Category: Gram Negative

Neutropenic Fever – I Need The Vancz

Neutropenic fever, defined as a single temperature 38.3C (101F) OR 38.0C (100.4F) for one hour in patients whose granulocyte count are <500 cells OR <1000 cells with an expected decline to <500 over the next 48 hours. This is actually a fairly frequent occurrence in those who undergo intensive chemotherapy, especially in hematological malignancies, which

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Urine Dipstick, Urinary Tract Infections, and How It Should Be Used.

I have a love-hate relationship with the urinalysis. It is one of the cheapest and quickest way to get a good idea of what is going on in the kidney, from its less used specific gravity, to the more well known microscopic examination that may involve the presence of casts, it is a widely available

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One or Two Antibiotics for Pseudomonas? A Look at the Data.

So, you are thinking about starting antibiotics to cover for pseudomonas? That is great. Piperacillin-tazobactam or cefepime are great choices. Perhaps ceftazidime is another one if you are feeling a bit wild. Piperacillin-tazobactam covers anaerobes while the other 2 do not, however metronidazole is a nice addition to the latter 2. Either way, these all

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What to do with MDR Acinetobacter Baumannii?

Here in the DrGermophile ranks, we talk about all beta-lactamases and how awesome they are. In particular, we like sulbactam. It is in combination with ampicillin, and its use is unappreciated to the uninitiated, but it plays a role in infections such as anaerobic pneumonia. It has a reasonably broad spectrum of activity, losing out

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Resistance is Futile, For Now – Overcoming Resistance with Ceftazidime-Avibactam

I think we can all agree that resistance is inevitable, despite what the quote says, in the world of infectious diseases. More and more, the use of broad spectrum antibiotics (looking at you, vanco-zosyn!) brings upon more resistant organisms, with beta-lactamases being one of the key methods of resistance in many gram negative bacteria. As

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Dogs, dirty mouths, cancer, and booze: What you need to know about Capnocytophaga

There are multiple associations in medicine where the mere mention of a location, occupation, or risk factor elicits a response with regards to the disease. In infectious disease, there are multiple such as “spelunking” being associated with histoplasmosis, IV drug abuser associated with MRSA endocarditis, or cows placentas being associated with Q fever. When it

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MDRO, DTR, WTF? Defining drug-resistance in Gram Negative Organisms

Gram negatives are a nightmare. Or at least, they are becoming a nightmare with all new patterns of resistance, beta-lactamases and carbapenamases, and plasmid-encoded resistances bringing forth the new generation of beta-lactam and beta-lactamase combinations that I find difficult to keep up with. The definitions of multi-drug resistant organisms tend to be more geared towards

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Hypervirulent Klebsiella Infection – It’s So Sticky!

Klebsiella pneumoniae is an organism that is typically seen as the cause of pneumonia in people with diabetes and alcoholics, and it also causes nosocomial bacteremia and urinary tract infections. This is a fairly common organism to deal with in the inpatient setting, however one particular type of Klebsiella has been more frequently described in

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Klebsiella Pneumonia Liver Abscess: PO vs IV Antibiotics

In the past few years, there has been an increasing in the incidence of hypeviscous Klebsiella pneumoniae. This is typically caused by phenotypes associated with K1 and K2 capsule serotypes and is seen in southeast Asia and the classical pathology is that of a liver abscess (why this is I do not know). Recently, a

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