Source of Infection

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Introduction

  • Usually a thorough review of systems on history is enough to identify the likely source of infection (the screening questions on the left side column is generally adequate)
  • Confirmatory microbiological testing does not need to proceed to make the decision to commence antibiotics if the source is clear or if the patient is unwell (consult a nationally or locally accepted standard such as Australian Therapeutic Guidelines)
  • In cases of uncertainty and if the patient is unwell it is reasonable to provide empirical cover to both Gram Positive and Gram Negative organisms e.g. Flucloxacillin and Gentamicin
  • Where source is unclear and patient is well, a period of observation for more localising symptoms to develop is reasonable
  • A basic screen of urinalysis and CXR is reasonable in a moderately unwell patient. ¬†Blood cultures are indicated if there is evidence of septicaemia
  • It is more reliable and accurate to culture fluid from the site of infection e.g. abscesses, urine, effusions, collections then attempt to identify the organism by blood culture

 

HISTORY EXAMINATION INVESTIGATION FOCI
Dysuria, Frequency, Nocturia
Flank pain
Recent bladder instrumentation/IDC
Suprapubic/Flank tenderness Urinalysis – leucocytes, nitrates, blood
MSU
UTI
Cough/Sputum
Dyspnea
Chest pain
Tachypnea
Decreased oxygenation
Focal chest findings
CXR abnormalities LRTI
Headache
Photophobia
Recent respiratory infection
Neck stiffness
Altered concious state
Seizures (esp. encephalitis)
Focal signs (if abscess)
CT brain
Lumbar puncture
CNS infections
Positional headache
Facial pain
Purulent rhinorrhea
Post-nasal drip
Maxillary dental pain
Sinus tenderness Sinus xrays Sinusitis
Otalgia
Ear discharge
Red, bulging drum Otitis media
Non-specific GI symptoms
Nausea, vomiting, diarrhea or constipation
Dysuria (adherent inflammatory mass to bladder)
Localised abdominal tenderness with peritonism Abdominal U/S
Abdominal CT
Intrabdominal infection
Perianal pain, swelling or discharge Rectal tenderness Rectal swab Perianal infection
Pelvic pain
PV discharge
Dyspareunia
Tampon use
Recent gynae instrumentation
STD risk factors
Cervical excitation
Adnexal tenderness/mass
Vaginal swab Gynaecological infection
Open sores/rashes
Recent skin trauma/surgical trauma
Skin inflammation
(remember to examine entire lower limb, back and sacrum)
Cellulitis
Bone/Joint pain Bone tenderness
Decreased ROM
Joint swelling/tenderness
Joint aspirate Osteomyelitis
Septic arthritis
Septic bursitis
  New murmurs
Splinter haemorrhages
Echocardiogram Endocarditis
Purpuric Rash Meningococcal
Sepsis

 

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