common sites of sepsis are 1) lungs, 2) bloodstream,
3) abdomen, 4) urinary tract, 5) skin and soft tissue;
pearl—
when source unknown, choose antibiotic that covers
abdominal pathogens
Origins of super bugs:
selection of agents with broader spectrum
than required; broad-spectrum antibiotics placed in animal
feed (
eg, cows, sheep, chickens); patients not finishing
their course of medication and giving leftover pills to friends
or relatives; propensity of physicians to overuse antibiotics
(medicate rather than educate); selection pressure number one
etiology of resistance,
ie, sensitive organisms killed by antibiotic,
resistant organisms multiply
Case:
3-yr-old presents with temperature of 39.5