infections antibiotics surgery-1

infections antibiotics surgery-1 - INFECTIONS AND...

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Unformatted text preview: INFECTIONS AND ANTIBIOTICS ANTIBIOTICS PATHOGENIC POTENTIAL OF MICROBES MICROBES EXALTATION PATHOGENIC SYNERGY ASEPSIS ASEPSIS SURGICAL RITUAL STERILIZATION * Wet heat * Dry heat * Irradiation * Special sterilizing chemicals, liquid or gases DISINFECTION SURGICAL INFECTION SURGICAL Infection,bacteremia&septicaemia Microbiological diagnosis of infection Wound infection Peritionitis Pelvic inflammatory disease Burns Pressure sores Sepsis, shock & SIRS WOUND INFECTION WOUND FACTORS PREDISPOSING TO INFECTION * contamination * foreign material * virulence enhancing effect of some materials,such as soil,calcium and iron .salts * delay in primary intention * Pathogenic synergy * Dentalized tissue * oedema / pressure / constriction * impaired blood supply * extravasation of tissue fluids& blood * host factors lowering resistance TISSUE OXYGENATION SYMPTOMS & SIGNS OF INFECTION POST­OPERATIVE WOUND INFECTION ANAEROBIC INFECTION ANAEROBIC TETANUS GAS GANGRENE/OTHER CLOSTRIDIAL INFECTIONS PROGRESSIVE BACTERIAL GANGRENE&NECROTIZING FASCITIS OTHER ANAEROBIC INFECTIONS HOSPITALHOSPITALACQUIRED(NOSOCOMIAL)INFECTIONS SITES OF COLONIZATION HAND­BORNE OR SURFACE­ MEDIATED CHALLENGES AIRBORNE CHALLENGES INGESTED CHALLENGES INOCULATED CHALLENGES HAZARDS ASSOCIATED WITH INTENSIVE CARE ANTIMICROBIAL MANAGEMENT OF WOUND INFECTIONS OF ORGANISM FIRST CHOICE ALTERNATIVE Methicillin­sensitive Flucloxacillin Eryhthromycin,cefuroxime Clindamycin Methicillin­resistant Vancomysin Telcoplanin,Linezolid Coagulase­negetive Vancomysin Telcoplanin Streptococcus pneumoniae Benzylpeniocillin Erythromycin,Cefuroxime Ceftriaxone Streptococcus pyogenes Benzylpenicillin Erythromycin,clindamycin Streptococcus Amoxicillin Gentamycin with Penicillin or Amoxicillin,Vancomysin Bacteroides species Metronidazole Co­amoxiclav,Clindamycin Erythromycin Escherichia Coli ­Sepsis Cefuroxime or gentamicin Ceftriaxone,ceftazidime, Ciprofloxacin ­ UTI Trimethoprim or Amoxicillin Coamoxiclav,Cefuroxime Cefotaxime,ceftazidine Norfloxacin Haemophilus influenza Amoxicillin Co­amoxiclav,cefroxime Ceftriaxone,trimethoprim Chloramphenicol Klebsiella Cefuroxime or gentamicin Cefotaxime,ceftazidime, Ciprofloxacin,meropenem Proteus Cefuroxime or gentamicin Ceftriaxone,ceftazidime, Ciprofloxacin Pseudomonas aeruginosa Ceftazidime with genatmicin Tazocin or Ciprofloxacin Clostridia Benzylpenicillin,metronidazole Clindamycin, Erythromycin PRINCIPLES OF GOVERNING THE CHOICE AND USE OF ANTIBIOTICS CHOICE INITIAL THERAPHY FOR ACUTE INFECTIONS Type of infection Antimicrobial Chest Infection ­­­­­­­­­­­­­­­­­­ Uncomplicated Amoxicillin,erythromycin Community­acquired pneumonia Cefuroxime+erythromycin Hospital­acquired/post operative Ceftazidime/ciprofloxacin+metronidazole Aspiration pneumonia Coamoxiclav or amoxicillin+metronidazole Atypical or legionella likey erythromycin or tetracycline UTI ­­­­ Lower infection Trimethoprim/amoxicillin/cephalexin/nitrofurantoin Acute pyelonephritis Cefuroxime/Ceftriaxone/ciprofloxacin/gentamycin Wound Infection ­­­­­­­­­­­­­­­­­­­­ Abdominal and Pelvic Metronidazole with 2nd or 3rd generation Cephalosporin or Benzyl Penicillin Genatmycin If Staph.Aureus suspected Fluxacillin or Cefuroximeor Erythromycin; Vancomycin for MRSA orCombination Theraphy As guided by sesnstivities Amputation and gas gangrene Benzyl Penicillin,Metronidazole Septicaemia and Septic Shock Bezyl Penicillin+Metronidazole and Genatamicin/ Ciprofloxacin Severe Pseudomonas infections Ceftazidime or piperacillin with Gentamicin for Candida Sepsis Synergy;ciprofloxin.amphotericin B; Alternative fluconazole PROPHYLACTIC USE OF ANTIBIOTICS ANTIBIOTICS SKULL FRACTURES & MENINGITIS TETANUS GAS GANGRENE PREVENTION OF ENDOCARDITIS CLEAN SURGERY GASTROINTESTINAL&GENITOURINARY SURGERY TREATMENT OF COMPOUND LIOMB FRACTURES PROSTHETIC IMPLANTS MANAGEMENT OF IMMUNOSUPPRESSED PATIENTS(including those who had splenectomy) splenectomy) PROPHYLAXIS TREATMENT ( A combination of Aminoglycoside with an antipseudomonal Penicillin or Cephalosporin is recommended for immunosuppressed patient ) INFECTION & ANTIBIOTICS INFECTION Clinical Scenarios A 53 year old woman develops a swing pyrexia five A 53 year old woman develops a swing pyrexia five days after an eventful cholecystectomy. On examination the wound appears inflammed, and there is oozing of pus from the upper end. Gram stain of the pus reveals Gram­positive cocci in cluster, with pus cells present a)What is the likely organism? b)What antibiotic is likely to be helpful? c)What other intervention may be necessary? A 70 year old man who is awaiting surgery for an enlarged prostate is admitted from home having been found collapsed by neighbours. He is confused and unable to give a history. Examination reveals only mild suprapubic tenderness, other systems are clear. He is pyrexial and hypotensive. What is the likely diagnosis? What is the likely organism? What other intervention might be necessary? A 65 year old man is transferred to ITU for ventilation after a difficult hemicolectomy. After three days of ventilation, he develops a low­grade pyrexia, rising white cell count and increased oxygen requirement.He had received treatment with amoxycillin for his chronic bronchitis before admission, and had prophylaxis with a second generation cephalosporin and metronidazole preoperatively. A tracheal aspirate shows moderate number of pus cells and Gram­negative bacilli. What is the likely organism? What antibiotic would be most suitable for treatment? ...
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