1 infec 85 - tabish60102

[ArchivalUser]

A 25-year-old woman is hospitalized because of fever and left-sided chest pain of 3 days' duration. The patient has a history of heroin injection drug use; her last injection was the morning of admission. Medical history is otherwise unremarkable.

On physical examination, temperature is 40 °C (104 °F), pulse rate is 120/min, respiration rate is 18/min, and blood pressure is 120/78 mg Hg. Swelling and tenderness are present over the left sternoclavicular joint. Cardiac examination discloses a grade 2/6 systolic murmur that increases in intensity on inspiration. The remainder of the examination is normal. The leukocyte count is 21,000/μL (21 × 109/L).

Aspiration of the left sternoclavicular joint reveals a small amount of purulent material. Blood and fluid from the aspirate are sent for culture.

Pending culture results, which of the following antimicrobial regimens should be initiated?

A Cefazolin
B Cefazolin plus gentamicin
C Vancomycin
D Vancomcyin plus cefepime
] E Vancomycin plus metronidazole plus ceftriaxone

[ArchivalUser]

dd

[ArchivalUser]

C) -according to First Aid..

[ArchivalUser]

tabish pls where do u get ur q's from?

[ArchivalUser]

well it says vancomycin OR gentamicin + ceftriaxone

[ArchivalUser]

i think D is a good choice. vanco covers mrsa and cefepime covers gram neg. choice E is for prosthetic valve

[ArchivalUser]

HIPP U R RT DDD
MRSA GM -

[ArchivalUser]

(Correct Answer = D)
Key Point
Staphylococcus aureus and Pseudomonas aeruginosa are the most likely causes of septic arthritis in an injection drug user.

This patient, who is an injection drug user, probably has tricuspid valve endocarditis and septic arthritis of the left sternoclavicular joint. The most likely causative pathogen is a methicillin-resistant strain of Staphylococcus aureus. Gram-negative bacilli are cultured from approximately 5% to 20% of patients with septic arthritis (especially neonates, the elderly, injection drug users, patients with noninfectious joint disease, and immunosuppressed patients). Pseudomonas aeruginosa may also cause septic arthritis, especially of the symphysis pubis and sternoclavicular, sternochondral, and sacroiliac joints. Because this patient has involvement of the sternoclavicular joint and is an injection drug user, antimicrobial coverage for both S. aureus and P. aeruginosa should be initiated. Of the antibiotic regimens listed, only vancomycin and cefepime will treat both organisms.

Although Candida species may also cause septic arthritis, empiric antifungal therapy is inappropriate and should only be started when culture results are available.

[ArchivalUser]

thanks tabish