Summary:
Bacteria develop multiple resistance to antibiotic
By:
1)producing B-lactamase
2)overexpression efflux pump to release extra antibiotic
3)antibiotic modify enzyme
4)ribosomal mutation
Thus appear all superbug such as ESBL, carbapenemase producing klebsiella etc
Pt infected with ESBL +ve had relative risk 1.85 of mortality compared to normal bugs
Treatment of commonest bugs in ICU –Acinetobacter spp.
Recommended to do C+S with MIC
Therapy promptly early
Start therapy right at beginning
Modification therapy as nessasary (de-escalation) early
Tigercycline- a new agt
It evades tetracycline efflux pump and ribosomal protective mechanism
Bacteriostatic
That is limitation no good blood level for therapeutic
Varied response to acinetobacter
Imipenem –launch with 4g/day
Recommend 2g/d as reduce seizure
Not enough as moderate susceptible organism need 1g qid .
Recommended for high MIC acinetobacter to give prolong infusion meropenem 1 g tds as long as 3 hr compared with 30min normally given.
Study proved similar dose with prolong infusion better outcome
Colistin monotherapy
Got 52% isolates for acinetobacter were polymycin only susceptible
The rest need colistin and one other antibiotic (rec add carbapenem)
As highest % of survival
Benault et al. showed Obesity highest rate septic shock
Partly related with leptin def
DM
FOsfamycin-good for Klebsiella spp and pseudomonas spp.
Another talk by gastro
If NDM1 may give fosfamycin + carbapenem.
UGIB
Commonest cause H. pylori followed by NSAID, Antiplatelet
Risk of UGIB-age, multiple co-morbidity and H/O peptic ulcer
If pt got cardiovascular problem, may restart antipltelet after 4-5 days of peptic ulcer
