Boli infectioase
Boli infectioase
Boli infectioase
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- ecografie abdominala / CT – pentru identificarea determinarilor<br />
septice secundare<br />
Diagnostic etiologic<br />
– hemoculturi + antibiograma + CMI, CMB<br />
• 3 probe la interval de 60 minute, insamantate pe medii diferite (aerobi,<br />
anaerobi, fungi) incubate 3 saptamani<br />
• Daca a primit tratament antibiotic anterior, repeta hemocultura la 7 zile<br />
– culturi determinarile secundare periferice.<br />
A.Valva nativa<br />
ENDOCARDITA POSIBILA<br />
Poarta de<br />
intrare<br />
probabila<br />
Dentar<br />
Digestiv,<br />
urinar,<br />
genital<br />
Agentul<br />
etiologic<br />
posibil<br />
Streptococi<br />
Viridans /<br />
nonviridans<br />
Enteroc,<br />
Str.bovis,<br />
BGN<br />
Tratamentul de<br />
prima intentie<br />
Penicilina G<br />
/AminoPen<br />
+Aminoglicozid<br />
AminoPen<br />
Aminoglicozid<br />
Cutanat stafilococ Oxacilina<br />
Aminoglicozid<br />
Necunoscut<br />
a*<br />
AminoPen<br />
Aminoglicozid<br />
Alternative<br />
terapeutice<br />
Glicopeptide<br />
+Aminoglicozi<br />
d<br />
Glicopeptide<br />
+Aminoglicozi<br />
d<br />
Glicopeptide<br />
+Aminoglicozi<br />
d<br />
Glicopeptide<br />
+Aminoglicozi<br />
d<br />
Durata<br />
terapiei<br />
4<br />
saptamani<br />
6<br />
saptamani<br />
4<br />
saptamani<br />
6<br />
saptamani<br />
*<br />
* evaluare la o saptamana de tratament ; in caz de evolutie nefavorabila, se<br />
recomanda schimbarea terapiei ( suspiciune de etiologie stafilococica )<br />
Proteza valvulara<br />
- Precoce ( sub 2 luni )<br />
- tardiva ( peste 2 luni )<br />
Tratamentul de prima intentie : Glicopeptide +Aminoglicozid ± Rifampicina<br />
(timp de<br />
6<br />
saptamani )<br />
!! evaluare la o saptamana de tratament ; in caz de evolutie nefavorabila, se<br />
recomanda schimbarea terapiei ( Cefalosporine gen III + Aminoglicozid ±<br />
antifungic)<br />
• In toate conditiile se va evalua necesitatea interventiei chirurgicale<br />
urgenta (in primele 14 zile)<br />
de<br />
24
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