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Cristina Conde Díaz
R3 Medicina Interna
• Rendimiento: 2 HC = 3 HC
• 3 hemocultivos:
– Sospecha de bacteriemia por microorganismo
probablemente no contaminante (s...
• Microorganismos que
siempre (o casi
siempre) representan
infección verdadera:
– S. aureus
– S. pyogenes (grupo A)
– S. a...
Antibiotic guidelines Johns Hopkins 2015-2016
S. aureus
Origen:
-Piel y PPBB
-Prótesis
-Endocarditis
-Neumonía
-Meningitis...
Antibiotic guidelines Johns Hopkins 2015-2016
S. pneumoniae
Origen:
-Neumonía
-Empiema
-Meningitis
Tratamiento:
-β-lactámi...
Antibiotic guidelines Johns Hopkins 2015-2016
S. pyogenes
Origen:
-Piel y PPBB
-Faringitis
Tratamiento:
-β-lactámico:
Amox...
Antibiotic guidelines Johns Hopkins 2015-2016
E. coli
Origen:
-Orina
-Abdomen
Tratamiento:
-Cefa 2ª y 3ª
-Quinolonas
-Si B...
Antibiotic guidelines Johns Hopkins 2015-2016
H. influenzae
Origen:
-Neumonía
-Meningitis
-Epiglotitis
Tratamiento:
-Cefa ...
Antibiotic guidelines Johns Hopkins 2015-2016
P.aeruginosa
Origen:
-Nosocomial
Tratamiento:
-β-lactámico +
Amika/Cipro/
Co...
Antibiotic guidelines Johns Hopkins 2015-2016
B. fragilis
Origen:
-Abdominal
-Piel y PPBB
Tratamiento:
-Metronidazol
Antibiotic guidelines Johns Hopkins 2015-2016
Candida
Origen:
-Mucosas
-Cutánea
-Diseminada:
ATB previo,
UDVP, IS
Tratamie...
• Bacteriemia por S. aureus
• Endocarditis
• Signos de infección tras 72 h de inicio de ATB
• Sospecha de penetración ATB ...
Gracias
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Interpretación de hemocultivos

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Sesión breve sobre interpretación de hemocultivos, principalmente para distinguir microorganismos potencialmente colonizadores y patógenos

Publicado en: Salud y medicina
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  • Sé el primero en recomendar esto

Interpretación de hemocultivos

  1. 1. Cristina Conde Díaz R3 Medicina Interna
  2. 2. • Rendimiento: 2 HC = 3 HC • 3 hemocultivos: – Sospecha de bacteriemia por microorganismo probablemente no contaminante (sepsis intraabdominal, neumonía) – Probabilidad baja-moderada de bacteriemia • 4 hemocultivos: – Probabilidad alta de bacteriemia – Sospecha de sepsis por patógeno normalmente contaminante (endocarditis de válvula protésica, infección de dispositivos endovasculares) Weinstein MP. Current blood culture methods and systems: clinical concepts, technology and interpretation of results. Clin Infect Dis 1996; 23:40 Patel R, Vetter EA, Harmsen WS, et al. Optimized pathogen detection with 30- compared to 20- milliliter blood culture drawns. J Clin Microbiol 2011; 49:4047 ↑ Nº de HC  ↑ Falsos positivos
  3. 3. • Microorganismos que siempre (o casi siempre) representan infección verdadera: – S. aureus – S. pyogenes (grupo A) – S. agalactie (grupo B) – S. pneumoniae – E. coli + otros Enterobacteriaceae – P. aeruginosa – Grupo B. fragilis – Haemophilus influenzae – Especies Candida • Microorganismos normalmente contaminantes: – Estafilococos coagulasa negativos – Corynebacterium – Bacillus (excepto anthracis) – P. acnes Melvin P. Weinstein, Md. Contaminated or not? Guidelines for interpretation of positive blood cultures
  4. 4. Antibiotic guidelines Johns Hopkins 2015-2016 S. aureus Origen: -Piel y PPBB -Prótesis -Endocarditis -Neumonía -Meningitis Tratamiento: -Cloxacilina -MR: Vanco, Tige, Cotri, Cefazolina... + Rifampicina
  5. 5. Antibiotic guidelines Johns Hopkins 2015-2016 S. pneumoniae Origen: -Neumonía -Empiema -Meningitis Tratamiento: -β-lactámico: penicilina G/Amoxi
  6. 6. Antibiotic guidelines Johns Hopkins 2015-2016 S. pyogenes Origen: -Piel y PPBB -Faringitis Tratamiento: -β-lactámico: Amoxicilina
  7. 7. Antibiotic guidelines Johns Hopkins 2015-2016 E. coli Origen: -Orina -Abdomen Tratamiento: -Cefa 2ª y 3ª -Quinolonas -Si BLEES: Carbapenem, Tige, Colistina
  8. 8. Antibiotic guidelines Johns Hopkins 2015-2016 H. influenzae Origen: -Neumonía -Meningitis -Epiglotitis Tratamiento: -Cefa 3ª -Quinolonas
  9. 9. Antibiotic guidelines Johns Hopkins 2015-2016 P.aeruginosa Origen: -Nosocomial Tratamiento: -β-lactámico + Amika/Cipro/ Colimicina -Colistina inhalada
  10. 10. Antibiotic guidelines Johns Hopkins 2015-2016 B. fragilis Origen: -Abdominal -Piel y PPBB Tratamiento: -Metronidazol
  11. 11. Antibiotic guidelines Johns Hopkins 2015-2016 Candida Origen: -Mucosas -Cutánea -Diseminada: ATB previo, UDVP, IS Tratamiento: -Equinocandina: ani/caspo/mica -Fluconazol
  12. 12. • Bacteriemia por S. aureus • Endocarditis • Signos de infección tras 72 h de inicio de ATB • Sospecha de penetración ATB limitada (abscesos o infecciones intraarticulares) • Infección intraabdominal o del SNC • Injertos vasculares protésicos, vías/catéteres, marcapasos cardiaco • Patógenos sospechosos de resistencia múltiple • Bacteriemia de origen desconocido
  13. 13. Gracias

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