Title : Key thoughts and strategies based on PBL for rapid managing of suspected gram-positive bacterial infection in ICU
Abstract:
According to the spirit of international sepsis guidelines and clinical practice in China, we explored the rapid diagnosis and treatment ideas and strategies of different pathogenic infections in ICU to shorten the diagnosis time and improve the rescue efficiency. Taking Gram-positive bacterial infection as an example, we propose ten key questions in the diagnosis process step by step by using problem-based learning (PBL) method.
Question 1: According to the medical history, is the patient infected in the community or in the hospital?
Question 2: Where is the patient infected? It needs to be analyzed from multiple angles, such as intra-and extra-pulmonary, lobar and lobular distribution, alveolar lesions and interstitial lesions.
Question 3: What are the possible pathogens? Differential diagnosis between different pathogens such as bacteria, fungi, viruses, mycoplasma and tuberculosis is required.
Question 4: Is it G+ or G-bacterial infection? Based on imaging, PCT level and pathogenic cultures.
How to interpret the differences of PCT variation curve in different pathogen infection?
Question 5: Is it a pyogenic or non-pyogenic infection? In general, the presence of necrosis is often indicative of pyogenic infection.
Question 6: Is there a drug-resistant infection? Clinical manifestations, imaging, drug sensitivity and NGS results were used to judge the results.
Question 7: How virulent are bacteria? Leukocidin and decreased white blood cells may indicate bacterial virulence.
Question 8: Is there any structural lung disease? From common etiologies and imaging to aid analysis.
Question 9: What is the tissue permeability of antibiotics? The tissue permeability was analyzed from the pharmacological point of view.
Question 10: How sensitive are antibiotics? What is the effect of this medicine on bacteria and virulence?
