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- 2. A biofilm (form a slimy coat) : protective matrix consisting of various polysaccharides and proteins. It covers surfaces like a film and allows the bacteria to adhere firmly to various structures (e.g., skin, heart valves, prosthetic joints, and catheters). Exopolysaccharide matrix(glycocalyx) is an important component of biofilms that excrete from bacteria cause organisms multiply and persist in colonies within this material. diffusion barrier for some antimicrobials--> persistent and difficult to treat , but other antimicrobials may bind to it
- 3. Biofilms play an important role in the persistence of Pseudomonas in the lungs of cystic fibrosis patients, Staphylococcus epidermidis and viridans streptococci that cause endocarditis, and also mediates adherence of certain bacteria, such as Streptococcus mutans, to the surface of teeth.in the formation of dental plaque, the precursor of dental caries.
- 5. Acute pyelonephritis Symptoms -Acute onset of fevers, chills -back pain -lower-tract symptoms such as dysuria, frequency, and urgency -Nausea and vomiting, and diarrhea are common Signs -costovertebral angle tenderness -fever and tachycardia
- 6. Acute cystitis Symptoms -Afebrile -Dysuria,urinary frequency and urgency -Suprapubic discomfort -Women may experience gross hematuria Signs -Suprapubic tenderness
- 7. Urethritis Symptoms -Dysuria (No frequency or urgency) -Discharge from the urethra (predominantly males) -Vaginal discharge possible Signs -mucopurulent urethral discharge on physical examination
- 8. Recurrent urinary tract infections with urease-producing organisms Proteus mirabilis, Pseudomonas aeroginosa, and, less commonly, Klebsiella spp., Staphylococcus spp., and Mycoplasma spp. (but not E coli) Hydrolyze urea to ammonia Urine alkalinization Struvite stone pH 犢犖犢犖犢犖犖 犢犖犖÷顕犖萎肩犖÷犖犢犖犖迦牽犖犖犖犖萎犖犖犖犖犖犖犖巌犖 Staghorn calculi
- 9. Nephrolithiasis Urinary stasis Bacteria overgrowth Urinary tract infection Such as Acute pyelonephritis
- 10. 犖犖犖迦犖∇顕犖犖朽犢犖犢 犢犖犖犖犖園犖犢犖犖巌検 -犢犖犢犖 3-7.5 mg/kg/day q 8 hrs -犖犖項犢犖犖犢 1-1.7 mg/kg q 8 hrs 犢犖犖犖迦硯犖萎犖犖犖 犖犖迦犖犖犖犖犢犖犖 Loading dose 1.5-2.0 mg/kg and maintenance dose with 1.5-2.0 mg/kg GFR (ml/min) >90 >50-90 10-50 <10 Dose interval q 8 h q 8-12 h q 12 h q 24-48 h
- 11. 犢犖犖 higher dose, extended interval 犖犖犖迦犖∇顕犖犖迦見犖犖園犖犖項犖犖朽犢犖犖犖迦犖迦犖犖犖犖 =3 - 7 mg/kg/d (犢犖犖ム元犢犖 5 mg/kg) 犖犖犖迦犖∇顕犖犖迦見犖犖園犖犖項犖犖朽犢犖犖犖迦犖迦犖犖犖犖犢犖犖 犢犖犢犖犖犖園犖犖萎権犖萎見犢犖迦犖犖迦牽犢犖犢犖∇顕犖犖迦検 creatinine clearance (Clcr) 犖犖犖犖犖項犖犢犖о権 犢犖犢犢犖÷犢犖犖萎犖 犢犖犢犢犖犢犖∇顕 犢犖÷厳犢犖 Clcr < 20 犖÷献./犖犖迦犖/70 犖犖. 犖犖犖迦犖∇顕 (mg./kg.) Creatinine clearance (ml./min/70kg) > 60 40-59 20-39 5-7 犖犖伍 24 犖犖園犖о犖÷ 犖犖伍 36 犖犖園犖о犖÷ 犖犖伍 48 犖犖園犖о犖÷