137.3 🩺 內科專科考前版

137.3.0.1 1⃣ 22E 曎新

  • STOP-IT trial 2015: short antibiotic course (4 d post-source) non-inferior — paradigm change
  • MERINO trial 2018: pip-tazo NOT non-inferior to meropenem for ESBL bacteremia from biliary/intra-abdominal → carbapenem preferred for confirmed ESBL
  • Ceftolozane-tazobactam, Ceftazidime-avibactam, Meropenem-vaborbactam, Imipenem-relebactam, Cefiderocol for MDR Pseudomonas / ESBL / CRE intra-abdominal
  • Hypervirulent K. pneumoniae (hvKp): in Taiwan/SE Asia; aerobactin, RmpA virulence genes

137.3.0.2 2⃣ Tertiary Peritonitis

  • Persistent infection after adequate Tx + source control
  • 倚 ICU 病人 + multi-organ failure
  • 病原: Candida, Enterococcus (VRE), MDR organism
  • 高死亡 (> 50%)
  • Treatment: broad-spectrum + antifungal + repeat source control

137.3.0.3 3⃣ Cholangitis (Charcot’s Triad)

  • Fever + RUQ pain + jaundice (+ Reynolds pentad: + AMS + shock)
  • E. coli, Klebsiella, Enterococcus
  • ERCP biliary drainage < 24 hr (life-saving)
  • Pip-tazo or ceftriaxone + metronidazole

137.3.0.4 4⃣ 台灣 context

  • hvKp liver abscess in DM — 經兞 internal medicine quiz
  • 健保 anti-MDR antibiotics (CAZ-AVI, ceftolozane-tazo, cefiderocol) restricted, ID consult required
  • ERCP capacity in major hospitals