TREATING SEPSIS

An 85 year old female is admitted unconscious and hypotensive from a nursing home. She has a fever and a leucocytosis and her urine is foul smelling. Presumed diagnosis – urinary tract infection.

The most common organisms causing urinary tract infections are Enterobacteriacae and enterococci, and the treatment is ciprofloxacin or ampicillin and gentamycin. In this case, however, the patient has been admitted from a nursing home and pseudomonas is a strong possibility. Twin therapy is often required, not mixing beta-lactam antibiotics:

Anti-pseudomonal quinolone or aminoglycoside plus anti-pseudomonal penicillin or cephalosporin.

Ciprofloxacin /gentamycin/amikacin plus piperacillin or ceftazidime.

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