Step II Antibiotics before culture

[Ronin786]

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I keep messing up with these antibiotics or culture questions. It seems like something extremely simple, yet I seem to always pick the wrong choice.

For example, an obvious case of endocarditis, so I choose empirical over culture. Turns out it didn't match enough criteria and a culture was needed.

Anybody have any good rules or tips for this? Im thinking of writing it all down pre-test time, but I was wondering if theres some sort of rule of thumb for this.

 

[jakeislove]

If it looks like Meninngitis (or any other instance where they'd die before cooties could be cultured) I go with ABX first.

 

[gravitywave]

i don't think i understand the question. if you were going to culture, when would you ever start antibiotics before culturing if you could help it? "empirical" treatment to me means either they're not sick and we're treating based on epidemiology and not going to culture right now (CAP), or they are sick and we're culturing first and covering them with broad-spectrum to prevent them from dying before we get sensitivities back (meningitis).

remember, we're in boards-world here, not real-world

 

[TheAssassin]

If it looks like Meninngitis (or any other instance where they'd die before cooties could be cultured) I go with ABX first.

In the case of meningitis ==> The immediate use of ABX is only indicated when there is a contraindication to performing a spinal tap, as in, headache, papilledema or seizure. In this instance the CSF culture could be falsely negative due to the initial induction of ABX. When there is a contraindication for doing a tap, start ABX and get a CT.

 

[Stellar Clouds]

For sepsis, directly from the surviving sepsis guidelines:

1. Cultures as clinically appropriate before antimicrobial therapy if no significant delay (> 45 mins) in the start of antimicrobial(s) (grade 1C). At least 2 sets of blood cultures (both aerobic and anaerobic bottles) be obtained before antimicrobial therapy with at least 1 drawn percutaneously and 1 drawn through each vascular access device, unless the device was recently (<48 hrs) inserted (grade 1C).

 

[evilbooyaa]

On boards, I would imagine that any infection requires cultures to be drawn, then empiric ABx while you wait for results. Unless there's a CI to the culture like ICP in a meningitis pt contraindicating a spinal tap.

Only thing I would say doesn't require a culture is pneumonia, based on the history. Even a UTI pt should give a urine sample prior to ABx. sepsis definitely requiers BCx2 prior to empiric abx.