II. Epidemiology
- Very serious problem
- Pneumococcus infection is common
- Otitis Media
- Meningitis
- Treatment failures common especially in Meningitis
- Hot spots of resistance
- International
- Spain
- Hungary
- South Africa
- United States
- Dallas
- Memphis
- Kansas City
- Oklahoma City
- International
- High Risk Groups (New York, 1995, n=282)
- Children under age 4 (7.5 cases per 100,000)
- Children under age 1 (30.3 cases per 100,000)
- Adults with Human Immunodeficiency Virus (HIV)
- Reference
- Day Care Prevalence (multiple U.S. state evaluation)
- Nasopharyngeal and middle ear swab: 22-29% PRP
- Hospital Prevalence (Minneapolis, MN)
- Community Hospitals: 15-22% PRP
- Tertiary Care Hospital: 50% PRP
-
Streptococcus Pneumoniae Resistance Rates (2003)
- Highest resistance (19-30%)
- Penicillin (21%)
- Cephalosporins: Cefprozil, Cefuroxime (23-25%)
- Macrolides: All are high resistance (23-28%)
- Tetracycline (19%)
- Trimethoprim-Sulfamethoxazole (30%)
- Lowest resistance rates (<10%)
- Amoxicillin-Clavulanate (4%)
- Cefepime (<1%)
- Ceftriaxone (2%)
- Fluoroquinolones: Levaquin, Avelox (<1%)
- Clindamycin (9%)
- Vancomycin (0%)
- References
- Highest resistance (19-30%)
III. Risk Factors
- Age over 65 years (Odds Ratio 3.8)
- Within last 3 months, beta-lactam Antibiotic - Penicillins, Cephalosporins, Carbapenems, and Monobactams (Odds Ratio 2.8)
- Alcohol Abuse (Odds Ratio 5.2)
- Immunosuppression
- Multiple comorbid medical conditions
- Exposure to day-care attending children
- Reference
- Fraboni (2012) Board Review Express, San Jose
IV. Management: Pneumonia or Sepsis
- Intermediate Resistance
- Higher Penicillin dosage: 150k-250k U/kg/day
- High Resistance
- Three drug Combination regimen
- Vancomycin (40 mg/kg/day) and
- Imipenem and
- Rifampin
- Two drug combination regimen
- Vancomycin
- Third Generation Cephalosporin (if not resistant)
- Three drug Combination regimen
V. Management: Meningitis
- Intermediate Resistance
- Vancomycin (60 mg/kg/day) and
- Imipenem
- High resistance
- Vancomycin (60 mg/kg/day) and
- Rifampin and
- Imipenem
- Follow-Up Spinal Tap in 24 hours
VI. Management: Otitis Media
- Intermediate Resistance
- Amoxicillin (75 mg/kg/d)
- Clindamycin
- No coverage for Haemophilus Influenzae
- No coverage for Moraxella catarrhalis
- Cefuroxime
- Cefprozil
- Cefpodoxime
- High Resistance
- Base on Tympanocentesis culture
VII. Prevention
-
Pneumococcal Vaccine
- Public Health may add to 2 year old Immunizations
- Would create Herd Immunity to some Pneumococcus
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| Definition (NCI) | A plasma sample that is prepared from whole blood, which has undergone a number of centrifugation steps to concentrate the amount of platelets. |
| Definition (NCI_CDISC) | A plasma sample that is prepared from whole blood, which has undergone a number of centrifugation steps to concentrate the amount of platelets. (NCI) |
| Definition (MSH) | A preparation consisting of PLATELETS concentrated in a limited volume of PLASMA. This is used in various surgical tissue regeneration procedures where the GROWTH FACTORS in the platelets enhance wound healing and regeneration. |
| Concepts | Body Substance (T031) |
| MSH | D053657 |
| SnomedCT | 116203006 |
| HL7 | PRP |
| LNC | LP7506-1, MTHU003693 |
| English | Plasma, Platelet-Rich, Platelet Rich Plasma, Platelet-Rich Plasma, plasma rich platelet, platelet rich plasma, plasma platelet rich, plasma platelets rich, PLATELET RICH PLASMA, PRP, Platelet-rich Plasma, Platelet rich plasma (substance), Platelet rich plasma |
| Portuguese | Plasma Rico em Plaquetas |
| Spanish | Plasma Rico en Plaquetas, plasma rico en plaquetas (sustancia), plasma rico en plaquetas |
| Russian | ТРОМБОЦИТ-НАСЫЩЕННАЯ ПЛАЗМА, ТРОМБОЦИТ-ОБОГАЩЕННАЯ ПЛАЗМА, TROMBOTSIT-NASYSHCHENNAIA PLAZMA, TROMBOTSIT-OBOGASHCHENNAIA PLAZMA |
| Italian | Plasma ricco di piastrine |
| German | Thrombozytenreiches Plasma, Blutplättchenreiches Plasma |
| French | Plasma riche en plaquettes, PRP (Plasma Riche en Plaquettes), Plasma enrichi en plaquettes |
| Swedish | Trombocytrikplasma |
| Finnish | Verihiutaletiiviste |
| Czech | plazma bohatá na destičky |
| Polish | Osocze bogatopłytkowe |
| Croatian | PLAZMA BOGATA TROMBOCITIMA |
| Norwegian | Trombocyttkonsentrater, Blodplaterik plasma |
