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antibiotic question

Timothy Hardcastle Hardcastle at ukzn.ac.za
Thu Nov 17 16:36:23 GMT 2016


That is why Trauma Surgeons run a Trauma ICU. ID is so behind the times.

We routinely stop when no fever over 38.4 x 24hrs in ICU and will only convert to oral rx if longterm rx needed such as endocarditis or osteotis. For pure line sepsis we just take out cvc and dont give AB. Read our recent paper accepted by WJS. Ramsamy Hardcastle Muckart.

Tim H
________________________________
From: trauma-list-bounces at trauma.org <trauma-list-bounces at trauma.org> on behalf of Errington Thompson <errington at erringtonthompson.com>
Sent: 17 November 2016 05:02:37 PM
To: 'Trauma-List [TRAUMA.ORG]'
Subject: antibiotic question

As usual, I'm in a relatively heated discussion over antibiotic therapy.



67 yo male presents after a motor vehicle crash. The patient presents to the
emergency room hypotensive and hypoxic. The patient undergoes intubation.
Multiple CT scans reveal the patient to have a pulmonary contusion as well
as multiple rib fractures. The patient is morbidly obese and a central line
is placed. The patient is admitted to the intensive care unit. On hospital
day #5 the patient develops a fever as well as a elevated white blood cell
count. Cultures are taken from the central line as well as peripherally. The
patient was started on broad-spectrum antibiotics. The patient grows out
Serratia marcescens from both the central line and the peripheral blood
culture. The patient grows out Enterobacter from the sputum. The patient is
continued on piperacillin - tazobactam. The patient central line is removed.
Three days later the patient has two sets of peripheral blood cultures drawn
in these are negative. How long do you keep the patient on intravenous
antibiotics? Should the patient be switched over to PO antibiotics if the
patient can tolerate it? How long is total therapy?

My infectious disease colleague is arguing for 10 - 14 days of total
antibiotic therapy. I am not sure that that is necessary. After seven days
of therapy the patient is afebrile, the white blood cell count is normal.
What are your thoughts? What is the data (I really have not been able to
find any)?



Errington C. Thompson, MD, FACS, FCCM

Chief of Trauma Services

Marshall University

 <http://www.erringtonthompson.com/> Website



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