[doctorF]

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

 

[doctorF]

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.