Case presentation on surgical site infection

case presentation

1. Case presentation on Post-transplant surgical site infection R.Anusha Pharm D V Year Roll No:07

2. Patient Name:Mr.AN Gender:Male Age:37 years IP No:IP291834 DOA:29/1/19 DOD:31/1/19

3. subjective Chief complaints: Complaint of fever associated with loose stools and also Oozing from surgical site infection since 2 days. Past medical history: K/c/o Hypertension, and CKD stage 5 (status post B/L renal transplant on 13th December 2018)

4. objective Vitals Pulse rate:85/min Respiratory rate:20/min Blood pressure:120/80 mm Hg Temperature:99.6 F Physical Appearance Height : 167 cms Weight : 107 kgs BMI : 38.4 kg/m 2

5. FINAL DIAGNOSIS: Patient post renal transplant status having acute febrile illness Surgical site infection K/c/o Hypertension

6. DRUG CHART Drug Generic Dose Freq. ROA Category Indication Inj.Meropenam Meropenam 1 gm BD IV Carbepenam I nfection IV Fluids NS Normal saline 50 ml/hr STAT IV Electrolyte Hydration Inj.Pan Pantoprazole 40 mg OD PO PPI APD T.Mycofit Mycophenolate Sodium 360 mg( 2tab) BD PO Immuno suppressant Renal transplant T.Pangraf Tacrolimus 2.5 mg BD PO Immuno suppressant Renal transplant T.Wysolone Prednisolone 20 mg OD PO steriod Renal transplant

7. T.Valren Valganciclovir 450 mg OD PO Antiviral CMV T.Bact O inment Mupirocin BD L/A Topical Antibiotic Surgical site infection (B acteria) T.Syscan-DT Fluconazole Dispersable Tablet 100 mg OD PO Antifungal Surgical site infection (Fungal) T.Betaloc Metoprolol 12.5 mg BD PO Beta blocker HTN

8. ASSESSMENT Patient a known case of renal transplantation came with complaint of fever associated with loose stools and oozing from surgical site wound. Swab culture was sent and urology referral was taken and dressing was changed. IV Fluids NS 50 ml/hr IV STAT was given for fluid management. Inj.Meropenam 1 gm BD IV given as an antibiotic for infection prophylaxis Inj.Pantoprazole 40 mg OD PO was given for APD

9. Patients who undergo solid organ transplant require lifelong immunosuppression to prevent organ rejection. T.Mycophenolate Sodium 360 mg( 2tab) BD PO given as Immuno suppressant. The initial adult post-transplant dose of mycophenolate sodium is 720 mg PO bid Mycophenolic acids are used in combination post-transplant immunosuppressive regimens to prevent solid organ transplant rejection. It selectively suppresses proliferation of T- and B-lymphocytes.

10. T. Tacrolimus 2.5 mg BD PO given as Immunosuppressant . Tacrolimus is an immunosuppressant used in combination with other immunosuppressants to prevent transplant rejection. Tacrolimus inhibits T-lymphocyte activation. The post-transplant initial adult oral dose of tacrolimus IMMEDIATE release is 0.12 to 0.15 mg/kg/day divided every 12 hours. Valganciclovir is a prodrug of ganciclovir,u sed for the prevention and treatment of cytomegalovirus (CMV) infections in immuno-compromised or immunosuppressed patients. 450 mg PO is the daily dose.

11. PLAN MONITORING PARAMETERS When mycophenolic acids are administered with acyclovir, ganciclovir, and valganciclovir, increased plasma concentrations of acyclovir, ganciclovir, and valganciclovir may occur due to competition for tubular secretion in the presence of renal failure.Monitor carefully. Many of the common side effects are dose dependent and can be ameliorated by reducing or discontinuing the immunosuppresants dose temporarily.However, this may leave the transplant recipient at increased risk of allograft acute rejection as a result of suboptimal immunosuppression .

12.   Patient was afebrile during hospital stay and general condition improved.

13. BMI as a risk factor for the development of SSI following renal transplantation. Median time from transplant to incisional surgical site infections was 20 days Surgical site infections (SSI) have remained a common and major complication in solid organ transplant (solid organ transplant) recipients and are reported to occur in 5-40% of these patients (2,9,17,19,74). The frequency of surgical site infections after solid organ transplant is similar to other surgical procedures of comparable complexity. The incidences of surgical site infections are highest following intestinal (102) transplantation followed by liver (33,75) and pancreas (68,78) transplantation; after renal (52,66) and heart (77,82) transplantation low rates of surgical site infections can be expected

14. Surgical site infections (SSI) have remained a common and major complication in solid organ transplant (solid organ transplant) recipients and are reported to occur in 5-40% of these patients predominant pathogen:Coagulase negative staphylococci, Gram-negative bacteria additional pathogen:Candida albicans

15. plan Monitor vitals Twice daily wound dressing

16. Patient counselling Surgical site infections (SSIs) are defined as infections occurring up to 30 days after surgery

17. Discharge medication Inj.Meropenem 1 gm to be taken twice daily intravenously for 6 days. T.Mycofit 360 mg to be taken orally twice daily for 6 days. T.Wysolone 20 mg to be taken orally once daily till review. T.Pangraf 2.5 mg to be taken orally twice daily till review. T.Valren 450 mg to be taken orally once daily till review. T.Syscan -DT 100 mg to be taken orally once daily for 3 months. T.Bact oinment for L/A twice daily T.Betaloc 12.5 mg to be taken orally twice daily till review. To review after 1 week with RP II and CBC reports.

18. Tacrolimus on empty stomach Vancyclovir with food Valganciclovir is a prodrug of Ganciclovir, which is rapidly converted to ganciclovir after oral administration Valganciclovir is approved for the prevention of cytomegalovirus (CMV) disease in solid organ transplant recipients who are at risk. Co-administration with other myelosuppressive agents (mycophenolic acids, azathioprine) increases the risk of toxicity