Đang chuẩn bị liên kết để tải về tài liệu:
INFECTIOUS DISEASES - PART 9

tính khả thi của việc sử dụng một tàu thay thế vào một ngày sau đó, và sự hiện diện hay vắng mặt của một ống thông liên quan đến huyết khối. Nhiễm trùng có nhiều khó khăn để điều trị khi kết hợp với một huyết khối, huyết khối, hoặc huyết khối nội-tâm nhĩ. Nếu một ống thông có thể được gỡ bỏ | exit site vs tunnel vs bacteremia the feasibility of using an alternative vessel at a later date and the presence or absence of a catheter-related thrombus. Infections are more difficult to treat when associated with a thrombus thrombophlebitis or intra-atrial thrombus. If a catheter can be removed there is no demonstrable thrombus and bacteremia resolves promptly a 3- to 5day course of therapy seems appropriate for CoNS infections in the immunocompetent host. A longer course is suggested when the patient is immunocompromised or if the organism is s aureus experts differ on optimal duration. If the patient needs a new catheter waiting 48 to 72 hours after bacteremia apparently has resolved before insertion is optimal. If a tunneled catheter is needed for ongoing care in situ treatment of the infection can be attempted. If the patient responds to antimicrobial therapy with immediate resolution of the s aureus bacteremia treatment should be continued for 10 to 14 days parenterally. Antibiotic lock therapy of tunneled catheters may result in a higher rate of catheter salvage in adults with CoNS infections but experience with this approach is limited in children. If blood cultures remain positive for staphylococci for more than 3 to 5 days or if the clinical illness fails to improve the catheter should be removed parenteral therapy should be continued and the patient should be evaluated for metastatic foci of infection. Vegetations or a thrombus in the heart or great vessels always should be considered when an intravascular catheter becomes infected. Transesophageal echocardiography if feasible is the most sensitive technique for identifying vegetations. Metastatic spread should be evaluated in patients with s aureus bacteremia. Isolation of the Hospitalized Patient Standard precautions are recommended for all patients. For patients with exposed lesions eg draining wounds SSSS burns bullous impetigo or abscesses caused by MSSA contact precautions are recommended for .