S13C146 - Sepsis

Question 1

SIRS

Answer 1

2 of:

• core temp >38.3 or 90 (or brady in children)
• RR >20 or PaCO2 12 or

Question 2

Empiric Abx: neonates (bugs and tx)

Answer 2

• bugs: GBS, e coli, klebsiella, enterobacter

- ampicillin 25mg/kg IV q8h plus cefotaxime 50mg/kg IV q12h

Question 3

Empiric Abx: Infants 1-3mo

Answer 3

• e. coli, klebsiella, enterobacter, h flu, strep pneumo, n meningitides
• CTX 75mg/kg q24h OR cefotaxime 50mg/kg IV q8h

Question 4

Empiric Abx: children >3mo

Answer 4

• s penumo, n meningitidis, s aureus, h flu

- CTX or cefotaxime or vanco

Question 5

Empiric Abx: Adult with no source

Answer 5

-gm- bacilli, s aureus, strep

=imipenem, meropenem 1g q8h, ertapenem PLUS vanco

Question 6

Empiric Abx: adult, suspected biliary sourcw

Answer 6

• aerobic gm- bacilli, enterococci

- pip-tax 4.5g IV q6h

Question 7

Empiric Abx: adult, suspected pneumonia

Answer 7

-s pneumonia, MRSA, gm- bacilli, legionella
-CTX 1-2g q12h
PLUS azithromycin 500mg IV then 250mg IV q24h
PLUS levofloxacin 750mg IV q24h
PLUS vanco 15mg/kg q6h

Question 8

Empiric Abx: adult, suspected IVDU

Answer 8

• s aureus

- vancomycin 15mg/kg IV q6h

Question 9

Empiric Abx: adult, suspected meningitis

Answer 9

• n meningitidis

- CTX 2g IV q12h

Question 10

Empiric Abx: adult, suspected intra-abdominal source

Answer 10

• mixed aerobic and anaerobic gm- bacilli

- impeniem/meropenem/pip-tazo

Question 11

Empiric Abx: adult, suspected urinary tract source

Answer 11

• aerobic gm- bacilli, enterococci

- levofloxacin 750mg IV q24h / pip-taz /CTX 1-2g IV q12-24h

Question 12

Empiric Abx: adult, complicated urinary tract infeciton

Answer 12

• eg. catheter
• enterobacteriaceae, pseudomonas aeruginosa, enterococci, s aureus
• pip-tax/imipenem/meropenem

Question 13

Empiric Abx: adult/child, neutropenic

Answer 13

• aerobic gm- bacilli, p aeruginosa, s aureus

- ceftazidine or imipenem, or pip-taz PLUS vanco

Question 14

Empiric Abx: adult, anaerobic (genito-urinary tract, necrotizing cellulitis, odontogenic)

Answer 14

-anaerobic plus gm-
-flagyl 15mg/kg IV load then 7.5mg/kg q8h
or clindamycin 600-900mg IV q8h

Question 15

Empiric Abx: asplenic pts

Answer 15

• encapsulated organisms, s pneumo, n meningitidis, h flu, capnocytophaga
• CTX 1g IV q24h