shirish_sss
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A CHRONIC DIABETIC PATIENT DEVELOPED DKA AND WENT INTO COMA..
HE WAS ADMITTED IN CRITICAL CARE UNIT AND THE PATIENT REGAINED CONCIOUSNESS AFTER 8 DAYS.
PT. WAS GIVEN IV FLUIDS AND MEDICATIONS THROUGH A CENTRAL VENOUS LINE.
ON DAY 12 THE PATIENT WAS FOUND TO DEVELOP CANDIDEMIA AND DEVELOPED FEVER DESPITE ON PROPHYLACTIC ANTIBIOTICS.
WHICH OF THE FOLLOWING SHOULD BE THE IMMEDIATE NEXT STEP IN MANAGEMENT OF THIS PATIENT....?
1) GIVING I.V. FLUCONAZOLE
2) GIVING I.V. FLOCONAZOLE WITH I.V. VANCOMYCIN
3) CHANGING THE CVP LINE
4) GIVING A COURSE OF FLUCONAZOLE AND THEN CHANGING THE CVP LINE
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| smitha
Forum Elite
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ANS: 4....giving a course of fluconazole & changing IV line :roll:
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| shirish_sss
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PATIENTS WHO HAD LONG STANDING CVP OR I.V. LINES ARE PRONE TO DEVELOP BIOFILMS
BIOFILMS ARE MICROCOLONIES OF FUNGUS AND BACTERIA BOTH TOGETHER THAT R ATTACHED TO THE SURFACE OF THE PROSTHETIC DEVICE OR TIP OF CVP LINES OR INDWELLING CATHETERS IN SUCH A WAY THAT THE CIRCULATING ANTIBIOTICS AND OTHER MEDICINES DO NOT HAVE ACCESS TO THEM.
THEY ARE INTERMINGLED IN SUCH A WAY AND ATTACHED TO THE SURFACE OF THE ARTIFICIAL DEVICE THAT THE CIRCULATING MACROPHAGES AND IMMUNE CELLS CANNOT KILL THEM.
THEY ARE A CONSTANT SOURCE OF VIABLE ORGANISMS.
SO THE FIRST STEP IN MANAGEMENT OF THIS TYPE OF PATIENTS IS REMOVING THE INDWELLING DEVICE AND REPLACING IT WITH NEW ONE
GIVE ANTIBIOTICS AND ANTIFUNGALS ONLY AFTER YOU HAVE REMOVED THE INDWELLING CVP LINE.
CORRECT ANSWER IS....3) CHANGE THE CVP LINE
AND ALL OTHER THINGS AFTER THAT........
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| shirish_sss
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http://www.med.sc.edu:85/mycology/opportunistic.h...
THE ABOVE LINK IS AN OPEN ONLINE MICROBIOLOGY LIBRARY.
READ ABOUT BIOFILM IN THIS ARTICLE......
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| smitha
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Thanx a lot shirish......... 
That was a real good one!!!!!!!!
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