{"id":830,"date":"2016-08-26T01:10:14","date_gmt":"2016-08-26T01:10:14","guid":{"rendered":"http:\/\/emedsa.org.au\/CoreMed\/?p=830"},"modified":"2017-04-01T12:08:53","modified_gmt":"2017-04-01T12:08:53","slug":"source-of-infection","status":"publish","type":"post","link":"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/26\/source-of-infection\/","title":{"rendered":"Source of Infection"},"content":{"rendered":"<p><a href=\"http:\/\/twitter.com\/share?url=http%3A%2F%2Femedsa.org.au%2FCoreMed%2F2016%2F08%2F26%2Fsource-of-infection%2F&amp;count=none&amp;text=Source of Infection - CoreMed\" class=\"twitter-share-button\">Tweet<\/a><\/p><p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-836\" src=\"http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Pus-4.jpg\" alt=\"OLYMPUS DIGITAL CAMERA\" width=\"1299\" height=\"2271\" srcset=\"http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Pus-4.jpg 1299w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Pus-4-172x300.jpg 172w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Pus-4-768x1343.jpg 768w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Pus-4-586x1024.jpg 586w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Pus-4-624x1091.jpg 624w\" sizes=\"auto, (max-width: 1299px) 100vw, 1299px\" \/><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Introduction<\/strong><\/p>\n<ul>\n<li>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)<\/li>\n<li>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)<\/li>\n<li>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 <em>e.g. Flucloxacillin and Gentamicin<\/em><\/li>\n<li>Where source is unclear and patient is well, a period of observation for more localising symptoms to develop is reasonable<\/li>\n<li>A basic screen of urinalysis and CXR is reasonable in a moderately unwell patient. \u00a0Blood cultures are indicated if there is evidence of <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/07\/26\/sepsis-a-practical-approach\/\">septicaemia<\/a><\/li>\n<li>It is more reliable and accurate to culture fluid from the site of infection <em>e.g. abscesses, urine, effusions, collections then attempt to identify the organism by blood culture<\/em><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<table border=\"1\" width=\"100%\" cellspacing=\"0\">\n<tbody>\n<tr>\n<td width=\"33%\"><b>HISTORY<\/b><\/td>\n<td width=\"33%\"><b>EXAMINATION<\/b><\/td>\n<td width=\"33%\"><b>INVESTIGATION<\/b><\/td>\n<td width=\"34%\"><b>FOCI<\/b><\/td>\n<\/tr>\n<tr>\n<td width=\"33%\">Dysuria, Frequency, Nocturia<br \/>\nFlank pain<br \/>\nRecent bladder instrumentation\/IDC<\/td>\n<td width=\"33%\">Suprapubic\/Flank tenderness<\/td>\n<td width=\"33%\">Urinalysis &#8211; leucocytes, nitrates, blood<br \/>\nMSU<\/td>\n<td width=\"34%\">UTI<\/td>\n<\/tr>\n<tr>\n<td width=\"33%\">Cough\/Sputum<br \/>\nDyspnea<br \/>\nChest pain<\/td>\n<td width=\"33%\">Tachypnea<br \/>\nDecreased oxygenation<br \/>\nFocal chest findings<\/td>\n<td width=\"33%\">CXR abnormalities<\/td>\n<td width=\"34%\">LRTI<\/td>\n<\/tr>\n<tr>\n<td width=\"33%\">Headache<br \/>\nPhotophobia<br \/>\nRecent respiratory infection<\/td>\n<td width=\"33%\">Neck stiffness<br \/>\nAltered concious state<br \/>\nSeizures (esp. encephalitis)<br \/>\nFocal signs (if abscess)<\/td>\n<td width=\"33%\">CT brain<br \/>\nLumbar puncture<\/td>\n<td width=\"34%\">CNS infections<\/td>\n<\/tr>\n<tr>\n<td width=\"33%\">Positional headache<br \/>\nFacial pain<br \/>\nPurulent rhinorrhea<br \/>\nPost-nasal drip<br \/>\nMaxillary