Lessons for life - Cultures before antibiotics

A middle-aged lady with diabetes mellitus admitted to the medical casualty ward with a high fever. She also complained of dysuria and left-sided loin pain.

She had dysuria for the past one week and had taken treatment from a private practitioner. She was given oral cefuroxime for 7 days. But she had stopped taking treatment after 3 days as her dysuria got better. two days later she developed a high-grade fever with chills and rigors with loin pain and vomiting.

On examination, she was ill and dehydrated. The pulse rate was 120/min. Her blood pressure was 90/60mmHg. There was marked left side renal angle tenderness.

Diagnosis - Left-sided pyelonephritis with shock in a patient with diabetes mellitus
After initial resuscitation and antibiotics, she made a good recovery.

Blood culture yielded E. coli which was only sensitive to meropenem.


Lessons
  • Never ever prescribe an antibiotic without taking proper cultures!
  • Always prescribe the correct antibiotic, in the correct dose, for the correct duration.
  • Make sure the patient will adhere to the regime.
  • If the patient is managed as an outpatient it's always good to review a patient after 48 hours to assess the response to treatment.
  • Infections in a patient with diabetes can be fatal if not properly treated.
  • If the patient is ill, always admit.
  • For blood sugar control in ill patients never use oral hypoglycemic agents. Always go for soluble insulin.
Homework 
  • Read about the acute management of sepsis. 'The sepsis bundle'.
  • Read about the organisms which cause urinary tract infections.




Comments

Post a Comment

Popular posts from this blog

2 min read - Cirrhosis

Image
A 55 years old male patient admitted to medical casualty with a febrile illness for 3 days with myalgia. Examination was unremarkable. He was previously well except for chronic bilateral knee joint osteoarthritis. He consumed liquor quarter to half a bottle on a daily basis. Investigations revealed. WBC - 5.6 Hb - 11.2 Plt - 135 AST - 45 ALT - 42 S.Cr - 54 He was managed as viral fever and became fever free the next day. However the platelet count was persistently low around 130. Further investigations arranged. Blood picture - Thrombocytopenia probably due to liver disease S. Bilirubin, ALP - Normal S. Albumin - 38, S globulin - 37 USS abdomen - Coarse echogenicity of liver. Mild portal hypertension. Mild splenomegaly. Compatible with chronic liver cell disease. This patient has Cirrhosis with portal hypertension. Now the obvious cause for his cirrhosis is alcohol, isn't it? NO! Just because of the history of significant alcohol consumption you ca
Read more

2 min read - Tachyarrhythmias

Image
A 32 years old previously healthy male patient admitted with a history of palpitations for 1 hour duration. He had experienced a similar episode a few months back which lasted only for few minutes. What are your concerns? First priority is to make sure that the patient is stable. Who is unstable? Hypotensive patient (Systolic BP < 90mmHg) Coronary ischemia (Ischemic chest pain) Cardiac failure (Patient has SOB) Patient with brain hypoperfusion (reduced conscious level) IF ANY OF ABOVE ARE PRESENT IRRESPECTIVE OF THE TYPE OF ARRHYTHMIA YOU WILL HAVE TO PERFORM DC CARDIOVERSION (SHOCK) ECG Analysing tachyarrhythmias is a long topic, which might bore you. Let's learn a few short cuts to diagnose common arrhythmias. Look at the QRS Is it narrow or broad? Narrow complex tachycardias we usually encounter are SVT (Read and understand the proper nomenclature. SVT is a wrong term!) Atrial fibrillation/ flutter In most patients both are managed the s
Read more