Critical Care Self-Study Resources-Antimicrobials in Critical Care

Video Transcription

Video Summary

The video focuses on antimicrobials in critical care, particularly for pneumonia, and discusses the use of novel antibiotics and current treatment guidelines. The importance of diagnostics and therapeutics in severe pneumonia in the ICU is emphasized. The video mentions scoring systems like the pneumonia severity index and CURB-65 to assess pneumonia severity and guidelines recommending the use of the PSI score to categorize patients based on their risk of requiring ICU admission. Diagnostic tests for severe community-acquired pneumonia, such as blood and respiratory cultures, Legionella urinary antigen, and strep urinary antigen, are also discussed. The audience is asked about their preferred antibiotic regimes, with beta-lactam and macrolide, and beta-lactam and fluoroquinolone being popular choices, which are supported by the guidelines. However, the guidelines also recommend considering MRSA and pseudomonal coverage based on patient risk factors. The rarity of MRSA and staphylococcal pneumonia in the absence of underlying conditions or recent hospital exposure is addressed. The video concludes with the speaker stressing the importance of initial antibiotics and obtaining cultures and specimens for further evaluation. <br /><br />In a specific case discussed, a kidney transplant recipient with HIV infection presents with respiratory symptoms and is started on heated high-flow nasal cannula in the ICU. A possible treatment regimen for this patient could include cefepime, azithromycin, and ambasome to cover a broad range of potential pathogens including fungi. The use of amphotericin B is also mentioned as a potential treatment for severe disease due to endemic fungi. Guidelines recommend tailoring treatment for immunocompromised patients based on individual risk factors and the time since transplantation.

Keywords

antimicrobials

critical care

pneumonia

treatment guidelines

diagnostics

severe pneumonia

ICU

antibiotic regimes

MRSA coverage

cultures

transplantation