Management of Common
Infections
Dr Chow Ting Soo
Infectious Disease Unit
Hospital Pulau Pinang
History- Basic info
• 42 year old lady
• Background medical history of Diabetes
mellitus for many years, not on regular
treatment
• Fever for 4 days
• Unwell, poor appetite, nausea , vomiting,
• In AE: T 39 degree C, BP 123/74, PR 104,
What further history would you
like to ask?
Case history
• 42 year old lady,
• DM type 2 , not on regular treatment
• Fever 4 days associated increasing urine
frequency, pain on micturition and also increasing
left loin pain, no passing out stone /sandy
particles per urethra, no blood seen in the urine,
• never had history of instrumentations on urinary
tract, no history of renal stone before, first
admission to hospital, not seen any other doctor
yet before this. (WHY is it important to ask these
questions??)
Clinical examination
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Temp 38.5
PR 110
BP 123/74
What do you want to do next?
Case examination
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REF: 15
RR 24
Oxygen 98% room air
CRT < 2 sec
BP 124/74
PR 110 good volume, bounding, warm periphery
Temp 38.5
GCS full, hydration fair, no neuro deficit
Lungs clear
CVS normal
Abd: soft non tender, left loin renal angle tender renal punch positive
Urine test : RBC numerous, PC +++, nitrate + , ketone –ve, urine pH 7.1 ( urine pH
high > alkaline when bact infection present, nitrate also positive indicate UTI)
FBC stat: TW 18, Hb 10, Plt 155, neutrophil 80%
BUSE : na 135 , K 3.5, BU 8, creatinine 140,
Diagnosis?
What investigations you would
do next?
Case - Investigations
• LFT- albumin 30, ALT 58,
• Blood C+S – at least 2 bottles, 2X 10 cc aerobics
sent and pending
• CXR- clear
• Urine C+S - pending
• VBG – HCO3 18
• US KUB –mild left hydronephrosis, no stones
seen, no hydroureter.
• Baseline ECG – normal ECG
• HbA1C – pending
Management
Starting antibiotic therapy:
Is not as easy as ABC
Which regime?
Answer?
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1. Imipenem
2. Meropenem
3.pip/tazo
4 Cefipime
5 ceftriaxone
6 Unasyn or augmentin
7 ertapenem
What Constitutes Initial
Appropriate Therapy?
List the class of antibiotic
1.
2.
3.
4.
5.
6.
7.
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So in this patient …
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Clinically sepsis, pyelonephritis,
Not hypotensive,
Not in shock, not severe sepsis,
Community acquired
• Cultures taken
• Need to Cover e.coli, kleb, strep, with ??
Timing on administration of
antibiotic
Treatment Duration?
Sepsis treatment is not
just antibiotics alone!
What else?