Fisa de introducere a antibioticului in terapie

RISCUL NOSOCOMIAL
A. Contactul cu sistemul de sanatate
CRITERII DE DIAGNOSTIC:
1. Fara
2. Consulturi
SIRS (systemic inflammatory response syndrome)
3. Spitalizare lunga/proceduri invazive
Cel putin 2 conditii indeplinite:
1. temp <36C sau >38C B. Antibioterapia anterioara
2. FC > 90 bpm 1. fara tratament
3. 3
leucocite <4000/mm sau >12000/mm 3
2. cu tratament
4. FR > 20 resp/min sau pCO2 <32 mmHg C. Pacient
1. Pacient tanar fara comorbiditati
SEPSIS
2. Pacient batran cu boli asociate
dg. SIRS + dg. de infectie localizata
3. Pacient cu imunodeficiente
SEPSIS SEVER
dg. SEPSIS + unul sau mai multe semne de disfunctie de organ, hipotensiune I. Pacient fara risc:
sau hipoperfuzie, cum ar fi acidoza metabolica, alterarea acuta a starii mentale, A.1 + B.1 + C.1
oliguria sau ARDS. (hipotensiune = TAS< 90 mmHg sau cu 40 mmHg sub media II. Pacient cu risc de infectie cu enterobacteriacee rezistente (ESBL):
Cel putin A.2 sau B.2 sau C.2
pacientului)
III. Pacient cu risc de infectie cu Pseudomonas ae. sau Acinetobacter baumanii :
OC SEPTIC
dg. SEPSIS + hipotensiune neresponsiva la resuscitare lichidiana + disfunctie de A.3 sau C.3.
organ sau hipoperfuzie

Ctre Comisia Medicamentului:

SECTIA: ______________
PACIENT: nume ___________________ prenume__________________________ salon______ pat_____
DIAGNOSTIC PRINCIPAL:________________________________________________________________________
DIAGNOSTIC DE INFECTIE:______________________________________________________________________
MOTIVATIA antibioterapiei:
Semne generale : temperatura :_______ C FC :______bpm leucocite :__________/mm3
frison (da/nu) :_______ FR :______rpm pCO2:_________mmHg
Semne locale :
Semne Rx :

CREATININA : _______ Varsta :________ Greutate :________ Clearence : (140-v)xG/72xCr =_________

FLORA suspicionata [/rezistente]: RECOLTARE produs patologic :
gram pozitivi [ risc MRSA] lichid peritoneal aspirat bronsic
gram negativi [ risc Pseudomonas] plaga/dren urina
anaerobi [ risc alte rezistente] sputa sange
fungi [ _____________________] alte:___________
NU s-a recoltat (de ce?):___________
ANTIBIOTERAPIA :
Antibiotic recomandat : ________________________ durata terapiei : _________ zile
Criterii pentru alegerea AB : Ghidul terapeutic ce recomanda alegerea : _____________________
________________________________________________________________________________________
Cost/zi terapie :______________
Alternativa la tratament :_____________________
Comentarii : _______________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Data : Medic Curant :