USMLE Forums banner
1 - 7 of 7 Posts

·
Registered
Joined
·
316 Posts
Discussion Starter · #1 ·
A 43-year-old electrician suffers third-degree burns over 40% of his body following an electric shock. One week following admission he is recovering uneventfully but develops a fever. Within 24 hours, he develops severe hypotension requiring pressors. The intensivist notes a sickly sweet odor and purulence on the patient’s wounds. Which antibiotic regimen should be empirically initiated?
A. Vancomycin and ciprofloxacin
B. Vancomycin and amikacin
C. Ceftriaxone
D. Piperacillin and tazobactam
E. Cefepime and gentamicin
 
  • Like
Reactions: dr-ahmed

·
Registered
Joined
·
6 Posts
staph.aureus is most common cause of infection in the 1st wk,and pseudomonas aeruginosa is the most common cause of infection in the 2nd wk in pts with burns,,so i will go for A :eek:
 

·
Registered
Joined
·
25 Posts
E. Cefipime and Gentamicin

Even though Piperacillin is an antipseudomonal, and works well with a B-Lactamase inhibitor Tazobactam against pseudomonas, and other B-lactamase producing strains as staph aureus, burns units usually have multi drug resistant Pseudomonas strains, and it is essential that an aminoglycoside is added to the treatment protocol.

E: Cefipime and Gentamicin are the best option here :)
 

·
Registered
Joined
·
919 Posts
i strongly wanted to choose D (just because of piperacilin), but tmsid's explanation is pushing me towards E now, because the 2 combinations combats pseudomonas synergistically.
 

·
Registered
Joined
·
68 Posts
i strongly wanted to choose D (just because of piperacilin), but tmsid's explanation is pushing me towards E now, because the 2 combinations combats pseudomonas synergistically.
For all USMLE style questions, when Pseudomona is the potential culprit, always choose the option w/ two effective anti-pseudomonals. Yes, Piperacillin works most the time, but so does an aminoglycoside + a 4th gen cephalosporin (Cefepime). It's like in war; 2 tanks are better than 1, 2 battle cruisers > 1 and lastly, $100 is better than $50 dollars.
 

·
Registered
Joined
·
316 Posts
Discussion Starter · #7 ·
The correct answer is E.

In a burn patient, a sweet odor ("grape-like") with rapid onset of septic shock (fever, hypotension) is highly concerning for Pseudomonas infection. Pseudomonal infections should be managed with a combination of extended-beta lactam antibiotics plus aminoglycosides. This combination is synergistic, enhancing the activity of both antibiotics. It also decreases rates of resistance, which is a significant problem in managing nosocomial Pseudomonal infections.

Effective antipseudomonal beta lactams include: cefepime, ceftriaxone, and piperacillin-tazobactam. Examples of aminoglycosides are: gentamicin, amikacin, tobramycin. Vancomycin is not effective against Pseudomonas.
 
1 - 7 of 7 Posts
Top