PMC4868870_01
Microbiological results and antibiotic treatment.. Notes: (A) Antibiotics applied during hospital stay. (B) Results of microbiological analyses performed during hospital stay with regard to MRSA. Swabs were taken from nose, throat, nose and throat, axilla, groin, biopsy, wound, blood culture, central vein catheter, urine, and stool. For N/T analysis, two swabs were taken, but the result did not discriminate between both swabs.. Abbreviations: A + C, ampicillin/amoxicillin and clindamycin; Ax, axilla; BC, blood culture; Bi, biopsy; Cf, ceftazidime; Cr, ceftaroline; Cu, cefuroxime; CVC, central vein catheter; Cz, cefazoline; Gr, groin; I, imipenem; iv, intravenous application; M, meropenem; MRSA, methicillin-resistant Staphylococcus aureus; No, nose; N/T, nose and throat; or, oral application; St, stool; Th, throat; Ur, urine; Wo, wound.
tcrm-12-749Fig1.jpg
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During her stay, she received the following antibiotics in dosages adapted to her body weight: cefazoline (1 g two times per day; 2x1 g/d), imipenem (4x0.5 g/d), meropenem (3x400 mg/d), ampicillin (3x400 mg/d) + clindamycin (3x150 mg/d) intravenously, amoxicillin (3x400 mg/d) + clindamycin (3x150 mg/d) orally, ceftazidime (3x1 g/d), ceftaroline (Zinforo  [AstraZeneca, London, UK]/Teflaro  [Allergan, Dublin, Ireland]; 2x225 mg/d), and cefuroxime (2x250 mg/d) (Figure 1A). MRSA was frequently isolated from various body sites within the first 3 weeks after admission (Figure 1B).
Vital signs of the presented patient between May and June 2014.. Notes: Similar to Figure 1, the lowest line shows microbiological results in regard to MRSA finding. MAP was calculated by using the formula: MAP = diastolic blood pressure +1/3 (systolic - diastolic blood pressure).. Abbreviations: BC, blood culture; Bi, biopsy; CRP, C-reactive protein; ICU, intensive care unit; MAP, mean arterial pressure (mmHg); MRSA, methicillin-resistant Staphylococcus aureus; No, nose; N/T, nose and throat; S, surgery; temp, temperature ( C); Th, throat; WBC, white blood cell count.
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As shown in Figure 2, systemic inflammatory response syndrome was present, as indicated by an increased heart rate (140/bpm), white blood cell count (>24,200/mm3), and decreased blood pressure (systolic arterial pressure 80-100 mmHg).