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+--- Thread: Q( Micro) - masha (/showthread.php?tid=324866)
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Q( Micro) - masha - ArchivalUser - 08-02-2008
65 y.old man with prostate cancer on chemoTX via Hickman catheter....
He has fever, chills, also at the exit site of catheter has erythema and tenderness
You already sent blood. culture.
Next step is ???
1. start Vancom and Genta. and remove catheter.
2. Remove catheter imediatly and wait for the result of culture
3. Start Vanco and Genta. but don't remove catheter.
4. start Vanco,and Genta plus Rifampicin but don't remove catheter
0 - ArchivalUser - 08-02-2008
3?
0 - ArchivalUser - 08-02-2008
3333.......
plz correct me if i m wrong
0 - ArchivalUser - 08-02-2008
isnt catheter should be removed?
0 - ArchivalUser - 08-02-2008
2. Remove catheter imediatly and wait for the result of culture
0 - ArchivalUser - 08-02-2008
y not 1....start empirical therapy and remove catheter
0 - ArchivalUser - 08-02-2008
absolutely start TXT this pt has signs of systemic infections and remove cath... you send the tip away for cultures and change antibiotics if necessary.. if there is some reason why you leave cath in please my choice a
0 - ArchivalUser - 08-02-2008
1.............
0 - ArchivalUser - 08-02-2008
To harsh: this patient has fever, chills, erythema and tenderness of the skin at the exit site of catheter, you have to do blood culture( 2 sets: 1 from the line and 1 peripherally), then remove the catheter and send the catheter tip for culture.
So we are left with 2 options:
1-Do we start empiric treatment while waiting for the culture to come based on the clinical finding and suspected bug? if yes what antibiotic?
Skin infection is most likely caused by S. epidermidis and S. saprophyticus
I think eventhough you can start an empiric tt., Vanco and Genta to treat are too big for first line tt.
That is why I choosed answer 2!
Nowdays, you dont have to wait for long time for blood culture result:
The BACTECâ„¢ MGITâ„¢ 960 System is the new generation in a proven line of mycobacteria testing systems from BD. It offers greater capacity, safe operation, fast results and highest throughput of any automated system“the first fully automated system for high-volume mycobacteria growth, detection and susceptibility testing.
http://www.bd.com/ds/productCenter/MT-Bactec.asp
Open to discussion.
0 - ArchivalUser - 08-03-2008
We need the right answer masha!!!