PATHOGEN INFECTION- ANTIBIOTIC HIGHER

Question 1

Scenario 1
46 male acute lymphoblastic leukaemia. Fever 38 and chills 7 days after chemo. fever seems worse after hickman line. pulse 85, bp 130/75. resp 16.
Blood cultures grow pseudomonas aerugnunosa, sensitive to gentamicin,tazobactam and staph epidermis. sensitive to mancomycin.

Answer 1

• top differential diagnosis: intravascular catheter associated bloodstream infection.
  Best test to confirm: paired through catheter and peripheral blood cultures to see time to positivityu and differential time.
  Most likely cause: coagulase negaive staphylococci.
  Best empiricle treatment: vancomyacin and gentamicin.
  Best directed treatment: piperacillin/tanzobactam and vancomycin.

Question 2

Scenario 2
same man 6 months later
chills, sweats, rigors, dry cough, confusion and shortness of breath
exam: 38.6 degrees, pulse 100, bp 120/65 and resp 25. scattered crackes in lungs and 02 sats 92.
all blood cultures grow coagulase negative staph.

Answer 2

top differential diagnosis: community acquired pneumonia
Best test to confirm: chest x ray
Best empiricle treatment: amoxicillin/clavilante and clanthromycin. + vancomycin due to negative staph epidermis.
DIAGNOSIS: endocardiography found vegetation on tricuspid valve staph epidermis infection–> endocarditits.