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Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
Infectious Diseases Emergencies
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Infectious Diseases Emergencies

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  • 1. Antibiotic Choices for Infections which Require Hospitalization Rodolfo E. Bégué, MD Chief, Infectious Diseases Pediatrics, LSUHSC rbegue@lsuhsc.edu
  • 2. Infections which require hospitalization Examples: r/o sepsis meningitis / encephalitis brain abscess / orbital cellulitis pneumonia / endocarditis acute abdomen urinary tract infection bone & joint skin & skin structures
  • 3. r/o sepsis • Toxicity = clinical picture - lethargy - hypoperfusion - hypoventilation, hyperventilation or cyanosis. • Hyperthermia or hypothermia • Tachycardia • Tachypnea • Leukocytosis or leukopenia
  • 4. Sepsis work-up • Cell Blood Count (CBC). • Urine analysis. • Chest roentgenogram. • Lumbar puncture. • Cultures: blood, urine, stool, CSF • Other: NPA • (CRP, Procalcitonin)
  • 5. Etiologies of Sepsis < 1 month of age • Group B Streptococcus • Escherichia coli • (Listeria monocytogenes) 1-3 months of age • Streptococcus pneumoniae (↓) • Group B Streptococcus • Neisseria meningitidis • Salmonella spp • (Haemophilus influenzae b) • (Listeria monocytogenes) 3-36 months of age • Streptococcus pneumoniae (↓) • Neisseria meningitidis • (Haemophilus influenzae b)
  • 6. Antibiotics for a child with r/o Sepsis Empiric Antibiotic Treatment: < 1 month: Ampicillin + Gentamicin Ampicillin + Cefotaxime 1-3 months: Ampicillin + Cefotaxime > 3 months: Cefotaxime (Vancomycin?) x 7-14 days
  • 7. Is it a contaminant? • 1 vs >2 positive culture • Pathogen vs no pathogen • Symptoms vs no symptoms • Plate vs broth (“thio”) • Timing
  • 8. Central Line Infection • Central & Peripheral Blood Culture • Gram-positive, Gram-negative, Fungi • If possible, change line (Staph, Enteroc, GN, Fungi, Mycobact) • vs treat through line • If line out: ~ 1 week If line in: ~ 2 weeks • Antibiotic lock
  • 9. Bacterial Meningitis • Diagnosis: LP, LP, LP • Should I do an LP? • Increased intracranial pressure • Prior antibiotics • “Bloody tap”
  • 10. Bacterial Meningitis: Treatment • Empiric treatment with: cefotaxime plus vancomycin • Modify according to susceptibilities: penicillin cefotaxime vancomycin plus cefotaxime • Corticosteroids (?) • Rifampin (?)
  • 11. Aseptic Meningitis • Viral (enterovirus vs others) • “Partially treated” • Other causes only on special populations
  • 12. Encephalitis • Not bacterial • Viral HSV Enterovirus Arbovirus (WNV) EBV, CMV, etc • ADEM
  • 13. HSV Encephalitis Acyclovir: 60 mg/kg/d div q 8 hr 750 mg/m2 /d div q 8 hr x 21 days IV
  • 14. Brain abscess Source: • Proximity: middle ear, sinuses • Meningitis • Hematogenous • Penetrating: wound, surgery
  • 15. Brain abscess Triad: • Headache • Focal neurologic findings • Fever Treatment: • Surgery • Antibiotics: Cefotax + Vanco + (Metro) • for 4-8 weeks (IV)
  • 16. Orbital Cellulitis Triad: • Proptosis • Decreased eye movement • Pain on eye movement
  • 17. Orbital Cellulitis Treatment: • Antibiotics: Cefotax + Vanco + (Metro) Cefotax + Clinda x 10-14 d IV and 7-14 d PO • Surgery (ORL, Ophthalmology)
  • 18. HSV Keratitis Management: • With an ophthalmologist • antivirals: 1-2% trifluridine 1% iododeoxyuridine 3% vidarabine x 14-21 days • topical corticosteroids contraindicated • No need for systemic acyclovir
  • 19. Pneumonia • Viral: Influenza, RSV • Bacterial Streptococcus pneumo Staph aureus Group A Streptococcus • TB • Chlamydia Mycoplasma • Fungal
  • 20. Empiric Treatment for Pneumonia • If sick enough to require admission (assuming viral panel negative), the regular r/o sepsis regimen is usually OK: • Ampi + genta / Ampi + cefotax / Cefotax • Usually add a macrolide (erythro or azithro) • Add Vancomycin if VERY sick or necrotizing • Others (TB, Gram-negative, PCP, fungal) only if a good reason to suspect
  • 21. Endocarditis • Acute  Staph (MRSA) • Subacute  viridans Strept • Antibiotics: Vanco + gentamicin • X 2 w, 4-6 w • Surgery (?) Pericarditis • “Purulent pericarditis” • Strept Pneumo Staph aureus (MRSA) • Antibiotics: Ceftriaxone + Vancomycin • X 4 weeks • Surgery (?)
  • 22. Acute Abdomen Treatment • Surgery • Antibiotics Mild-moderate Severe Ampi/sulb, Ticar/clav Piperac/Tazobactam Imipenem, Meropenem, Ertapenem Cefazolin or cefuroxime + metronidazole Cefotax, ceftriax, ceftaz, cefepime + metronidazole Gentamicin (Tobra) plus Clinda (Metronidazole) + ampicillin Cipro, levoflox, gatiflox + Metronidazole Aztreonam + Metronidazole For 5-7 days IDSA. CID 2010;50:133-64
  • 23. Urinary Tract Infection • Always suspect in febrile children < 2 yrs of age • Dx of UTI requires a UCx (bag-specimen not good) • UA (WBC), dipstick OK as a guide, especially in combination • Gram stain (“unspun” urine) Etiology • Escherichia coli • Enterococcus
  • 24. Urinary Tract Infection Follow-up • US, VCUG • DMSA scan • Consider prophylaxis Inpatient • Cefotaxime or Ceftriaxone • Ampicillin + gentamicin
  • 25. Septic arthritis • Fever, joint pain/swelling, decreased ROM • Diagnosis: clinical, XR (hip), US, arthrocentesis, CT (SI)
  • 26. Septic arthritis Treatment: • Aspirate vs Surgery: hips, shoulders • Antibiotics: Oxacillin + cefotaxime Cefuroxime • x 3 weeks (IV/PO) Etiologies: • Staph aureus • Streptococcus (GAS, Strept pneumo) • Kingella kingae • Neisseria (GC, N. meningitidis) • (H. influenzae)
  • 27. Osteomyelitis • Staph aureus • (Others in especial populations) • Clindamycin Vancomycin Linezolid • X 4 weeks (IV/PO) • Surgery
  • 28. Puncture wounds (foot) Etiology • Staph aureus (~ 3 d) • Pseudom spp (~ 7 d) • Mycobacteria (~ 2-4 w) Treatment • Wound care Tetanus vaccine Anti-Staph antibiotics • If no response Surgical exploration → culture Ceftazidime → ciprofloxacin (for 2 w)
  • 29. Skin and Soft Tissue • Etiology: Group A Streptococcus Staphylococcus aureus (MRSA) Strep pneumo / Hib • Treatment: Vancomycin or Clindamycin add genta or rifampin? linezolid?? • Drain any abscess
  • 30. D test • MRSA • Erythro R Clinda S • D test negative: OK to use Clinda • D test positive: do not use Clinda Siberry et al. CID 2003;37:1257-1260

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