doyoudig
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. A 28-year-old patient with end-stage renal disease (ESRD) on continuous ambulatory peritoneal dialysis (CAPD) for two months presents with fever, abdominal pain and cloudy dialysis fluid. There is no diarrhea or vomiting and the pain has been present for about 12 hours. The patient has ESRD secondary to chronic glomerulonephritis, there is no history of diabetes, urinary infections or antibiotic use. Examination reveals a temperature of 38.9 C (102 F), and blood pressure of 110/70 mm Hg. The throat is clear, as are the lungs. Cardiac examination reveals a grade 2/6 systolic murmur. Abdominal examination reveals decreased bowel sounds with diffuse tenderness. There is mild rebound. There is no edema or skin rash. A complete blood count shows a leukocyte count of 14,200/mm3, hemoglobin is 12.5 g/dL. Peritoneal fluid is cloudy with 1,000 white blood cells, 85% of which are polymorphonuclear leukocytes. Gram's stain of fluid is negative. Cultures of blood and peritoneal dialysis fluid are taken. Which of the following is the most appropriate initial step in management?
A. Fluconazole
B. Immediate removal of dialysis catheter.
C. Intravenous vancomycin
D.Intravenous gentamicin
E.Oral ciprofloxacin
The answer is CC, but my answer was B, CAP, MCC Staph try Ab's 1st and if that does not work then remove catheter
I came across a question in UW where a Pt w/ Catheter had cystitis, and the 1st step was to remove the catheter b/c of Ab Resistance (this was given as what is the best prevention) In another question it was an IV line in the arm, and again Pt got infection and initial Mx was removal of line.
What is the difference btw these question and this case?
Can somone give me a general understsnding on when to use Abs' or remove the source of infection???
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| doyoudig
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???
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| ssrpk
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this patient is having fluid overload as well, as evidenced by grade 2/6 systolic murur [high flow], therefore terminating the dialysis should not be it, i think.
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