1 / 13

Infections in Patients with Diabetes

Infections in Patients with Diabetes. David Joffe, BSPharm , CDE Diabetes In Control Kelsey Schultz PharmD Candidate 2013 Butler University. Rhinocerebral Mucormycosis. Fungal infection caused mainly by Rhizopus oryzae High risk of infection in those with DKA

htoland
Télécharger la présentation

Infections in Patients with Diabetes

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Infections in Patients with Diabetes David Joffe, BSPharm, CDE Diabetes In Control Kelsey Schultz PharmD Candidate 2013 Butler University

  2. Rhinocerebral Mucormycosis • Fungal infection caused mainly by Rhizopus oryzae • High risk of infection in those with DKA • Presents as fever, nasal pain, ulceration, and necrosis with black nasal discharge • Can spread quickly to the brain Cox GM. Mucormycosis (zygomycosis). In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA. 2012. Grandis JR, Yu VL. Malignant (necrotizing) external otitis. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA. 2012 http://trialx.com/curetalk/wp-content/blogs.dir/7/files/2011/05/diseases/Mucormycosis-1.jpg

  3. Rhinocerebral Mucormycosis Treatment • Surgical debridement of tissues • IV lipid formulation of amphotericin B is the drug of choice • Amphotericin 5mg/kg daily is the usual starting dose. • Some doctors increase the dose to amphotericin 10mg/kg daily • Control of contributing factors: hyperglycemia, metabolic acidosis Cox GM. Mucormycosis (zygomycosis). In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA. 2012. Grandis JR, Yu VL. Malignant (necrotizing) external otitis. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA. 2012 http://trialx.com/curetalk/wp-content/blogs.dir/7/files/2011/05/diseases/Mucormycosis-1.jpg

  4. Urinary Tract Infections • / http://urinarytract-infection-symptoms.com

  5. Urinary Tract Infections http://www.200eastchestnut.com/2010/11

  6. Urinary Tract Infections • Urinary infections diabetics are at increased risk for include: • Urinary tract infections • Pyelonephritis • Asymptomatic bacteriuria http://abouthealthandmore.blogspot.com/p/interstitial-cystitis.html Khardori R. Infection in patients with diabetes mellitus. Medscape reference. WebMD 2011.

  7. Urinary Tract Infections • Presence of bacteria in the urinary tract • bladder, urethra, prostate, kidneys • Caused by Escherichiacoli about 85%of the time • Bacteria often comes from normal flora found around the rectal area • Patient education point: wipe from front to back Coyle EA, Prince RA. “Urinary Tract Infections and Prostatitis.” Dipiro et al. Pharmacotherapy: A Pathophysiologic Approach, 7th Ed. McGraw-Hill; 2008:1899-1913. Khardori R. Infection in patients with diabetes mellitus. Medscape reference. WebMD 2011.

  8. Urinary Tract Infections • More common in women due to shorter urethra length and close proximity of urethra to rectum • Signs and symptoms include: • Dysuria, urgency, nocturia, flank pain • Elderly present a little differently: • Altered mental status, change in eating habits, gastrointestinal symptoms Coyle EA, Prince RA. “Urinary Tract Infections and Prostatitis.” Dipiro et al. Pharmacotherapy: A Pathophysiologic Approach, 7th Ed. McGraw-Hill; 2008:1899-1913. Khardori R. Infection in patients with diabetes mellitus. Medscape reference. WebMD 2011.

  9. Urinary Tract Infections Treatment • Generally the same as those without diabetes, except 7 days of treatment is preferred • Nitrofurantoin 100mg orally twice daily for 7 days • Trimethoprim/sulfamethoxazole DS 160mg/800mg orally twice daily for 7 days • NOT if sulfa allergy! Coyle EA, Prince RA. “Urinary Tract Infections and Prostatitis.” Dipiro et al. Pharmacotherapy: A Pathophysiologic Approach, 7th Ed. McGraw-Hill; 2008:1899-1913. Khardori R. Infection in patients with diabetes mellitus. Medscape reference. WebMD 2011.

  10. Pyelonephritis • Upper UTI affecting kidneys • Mainly caused by E. coli • Presents as fever and severe flank pain • Treatment doesn’t differ for diabetics, but hospitalization threshold may be lower Coyle EA, Prince RA. “Urinary Tract Infections and Prostatitis.” Dipiro et al. Pharmacotherapy: A Pathophysiologic Approach, 7th Ed. McGraw-Hill; 2008:1899-1913. Khardori R. Infection in patients with diabetes mellitus. Medscape reference. WebMD 2011. http://www.smartdraw.com/examples/view/urology+-+pyelonephritis/

  11. Pyelonephritis Outpatient Treatment • Oral antibiotics are preferred in outpatients • Fluoroquinolones or trimethoprim/sulfamethoxazole are the drugs of choice • Treat for at least 2 weeks • Cipro XR 1000mg orally daily or trimethoprim/sulfamethoxazole DS 160mg/800mg orally twice daily for 14 days Coyle EA, Prince RA. “Urinary Tract Infections and Prostatitis.” Dipiro et al. Pharmacotherapy: A Pathophysiologic Approach, 7th Ed. McGraw-Hill; 2008:1899-1913. Khardori R. Infection in patients with diabetes mellitus. Medscape reference. WebMD 2011. http://www.smartdraw.com/examples/view/urology+-+pyelonephritis/

  12. Pyelonephritis Inpatient Treatment • For seriously ill patients hospital admission and IV therapy are appropriate • Broad coverage is warranted empirically • Possible therapy includes: • IV fluoroquinolone • Aminoglycoside +/- ampicillin • Extended spectrum cephalosporin • Generally stop IV therapy and switch to oral after patient is afebrile for 24 hours • Total therapy duration should be 2 weeks Coyle EA, Prince RA. “Urinary Tract Infections and Prostatitis.” Dipiro et al. Pharmacotherapy: A Pathophysiologic Approach, 7th Ed. McGraw-Hill; 2008:1899-1913. Khardori R. Infection in patients with diabetes mellitus. Medscape reference. WebMD 2011. http://www.smartdraw.com/examples/view/urology+-+pyelonephritis/

  13. Pyelonephritis Complications • Diabetes patients are at an increased risk for complications from pyelonephritis: • Renal abscess • Emphysematous pyelonephritis • Renal papillary necrosis (see white spots on picture) • Gram-negative sepsis • Insulin resistance makes controlling blood sugars more difficult Khardori R. Infection in patients with diabetes mellitus. Medscape reference. WebMD 2011. http://library.med.utah.edu/WebPath/RENAHTML/RENAL172.html

More Related