Urinary Sepsis

In another review it was suggested that the risk of lactic acidosis when metformin is used as recommended is close to zero (84). The author discussed the COSMIC study, which compared metformin treatment for 1 year (n = 7227) with usual care with other antidiabetic agents (n = 1505). There were no cases of lactic acidosis. The findings in controlled trials contrast with case reports of lactic acidosis. About one million patients have received metformin in the USA and the FDA has received 47 reports of lactic acidosis (20 fatal). Of these, 43 patients had renal insufficiency or susceptibility factors for lactic acidosis, such as congestive cardiac failure. Only four cases appeared to have no other susceptibility factors, one of which may have been precipitated by urinary sepsis none of these four died. 

Percutaneous nephrostomy can be utilized as a temporizing measure prior to definitive therapy of underlying obstruction. Percutaneous decompression of the obstruction allows time for improvement in renal function, treatment of urinary sepsis, and a more accurate assessment of the renal unit. Children with postoperative ureteral edema, leakage, or obstruction from extrinsic compression of calculi insertion or a percutaneous nephrostomy may be cured. 

Urosepsis The sepsis syndrome that may be seen in patients with a urinary tract infection. 

The sites of infections that most frequently led to sepsis were the respiratory tract (21% to 68%), urinary tract (14% to 18%), and intraabdominal space (14% to 22%). Sepsis may be caused by gram-negative (38% of sepsis) or gram-positive bacteria (40%), as well as by fungi (17%) or other microorganisms. 

The antibiotics that may be used for empiric treatment of sepsis are listed in Table 45-4. In the nonneutropenic patient with urinary tract infection, fluoroquinolones are generally recommended. 

General measures such as evaluating for electrolyte disturbance (especially hypercalcemia or hyponatremia), hypoxemia, or infection (especially encephalitis, sepsis, or urinary tract infection). 

Cefalotin is used for bacterial infections of the lower respiratory tract, urinary tract, skin, soft tissues, bones and joints, sepsis, peritonitis, osteomyelitis, mastitis, infected wounds, and post-operational infections. Synonyms of this drag are ceflin, seffein, coaxin, and others. 

It is used for bacterial infections caused by microorganisms that are sensitive to the drug. These may be abdominal and gynecological infections, sepsis, meningitis, endocarditis, infections of the urinary and respiratory tracts, bones, joints, skin, and soft tissnes. It is widely nsed for pneumonia as well as bacterial meningitis in children, and for post-operational infections complications. Synonyms of this drug are ceftin, zinacef, curoxim, kefox, and many others. 

It is used for severe bacterial infections peritonitis, sepsis, meningitis, osteomyelitis, endocarditis, pneumonia, pleural empyema, pulmonary abscess, purulent skin and soft tissue infections, and infections of the urinary tract that are caused by microorganisms sensitive to the drug. Synonyms of this drag are amikin, bikhn, novamin, and others. 

These drugs are used for gastrointestinal diseases (cohtis, enterocolitis, severe and chronic dysentery, sepsis, meningitis, pneumonia, infections of the urinary tract, and others caused by P. aeruginosa), when other antibiotics are ineffective. They are effectively nsed in the form of ointments for treating a few forms of eczema, boils, hidradenitis, and other skin diseases. 

Adverse reactions occurring in at least 3% of patients include the following abdominal pain, atrial fibrillation, back pain, bradycardia, cardiac arrest, chest pain, diarrhea, dyspnea, fever, headache, hypotension, infection. Ml, nausea, pain, pneumonia, sepsis, urinary tract infection, ventricular tachycardia, vomiting. 

Uses Infxns of skin, bone, resp, urinary tract, abd, sepsis Action 4th gen PCN bactericidal X cell wall synth Dose Adults. 2-4 g IV q4-6h Peds. 200-300 mg/kg/d IV -5- q4-6h X in renal failure Caution [B, M] Contra PCN sensitivity Disp Inj SE X Pit aggregation, interstitial nephritis, renal failure, anaphylaxis, hemolytic... 

L B. The patient has complicated urinary tract infection and nonsevere sepsis syndrome caused by P. aeruginosa. Effective antibiotics for Pseudomonas spp. include mezlocillin, piperacillin, piperacillin-tazobactam, ticarcillin, and ticarciUin-clavulanate. The carbapenems (imipenem and meropenem) and the monobactam (aztreonam) are also active against P. aeruginosa. Ampicillin-sulbactam and cefazolin are ineffective against P. 

Cefotaxime (Claforan) [Antibiotic/Cephalosporin-3rd Generation] Uses Rx Infxns of resp tract, skin, bone, urinary tract, meningitis, sepsis Action 3rd-gen cephalosporin cell wall synth Dose Adults. 1-2 g IV... 

Piperacillin-Tazobactam (Zesyn) [Anribioric/Extended Spectrum Penicillin, Beta Lactamase Inhibitor] Uses Infxns of skin, bone, resp urinary tract, abd, sepsis Action PCN plus 3-lactamase inhibitor bactericidal i cell wall synth Dose Adults. 3.375-4.5 g IV q6h i in renal insuff Caution [B, M] Contra PCN or 3-lactam sensitivity Disp Powder for inj frozen, premix inj 3.25, 3.375, 4.5 g SE D, HA, insomnia, GI upset, serum sickness-like Rxn, pseudomembranous colitis Interactions T Effects W/ probenecid T effects OF anticoagulants, MTX i effects W/ macrolides, tetracyclines i effects OF OCPs EMS T Effects of anticoagulants monitor for signs of electrolyte disturbances and hypovolemia d/t D such as X- K+ may cause allergic Rxn in pts sensitive to PCN OD May cause N/V/D, resp difficulty, and Szs symptomatic and supportive... 

A 70-year-old woman with a 2-year history of primary biliary cirrhosis confirmed by histological and immunological criteria took colestyramine sachets twice daily for 2 months and developed lethargy, confusion, and drowsiness (3). She had signs of chronic liver disease, portal hypertension, and hepatic encephalopathy. Laboratory investigations confirmed a metabolic acidosis (pH 7.15) and hyperchloremia. Multiple cultures failed to reveal sepsis, and a urinary pH of 4.85 together with tests of renal acidification excluded renal tubular acidosis. No other cause was found and she responded to 600 mmol of sodium bicarbonate intravenously over 36 hours. 

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