Pneumonia staphylococcal

Class A Serine p-lactamases SHV-1 penicillinase in K. pneumoniae, and Koxy with activity against certain third generation cephalosporins in K. oxytoca BlaZ staphylococcal penicillinase TEM, SHV, VEB, PER and CTX-M penicillinases and ESBLs (P-lactamases with activity against third generation cephalosporins and aztreo-nam) KPC, IMI/NMC and SME carbapenemases... 

Broad intravenous antibiotic coverage for the encapsulated organisms can include ceftriaxone or cefotaxime. For patients with true cephalosporin allergy, clindamycin may be used. If staphylococcal infection is suspected owing to previous history or the patient appears acutely ill, vancomycin should be initiated. Macrolide antibiotics, such as erythromycin and azithromycin, may be initiated if Mycoplasma pneumonia is suspected. While the patient is receiving broad-spectrum antibiotics, their regular use of penicillin for prophylaxis can be suspended. Fever should be controlled with acetaminophen or ibuprofen. Because of the risk of dehydration during infection with fever, increased fluid may be needed.6,27... 

A 60-year-old male with a temperature of 104°F and a productive cough is diagnosed as having staphylococcal pneumonia After several days on nafcillin, he develops truncal urticaria and pruritis. Which of the following agents is best avoided in this patient ... 

A 65-year-old male with a pneumonia has a sputum culture that is positive for a staphylococcal strain that is p-lactamase-positive. Which is the best choice of penicillin therapy in this patient ... 

Differential Diagnosis An epidemic of inhalation anthrax in its early stage with nonspecific symptoms could be confused with a number of viral, bacteria, and fungal infections. Progression over two to three days with sudden development of severe respiratory distress followed by shock and death within twenty-four to thirty-six hours in essentially all untreated cases eliminates diagnosis other than inhalation anthrax. Other diagnosis to consider would include aerosol exposure to staphylococcal enterotoxin B (SEB), plague, or tularemia pneumonia. 

This drug is effective for infections caused by streptococci, gonococci, pneumococci, staphylococci, and also colon bacillus. Sulfacytine is used for pneumonia, cerebral meningitis, staphylococcal and streptococcal sepsis, and other infectious diseases. A synonym of this drug is renoquid. 

Many patients receive lengthy courses of antibiotics that probably should not have been started. More than half of courses of antimicrobial chemotherapy are inappropriate. Influenza pneumonia and viral upper respiratory infections, for example, are impervious to assault by antibiotics, although many patients with these illnesses receive such antibiotics. Of course, influenza may be complicated by postinfluenzal staphylococcal pneumonia, for which antibiotics are indicated. Careful sequential evaluation of seriously ill patients for whom antibiotics are deferred is as important as in patients for whom antibiotics are prescribed. 

For parenteral therapy, nafciUin and oxacillin offer comparable efficacy and antimicrobial spectra of activity. Although both drugs undergo hepatic metabolism, only nafcillin requires dose adjustment in patients with combined hepatic and renal insufficiency. Other pharmacokinetic data for nafcillin and oxacillin appear in Table 45.1. Indications for nafcillin or oxacillin include severe staphylococcal infections like cellulitis, empyema, endocarditis, osteomyelitis, pneumonia, septic arthritis, and toxic shock syndrome. 

Cefazolin penetrates well into most tissues. It is a drug of choice for surgical prophylaxis. Cefazolin may be a choice in infections for which it is the least toxic drug (eg, penicillinase-producing E coli or pneumoniae) and in persons with staphylococcal or streptococcal infections who have a history of penicillin allergy other than immediate hypersensitivity. Cefazolin does not penetrate the central nervous system and cannot be used to treat meningitis. Cefazolin is an alternative to an antistaphylococcal penicillin for patients who are allergic to penicillin. 

Chemical analysis of Mur levels has proved effective in both clinical and environmental samples, since Mur is not synthesized by eukaryotic cells. For example, it is readily detected in infected human body fluids, for example, synovial fluids from patients with staphylococcal arthritis and spinal fluids from those with pneumococcal pneumonia [7,16]. However, the most widely used method for its analysis, as an alditol acetate, is time consuming. A large number of derivatives have been tested in order to develop a simpler alternative. Unfortunately the limit of detection for these alternative approaches has not been optimal [17,18]. 

First generation Cephalosporins designated first generation (Figure 30.8) act as penicillin G substitutes that are resistant to the staphylococcal penicillinase. They also have activity against Proteus mirabilis. Escherichia coli, and Klebsiella pneumoniae (the acronym PEcK has been suggested). 

Bacillus coagulans and Bacillus dysenteriaeaxt two species of bacilli. Staphylococcus aureus is the bacterium that causes staphylococcal infection. Streptococcus pneumoniae (genus and species)... 

Pneumonia following influenza is often caused by Staphylococcus aureus, and best guess therapy is usually achieved by adding flucloxacillin to one of the regimens above. When staphylococcal pneumonia is proven, sodium fusidate p.o. plus flucloxacillin i.v. should be used in combination. 

Raymond et al. reported on a rotation study in a surgical intensive care unit with a different twist.Patients were stratified as either having sepsis/peritonitis or pneumonia, and empiric therapy was cycled every 3 months by syndrome. Fourteen hundred fifty-six admissions and 540 infections were treated over a 2-year period. With similar severity of illness during the before and after periods (mean APACHE II = 19), the authors demonstrated a reduction of length of stay from a mean of 62 days to 39 days, a reduction of vancomycin-resistant enterococcal and methicillin-resistant staphylococcal infection from 14 per 100 admissions to 8 per 100 admissions and death due to any cause dropped from 25 in the before period to 18 in the rotation period. Antimicrobial susceptibility and several other key parameters needed to evaluate the effectiveness of this program were not reported. 

Most streptococci (but not enterococci) are very susceptible to the drug. However, penicillin-resistant viridans streptococci and S. pneumoniae are increasingly seen. Penicillin-resistant pneumococci also are resistant to third-generation cephalosporins and are especially common in children. More than 90% of staphylococcal isolates are now resistant to penicillin G, as are most strains of S. epidermidis and many strains of gonococci. With rare exceptions, meningococci are quite sensitive to penicillin G. 

Clarithromycin (Biaxin) u Mycoplasma, Chlamydia, Mycobacterium. Most Gram pos Gram neg aerobes (including H.flu), Anaerobes Clostridium, B. melanino-genicus, Peptococcus. Mycoplasma or Pneumococcal pneumonia, Strep throat, upper respiratory infections caused by susceptible organisms. Staphylococcal skin infections. 

Secondary infections often occur when a primary pathogen reduces the immunological resistance of the patient, so that other microorganisms of limited pathogenicity produce disease [4]. For example, a primary viral infection may lead to a secondary bacterial infection. Staphylococcal pneumonia is rarely a primary disease, but is often observed as a sequel to viral influenza. This predisposition to a secondary infection is generally due to a stress disruption of both cellular and humoral immunity and a suppression of phagocytosis due to a distinct drop in the opsonization of antigen [5,6]. 

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