Biliary infection is a fairly common cause of septic shock (especially ascending cholangitis). Evidence isn't terrific regarding exactly when and how interventions should be done to obtain source control (particularly among cholecystitis). This chapter attempts to reach some clarity on the topic, but honestly, it remains a bit murky.
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The IBCC chapter is located here.
- The podcast & comments are below.
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Is enterococcus faecium a rate pathogen where you work? Almost always resistant to beta lactams, usually sensitive to vanc. We see it very commonly in Belgium – though it tends not to be at the forefront in community-acquired infections and so I usually tend not to give vanc empirically.
I dont understand why you use a table about the bile penetration of antibiotics, which was used in the publication by Ansaloni et al. (WSES Journal), but initially comes from the book antibiotics in laboratory medicine (second edition 1986). In newer editions of the same book this table isnt used anymore, because the bile penetration of antibiotics is very variable and it is not clear and questioneable whether the bile concentration of antibiotics has any impact on clinical relevanht endpoints. Antibiotics in laboratory medicine 5th edition: Ratios of site-to-serum levels are extremely variable, ranging from zero in the presence of… Read more »