Question

CASE STUDY 2 Peter a 46-year-old salesperson with obesity and poorly controlled Type 2 Diabetes Mellitus underwent scheduled laparoscopic gastric bypass surgery. Peter was brought to the operating room at 08:58 am. The first laparoscope trocar was inserted into the abdomen with some unexpected resistance, but there was no apparent injury sustained. Three additional laparoscope trocars were inserted into the abdomen and the procedure was completed when the last of the 4 laparoscope trocar incisions was closed. The patient was transferred to the Intensive Care Unit in a stable condition. At 18:00, he was awake and responsive with patient-controlled pain management and a temperature of 37.5°C. At 03:15 am the following day, Peter complained of severe pain around the area close to the insertion site of the first trocar. He had a temperature of 38.6°C. The medical intern ordered blood and urine cultures, and a scan. The scan, performed at 03:50 am, revealed free fluid close to the large intestine. The patient reported that the pain had increased and had spread across his abdomen. By 04:00 am, his temperature had reached 40°C, and he was returned to the operating room. An exploratory emergency laparotomy performed at the site of the primary incision revealed a perforated large intestine (also known as perforated viscus) and faecal material in the abdomen. The tissues were inflamed, and small amounts of pus were seen. The abdomen was washed out, and the perforation was repaired. Once the incision was closed, the patient was returned to the Intensive Care Unit where he was treated with a number of different I.V. antibiotics.

Question:

Antimicrobial use may be prophylactic, empirical, or directed against a known organism. Explain whether Peter is receiving prophylactic, empirical, or directed therapy in this case. You will need to consult the Therapeutic Guidelines and your course resources.

Answer 1

Prophylactic antimicrobial therapy is the treatment given to prevent occuarance of disease. This is treatment is given patient without having infection.

Empirical antimicrobial therapy is medical treatment or therapy based on experience and, more specifically, therapy begun on the basis of a clinical "educated guess" in the absence of complete or perfect information.

Antimicrobial therapy Directed against a known organism, name itself saying that treatment given togive a specific organism which a known agent for the infection.

We can say here peter is receiving Empirical antimicrobial therapy, because already he is having infection ( he is having fever, pus at surgical site), it is not prophylactic therapy And not direct therapy against known organism.

urine and blood cultures are ordered. But the cause for his infection is not yet known.

So that his treatment is empirical therapy.