Category Hospital practice
Human metapneumovirus causes severe pneumonia at any age
Further to another hMPV case managed in one of our intensive care units (an adult with acute COPD deterioration), I’m sharing this presentation concerning local experience with hMPV infections that also summarises current hMPV knowledge. Metapneumovirus presentation 2014 im id meeting. Picture: acute severe pneumonia due to human Metapneumovirus infection in an 82 year old diabetic […]
Maximising the value of blood cultures
Blood cultures give a critically important window on bacterial and fungal sepsis, providing direct patient treatment guidance and reliable antimicrobial susceptibility data that are used to construct cumulative antibiograms and empirical treatment guidelines. They also help to rule out serious bacterial infection, provided that collection occurs prior to antibiotic treatment and an adequate patient sample is taken. Here […]
Bronchiectasis and goals of antibiotic treatment – thinking it through
The setting – patients with bronchiectasis (including those with cystic fibrosis) have impaired respiratory secretion clearance and a vastly different lower respiratory flora (microbiome) than patients with normal lungs. They are frequently colonised with conventional respiratory species such as Haemophilus influenzae and Moraxella catarrhalis, Staphylococcus aureus, a diverse range of Gram negative bacteria and even fungi. Colonisation/infection with non-tuberculous […]
Inducing ceftriaxone-deficiency in hospitals: practical stewardship insights
2018 update! Just as relevant. Upside – Ceftriaxone and cefotaxime (third generation cephalosporins-TGC) are amongst the most important agents for directed therapy of infections due to Gram negative organisms that are resistant to ampicillin or cephazolin (a first generation cephalosporin), including Klebsiella pneumoniae . They penetrate the CSF well, making them important agents for treatment of meningitis due to […]
Appropriate use of azithromycin
Azithromycin is a macrolide antibiotic with broad-spectrum bacteriostatic activity against many Gram-positive and Gram-negative bacteria. It also has activity against Mycoplasma pneumoniae, Treponema pallidum, Chlamydia sp. and Mycobacterium avium complex. In addition azithromycin has immunomodulating effects and is used in chronic respiratory inflammatory diseases, including cystic fibrosis, as an anti-inflammatory.
Acute infections that present with a normal or low white cell count (doxycycline deficiency!)
There is a long list that will vary according to your locale. Across Northern NSW, the important ones to consider include: Viral illnesses including influenza, adenovirus, viral hepatitis, parvovirus, EBV and CMV Rickettsial disease (spotted fevers, rarely murine typhus). See useful information page from NSW Health. Q Fever (Coxiella burnetti) (low platelets often, moderately abnormal […]
Is it really cellulitis? – differential diagnosis of a red leg
Cellulitis is frequently over-diagnosed. Clinical signs need to include more than just redness – other indications of inflammation are required for diagnosis – e.g. tenderness, pain, swelling, lymphangitis. The onset and progression of the disorder is also a good pointer – streptococcal cellulitis has a rapid onset usually with rapid expansion of the erythematous zone. New […]
Australian Antimicrobial Stewardship Clinical Care Standard
The Australian Commission on Safety and Quality in Healthcare, in collaboration with consumers, clinicians, researchers and health organisations, has developed the Antimicrobial Stewardship Clinical Care Standard and resources to guide and support its implementation. Increasing antibiotic resistance presents a challenge for clinicians and poses a significant public health risk. This new Standard is an important guide […]
AIMED - Let's talk about antibiotics 