SAQ 431 – Infectious Diseases – septic shock after prostate biopsy

Infectious Diseases – septic shock after prostate biopsy.

a. Organism

• Escherichia coli causing urosepsis after transrectal prostate biopsy.

b. Antibiotics

• Gentamicin 4-5 mg/kg IV, adjusted for renal function and local policy, plus ampicillin 2 g IV every 6 hours if enterococcal cover is required.
• If penicillin allergy or renal concerns alter the regimen, use local severe urosepsis guidance such as ceftriaxone if appropriate.
• Use meropenem or another broader regimen if multidrug-resistant Gram-negative infection is suspected or previous cultures indicate this.

c. ARISE trial

• In critically ill emergency department patients with early septic shock, protocolised early goal-directed therapy did not reduce 90-day all-cause mortality compared with contemporary usual care.
• Early recognition, antibiotics, fluids, vasopressors when required, and appropriate source control remain important.

d. Bedside ultrasound uses

• Ultrasound-guided peripheral or central venous access.
• Cardiac assessment of contractility and pericardial effusion.
• IVC/volume assessment as one component of resuscitation.
• Renal tract assessment for hydronephrosis.
• Bladder localisation/volume.
• Ultrasound-guided arterial line placement.