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Emergencies in Infection

Emergencies in Infection. Reşat ÖZARAS, MD, Prof. rozaras@yahoo.com. Sepsis. Definitions American College of Chest Physicians Society of Critical Care Medicine 1992. Systemic Inflammatory Response Syndrome 2 or more Fever > 38°C or < 36°C Heart rate > 90 /min.

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Emergencies in Infection

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  1. Emergencies in Infection Reşat ÖZARAS, MD, Prof. rozaras@yahoo.com

  2. Sepsis

  3. Definitions American College of Chest PhysiciansSociety of Critical Care Medicine 1992 Systemic Inflammatory Response Syndrome 2 or more • Fever > 38°C or < 36°C • Heart rate > 90 /min. • Respiratory rate> 20 /min. or PCO2<32 mmHg • Leukocyte > 12.000/mm3, < 4000/mm3 or stabs > 10%

  4. Definitions Systemic Inflammatory Response Syndrome 2 or more Temperature > 38°C or < 36°C Tachycardia > 90 /min. Tachypnea> 20 /min. or PCO2<32 mmHg Leukocyte > 12.000/mm3, < 4000/mm3 or stabs > 10%

  5. Temperature • Tachycardia • Tachypnea • Leukocyte 3T1L

  6. SIRS Multiple Trauma Hemorrhagic shock Pancreatitis Ischemia Burn Infection

  7. SEPSIS SIRS + Documented infection (Clinical, radiological, microbiological, histological)

  8. SEVERE SEPSIS Organ disfunction, Hipoperfusion abnormalities or Hipotension ARDS, DIC, RF Lactic acidosis Oliguria Mental changes SysBP < 90 mm Hg or >40 mmHg decrease from baseline SysBP

  9. SEPTIC SHOCK Despite replacing adequate fluid (>1 L) hypotension (> 1 hour) + Hypoperfusion abnormalities

  10. Skin and Soft Tissue Infections

  11. Impetigo • Frequent in children • Etiology ; S.pyogenes**, S.aureus (<10%)

  12. Erysipelas and Cellulitis • Erysipelas; involves skin and subcutaneous tissue • Cellulitis; involvement of dermis, subcutaneous tissue, and deeper soft tissues • Etiology: S.pyogenes, rarely S.aureus • Treatment: amox/clav, cefazolin

  13. Gaseous gangrene • Necrotic tissues and foreign substance-containing wounds • Subcutaneous tissue necrosis and gas formation within tissues • Etiology;Clostridia, staphylococci, E.coli, Proteus, Pseudomonas, anaerobs.

  14. Treatment • Surgery • Antibiotics: • Ceftriaxone+metronidazole • Piperacillin/tazobactam • Carbapenem

  15. Necrotising fasciitis(Streptococcal gangrene) • Immunosuppresives, diabetics,alcoholics, IV drug users, peripheral vascular disorders,… • Necrosis of subcutaneous tissue and fascia Etiology; • Group A streptococci • S.aureus and gram(-) bacilli and anaerobs

  16. www.dermatlas.com

  17. Meningococcemia

  18. Endocarditis

  19. IE: Clinical classification Acute IE Main etiology: S. aureus Mortality without treatment: 100% within 2 mo. Subacute/chronic IE Main etiology: Viridans streptococci Mortality without treatment: 100% within 1 y.

  20. Prosthetic valve endocarditis: Epidemiology • Early Prosthetic valve endocarditis (< 2 mo.) Hospital acquired • Intermediate prosthetic valve endocarditis (2-12 mo.) Hospital/community acquired • Late prosthetic valve endocarditis (>12 mo.) Community acquired

  21. Treatment • MSSA • Sulbactam/ampicillin • MRSA • Vancomycin

  22. Bacterial Meningitis

  23. Approach to a patient with presumed diagnosis of meningitis Decide within 30 min. Clinical evaluation Admission Acute (1 day-1 week) Subacute (1 week-1 month) Chronic (> 1 month) Clues from history and PE General condition of the patient Immune status of the patient

  24. LP must not be done if Absolute: Skin inf. Papilledema, focal neurological findings, Relative: Suspect mass Spinal cord tumor Spinal epidural abscess Tendency to bleed, low platelets

  25. Meningococci in CSF

  26. Pneumococci in CSF

  27. CSF Findings

  28. Empirical Treatment of Meningitis Clinical SituationProbable Bacteria Treatment Community Acquired S. pneumoniae Ceftriaxone N. meningitidis 2 x 2 grams [Listeria] + [H. influenzae] Ampicillin6x2 grams +Dexamethasone amp 4 x 8 mg, 4 days

  29. Urinary Tract Inf

  30. Acute pyelonephritis : fever+costovertebral angle tenderness; back pain+/- dysuria, frequency • Cystitis : dysuria, frequency, urgency, suprapubical tenderness

  31. Definitions • Bacteriuria : > 100.000/ml bacteria/urine • Complicated UTI: Anatomical or physiological • Relapse: Recurrence of the same infection with the same pathogen

  32. UTI

  33. Acute Pyelonephritis • Chills, fever • Flank pain, abdominal pain, back pain • Nausea, vomiting • Hypotension() • Tenderness on costovertebral angle • Symptoms of cystitis • Urgency • Frequency • Dysuria • Suprapubic tenderness

  34. Diagnosis • History, PE • Urine analysis • Gram’s staining • Culture • ESR, CBC, CRP

  35. Perinephritic abscess

  36. Treatment • Hospital/community • Quinolones? • Ceftriaxone

  37. Pneumonia

  38. Outpatient settings • Inpatient settings • Ward • Intensive Care

  39. Work-up • History (standard+ antibiotics use, risk faktors) • PE, vital signs (standard+ severity signs) • Basic Lab (CRP, CBC, ALT, bilirubins, creatinine, Na, LDH) • Sputum exam. • Plain chest X-ray

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