Antibiotics

1. Common Hospital Infections www.hi-dentfinishingschool.blogspot.com

11. Sepsis- Early goal directed therapy

34. Pneumonia Severity Index- PORT Score

35. Fine, M. J. et al. N Engl J Med 1997;336:243-250 Applying the PORT score

36. PORT in our patient Total= 113 PORT score 20 BUN 10 CKD 10 CHF 73 Age

44. Risks for MDR

47. Recommendation for empiric therapy

48. Empiric treatment of HAP- early onset and no known risk factors for MDR

49. Empiric treatment of HAP

57. Low risk vs. high risk

58. Empiric therapy for high risk patients

60. Duration of therapy

61. Fever resolved in first 3-5 days

62. Persistent fever in first 3-5 days

68. Pathogenesis- 3 hit theory From Cohen and Powderly Figure 44.1 The pathogenesis model for hospital-acquired Clostridium difficile -associated diarrhea (CDAD). ]

69. Risk factors associated with Clostridium difficile Risk factor Comments Specific antibiotics -Clindamycin -3 rd generation cephalosporins -Fluoroquinolones Cefazolin OR=3.5 Levofloxacin OR=2.1 Increasing age OR=2.8 for age >71 Use of proton pump inhibitor OR=2.1 Gastrointestinal surgery OR=7.9 Length of stay >7 days OR=2.3 Feeding via NG tube OR=2.8 Admission to intensive care unit

71. THE END