抗生素英文课件精品ChoosingAntibiotics Before and After the Culture .pptVIP

Stenotrophomonas maltophilia Inherently resistant to Carbapenems Drug of choice is TMP-SMX TMP-SMX Levo Ceftaz S. maltophilia 98% 88% 47% * Creatinine clearance for drug dosing calculated by Cockcroft Gault. The MDRD given by SCC is not accurate. This is the reason that when you call for abx approval you get someone asking you about creatinine, age, “big guy” or “little gal” * Figure 1. Spectrum of Clinical Findings. Manifestations of the serotonin syndrome range from mild to life-threatening. The vertical arrows suggest the approximate point at which clinical findings initially appear in the spectrum of the disease, but all findings may not be consistently present in a single patient with the serotonin syndrome. Severe signs may mask other clinical findings. For example, muscular hypertonicity can overwhelm tremor and hyperreflexia. * This is the typical antibiogram of a carbapenem susceptible, ESBL producing gram-negative. This isolate is surprisingly susceptible in vitro to quinolones and sulfa agents. There are data, however, suggesting clinical failure in treating these patients with those classes of drugs despite in vitro susceptibility data. * Something that most of you have seen are infections with what we refer to as the ESBL-producing organism. Extended-spectrum B lactamase producing organisms were first described in the 80s very soon after the advent of extended spectrum cephalosporins like ceftriaxone and ceftazidime. The organisms produce enzymes that are able to cleave or hydrolyze b-lactams including cephalosporins, penicillins, and aztreonam. Due to clinical failures with alternative regimens, carbapenems became the drug of choice to treat suspected or documented infections with ESBL-Klebsiella or E. coli. * This is the typical antibiogram of a carbapenem susceptible, ESBL producing gram-negative. This isolate is surprisingly susceptible in vitro to quinolones and sulfa agents. There are data, however, suggesting clinical failure in treating