dental pain<\/td>\n<td width=\"33%\">Sinus tenderness<\/td>\n<td width=\"33%\">Sinus xrays<\/td>\n<td width=\"34%\">Sinusitis<\/td>\n<\/tr>\n<tr>\n<td width=\"33%\">Otalgia<br \/>\nEar discharge<\/td>\n<td width=\"33%\">Red, bulging drum<\/td>\n<td width=\"33%\"><\/td>\n<td width=\"34%\">Otitis media<\/td>\n<\/tr>\n<tr>\n<td width=\"33%\">Non-specific GI symptoms<br \/>\nNausea, vomiting, diarrhea or constipation<br \/>\nDysuria (adherent inflammatory mass to bladder)<\/td>\n<td width=\"33%\">Localised abdominal tenderness with peritonism<\/td>\n<td width=\"33%\">Abdominal U\/S<br \/>\nAbdominal CT<\/td>\n<td width=\"34%\">Intrabdominal infection<\/td>\n<\/tr>\n<tr>\n<td width=\"33%\">Perianal pain, swelling or discharge<\/td>\n<td width=\"33%\">Rectal tenderness<\/td>\n<td width=\"33%\">Rectal swab<\/td>\n<td width=\"34%\">Perianal infection<\/td>\n<\/tr>\n<tr>\n<td width=\"33%\">Pelvic pain<br \/>\nPV discharge<br \/>\nDyspareunia<br \/>\nTampon use<br \/>\nRecent gynae instrumentation<br \/>\nSTD risk factors<\/td>\n<td width=\"33%\">Cervical excitation<br \/>\nAdnexal tenderness\/mass<\/td>\n<td width=\"33%\">Vaginal swab<\/td>\n<td width=\"34%\">Gynaecological infection<\/td>\n<\/tr>\n<tr>\n<td width=\"33%\">Open sores\/rashes<br \/>\nRecent skin trauma\/surgical trauma<\/td>\n<td width=\"33%\">Skin inflammation<br \/>\n(remember to examine entire lower limb, back and sacrum)<\/td>\n<td width=\"33%\"><\/td>\n<td width=\"34%\">Cellulitis<\/td>\n<\/tr>\n<tr>\n<td width=\"33%\">Bone\/Joint pain<\/td>\n<td width=\"33%\">Bone tenderness<br \/>\nDecreased ROM<br \/>\nJoint swelling\/tenderness<\/td>\n<td width=\"33%\">Joint aspirate<\/td>\n<td width=\"34%\">Osteomyelitis<br \/>\nSeptic arthritis<br \/>\nSeptic bursitis<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<table style=\"width: 622px;\">\n<tbody>\n<tr>\n<td style=\"width: 167px;\">&nbsp;<\/td>\n<td style=\"width: 172px;\">New murmurs<br \/>\nSplinter haemorrhages<\/td>\n<td style=\"width: 162px;\">Echocardiogram<\/td>\n<td style=\"width: 79px;\">Endocarditis<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 167px;\"><\/td>\n<td style=\"width: 172px;\">Purpuric Rash<\/td>\n<td style=\"width: 162px;\"><\/td>\n<td style=\"width: 79px;\">Meningococcal<br \/>\nSepsis<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tweet &nbsp; 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&#8230; <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/26\/source-of-infection\/\">Read more &raquo;<\/a><\/p>\n","protected":false},"author":1,"featured_media":836,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"episode_type":"","audio_file":"","cover_image":"","cover_image_id":"","duration":"","filesize":"","date_recorded":"","explicit":"","block":"","filesize_raw":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-830","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts\/830","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/comments?post=830"}],"version-history":[{"count":4,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts\/830\/revisions"}],"predecessor-version":[{"id":1097,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts\/830\/revisions\/1097"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/media\/836"}],"wp:attachment":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/media?parent=830"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/categories?post=830"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/tags?post=830"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}