Question

A 52-year-old man with chronic eczema was admitted to the Prince of Wales Hospital, Hong Kong, with fever and chills. Before admission, he had been treated for infected eczematous lesions for several weeks with oral ampicillin, cloxacillin, and cefazolin. He had no history of hospitalization in the past 10 years, and none of his family members were healthcare workers.

Examination showed an oral temperature of 40°C, blood pressure 95/55 mm Hg, and no audible murmur. Cellulitis in the left leg complicated his eczematous skin lesions. Chest radiograph showed right-middle-zone pneumonia. Neutrophilia (leukocytes 15.5 × 109/L, neutrophils 86%), thrombocytopenia (platelets 55 × 109/L), prolonged activated partial thromboplastin time (43.6 s), and elevated bilirubin level (31 μmol/L) were observed.

Two initial blood cultures grew gram-positive cocci in clusters, identified as S. aureus by positive results for catalase and slide/tube coagulase and a negative result for ornithine decarboxylase. Intravenous cloxacillin (2 g every 6 h) was given on days 2–5.

However, the patient's condition progressively deteriorated from day 2 to day 10 with persistent fever, chills, hypotension, and hemoptysis. A repeated chest radiograph showed small lung cavities with fluid, and a thoracic computed tomographic scan confirmed multiple lung abscesses. Results of an initial transthoracic echocardiograph were normal, but a subsequent transesophageal echocardiograph demonstrated tricuspid valve vegetation.

Questions

1.How do you find out if the strain that infected the patient is is MRSA?

2.What antibiotic/s can be substituted?

3.What are the precautions to be taken if this patient was to be hospitalized and why?

4.What would you recommend to do if this patient developed bed sores in the hospital

Answer 1

How do you find out if the strain that infected the patient is is MRSA?

• Rapid determination of healing facility obtained contamination is basic with a specific end goal to begin suitable treatment early and furthermore start techniques to keep the spread of MRSA.
• Molecular testing techniques - polymerase chain response (PCR) tests - are presently accessible to distinguish MRSA inside a few hours. PCR from culture tests might be utilized to recognize the mecA quality, affirming the nearness of MRSA. Completely robotized business tests are currently accessible.
• MRSA DNA has now been decoded and a test in view of two duplex responses run at the same time can identify MRSA, meticillin-safe coagulase-negative staphylococci and meticillin-powerless S. aureus (MSSA).
• A sans pcr test accessible at the purpose of care has been produced

What antibiotic/s can be substituted?

• Antibiotics are once in a while vital in the administration of atopic dermatitis, regularly when there are indications of bacterial contamination, for example, sobbing, crusting, pustules or agonizing swelling (cellulitis). The anti-infection agents are for the most part given orally, however in some cases doctor's facility confirmation is fundamental for intravenous treatment.
• In New Zealand, the penicillin subordinates flucloxacillin or dicloxacillin are generally recommended, or erythromycin in those adversely affected by penicillin. Another medication dynamic against staphylococcus and streptococcus might be favored.
• On ceasing the oral anti-infection, the patient may endure another flare. In the event that this happens over and over, anti-microbials might be recommended for a little while or months. There is a generally safe of reactions from such treatment. The principle concern is the improvement of bacterial protection from anti-toxins (MRSA).
• Antibiotic creams and salves are not prescribed for use in extenisve atopic dermatitis. They are not as viable as oral anti-infection agents. They may likewise cause contact unfavorably susceptible dermatitis or advance the improvement of bacterial protection from anti-toxins.

What are the precautions to be taken if this patient was to be hospitalized and why?

• Take all prescriptions as endorsed and expect moderate continuous change.
• Keep the influenced territory as spotless, dry, and ensured as conceivable to keep away from promote breakdown of the skin and counteract disease.
• Apply steroid cream until the point when the rash has totally left.
• If physician recommended solutions are not controlling the skin inflammation or the doctor prescribed drugs are running out, influence a meeting with a wellbeing to mind proficient.
• Watch the region deliberately for indications of contamination: expanded redness, warmth, torment, pustules, or a release from the zone. See as medicinal services proficient if a disease is suspected.

What would you recommend to do if this patient developed bed sores in the hospital?

Stage I or II injuries will recuperate if administered to deliberately. Stage III and IV bruises are harder to treat and may set aside a long opportunity to recuperate. Here's the means by which to tend to a weight sore at home.

Diminish the weight on the zone.

• Use uncommon pads, froth pads, booties, or bedding cushions to lessen the weight. A few cushions are water-or air-filled to help support and pad the zone. What kind of pad you utilize relies upon your injury and whether you are sleeping or in a wheelchair. Converse with your specialist about what decisions would be best for you, including what shapes and sorts of material.
• Change positions frequently. On the off chance that you are in a wheelchair, endeavor to change your position like clockwork. In the event that you are sleeping, you ought to be moved about at regular intervals.

Tend to the sore as coordinated by your medicinal services supplier. Keep the injury clean to counteract contamination. Clean the sore each time you change a dressing.

• For a phase I sore, you can wash the territory delicately with mellow cleanser and water. If necessary, utilize a dampness hindrance to shield the territory from natural liquids. Solicit your supplier what compose from cream to utilize.
• Stage II weight bruises ought to be cleaned with a salt water (saline) wash to expel free, dead tissue. Or on the other hand, your supplier may prescribe a particular chemical.
• DO NOT utilize hydrogen peroxide or iodine chemicals. They can harm skin.
• Keep the sore secured with an exceptional dressing. This ensures against disease and helps keep the sore soggy so it can recuperate.
• Talk with your supplier about what sort of dressing to utilize. Contingent upon the size and phase of the sore, you may utilize a film, bandage, gel, froth, or other sort of dressing.
• Most organize III and IV bruises will be dealt with by your supplier. Approach about any extraordinary guidelines for home care.

Stay away from assist damage or contact.

• Powder your sheets softly so your skin doesn't rub on them in bed.
• Avoid slipping or sliding as you move positions. Endeavor to maintain a strategic distance from positions that put weight on your sore.
• Care for sound skin by keeping it clean and saturated.
• Check your skin for weight wounds each day. Ask your parental figure or somebody you trust to check territories you can't see.
• If the weight sore changes or another one structures, tell your specialist.

Deal with your wellbeing.

• Eat solid nourishments. Getting the correct sustenance will enable you to mend.
• Lose overabundance weight.
• Get a lot of rest.
• Ask your specialist if it's OK to do delicate extends or light activities. This can help enhance course.

Try not to knead the skin close or on the ulcer. This can cause more harm. Try not to utilize doughnut molded or ring-formed pads. They decrease blood stream to the zone, which may cause wounds.