Saturday, November 1, 2014

A 70-year-old man with a history of chronic obstructive pulmonary disease

A 70-year-old man with a history of chronic obstructive pulmonary disease is brought to the hospital with confusion, fever, chills, productive cough, and severe dyspnea.

He is tachycardic, tachypneic, and hypotensive. His chest radiograph reveals bilateral infiltrates and he requires intubation and admission to the intensive care unit (ICU).

His sputum is purulent, green, and has a smell you associate with Pseudomonas aeruginosa. An appropriate antibiotic regimen would be:

a. Ceftriaxone and azithromycin.
b. Levofloxacin and metronidazole.
c. Cefuroxime.
d. Cefuroxime and azithromycin.
e. Amikacin and piperacillin/tazobactam.


The answer is e. Pneumonia resulting from pseudomonal infection may develop in patients with chronic lung disease or congestive heart failure. Pneumonia results from the aspiration of upper tract secretions, which is more likely in patients with cerebrovascular accident. Pneumonia may present as an acute life-threatening infection. Early antibiotic treatment should be instituted. When pseudomonal pneumonia is suspected, antibiotics with antipseudomonal activity are used, including aminoglycosides, select third-generation cephalosporins (e.g., ceftazidime, cefoperazone), select extended-spectrum penicillins, carbapenems (imipenem, meropenem), aztreonam, and fluoroquinolones.

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