Smart Phrases And Workups – ID

CELLULITIS	
Cellulitis
Exam:
Risk factors: venous stasis, lymphedema, PVD, DM, obesity, IVDU, tinea pedis, ulcer, trauma, eczema, XRT


C. DIFF	C. Difficile Colitis
WBC:
- f/u stool PCR
- vanc 125 mg PO q6h OR fidaxomicin 200 mg BID
DIABETIC FOOT WOUND	
Diabetic Foot Wound
- ortho consulted, appreciate recs
- f/u MRI
- f/u wound culture
- trend ESR/CRP (note CRP more sensitive to acute changes)
- MILD: dicloxacin/cephalexin/augmentin PO x1-2 weeks
- MODERATE/SEVERE: abx based on Cx, duration x2-4 weeks
FEVER	
Fever of Unknown Origin
CXR ***
- f/u CBC w/ diff, BMP, LFTs, ESR, CRP, UA, procal
- f/u BCx from 3 sites, UCx
INFECTIVE ENDOCARDITIS
Infective Endocarditis
In native valve consider S. aureus, Strep, enterococcus
- BCx daily until clear
- vanc + CTX

In prosthetic valve consider S. aureus & S. epi
- BCx daily until clear
- vanc +/- gentamycin
MENINGITIS	
Meningitis
Presented with:
- f/u BCx, UCx
- plan for LP
- vanc + CTX 2g q12h
- if >50 y/o / immunocompromised / EtOH use: add ampicillin or TMP/SMX for listeria coverage
- if concern for HSV add acyclovir
- if S. pneumo, add dexamethasone 10 mg PO/IV q6h x4 days
NECROTIZING FASCIITIS
Necrotizing Fasciitis
Pian out of proportion to exam, bullae, induration, rapid skin changes, crepitus
- f/u CK, lactate, Cr, WBC
- surgery consult, appreciate recs
- vanc + Zosyn + clinda for toxin inhibition
OSTEOMYELITIS	
Osteomyelitis
- f/u BCx
- ortho consulted, appreciate recs
- f/u bone bx
- hold antibiotics until bone bx while HDS; plan on vanc + CTX
PNEUMONIA - Aspiration
Aspiration Pneumonia
CXR ***
- f/u sputum Cx
- CTX + azithro x7 days
- addUnasyn OR CTX + metronidazole IF loss of consciousness secondary to alcohol/drug overdose AND gingival disease/esophgeal dysmotility (Infect Dis 2007;44:S22)
PNEUMONIA - CAP	
Community Acquired Pneumonia
P/w
CXR ***
Organisms: viral, S. pneumo, H. flu, moraxella, legionella, mycoplasma, chlamydia, klebsiella (EtOH)
- f/u sputum Cx, urine s. pneumo and legionella
- f/u BCx if severe disease (Clin Infect Dis 2007;44:S27)
- CTX + azithro/doxy OR levofloxacin x3-5 days
PNEUMONIA - HAP	Healthcare Associated Pneumonia
P/w
CXR ***
- f/u BCx, sputum Cx
- vanc + cefepime x7 days
UTI	
Urinary Tract Infection
Symptoms:
UA:
- f/u UCx

Uncomplicated (E. coli, Klebsiella, Staph saprophyticus, Proteus)
- nitrofurantoin / fosfomycin / TMP/SMX

Complicated (enterococcus, pseudomonas, serratia)
- CTX or cefepime
- ampicillin for enterococcus