The Shift

The first 3 numbers from the left (WBC total, bands, and neutrophils) are important because the total number of white blood cells increases when you have an acute infection, and the numbers of bands and neutrophils also increase, causing a shift in percentages because, as the percentage of bands and neutrophils increase, the percentages of the other cells must decrease. This then constitutes the "shift to the left."

取自：What Is a Shift to the Left in Blood Testing?

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SIRS, Sepsis, Septic Shock

l   SIRS: 2 or more of the following are present:

Heart rate > 90 beats per minute

Body temperature < 36 or > 38°C

Tachypnea (high respiratory rate) > 20 breaths per minute or, on blood gas, a PaCO2 < 4.3 kPa (32 mm Hg)

White blood cell count < 4000 cells/mm³ or > 12000 cells/mm³, or the presence of greater than 10% immature neutrophils.

l   SIRS+Infection=Sepsis

l   To diagnose septic shock the following two criteria must be met:

Evidence of infection, through a positive blood culture.

Refractory hypotension - hypotension despite adequate fluid resuscitation and cardiac output.

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Antibiotics

1.      Neutropenic fever:

a. Cefrom(Cefpirome, 4代CEFA)

b. Tapimycin(Piperacillin+Tazobactam)

c. Maxipime(Cefepime, 4代CEFA)

+/- Amikin(Aminoglycosides)

d. If 對βlactams過敏à Quinolone：
Ciproxin(Ciprofloxacin)、Cravit( Levofloxacin)
    +/- Amikin(Aminoglycosides)

e. If MRSAàTargocid(Teicoplanin)
腎毒性低，對lung, bone穿透力是vanco的8-10倍。

2.      UTI (with abdominal infection):

Ø   輕微àCefmetazon(Cefmetazol, 2代CEFA)

Ø   稍重àCloforan(cefotaxime, 3代CEFA )

Ø   嚴重àCefrom(Cefpirome, 4代CEFA)、
      Maxipime(Cefepime, 4代CEFA)、
      Tapimycin(Piperacillin+Tazobactam)、
      Ciproxin(Ciprofloxacin)
         +/- Amikin(Aminoglycosides)

3.      Pneumonia:

Ø   CAPàAugmentin、
     Cravit( Levofloxacin)、
     Claform(cefotaxime, 3代CEFA )、
     Rocephin (Ceftriaxone, , 3代CEFA )
         +/-Zithromax(Azithromycin)

Ø   院內àCefrom(Cefpirome, 4代CEFA)、
      Tapimycin(Piperacillin+Tazobactam) 、
      Maxipime(Cefepime, 4代CEFA)。

Ø   If 對βlactams過敏à Quinolone：
      Ciproxin(Ciprofloxacin)、Cravit( Levofloxacin)
         +/- Amikin(Aminoglycosides)

Ø   If MRSA可加Targocid(Teicoplanin)、Vanco

4.      Cellulitis:

Augmentin、Oxacillin

    +/- Amikin(Aminoglycosides)

5.      Targocid(Teicoplanin)：

endocarditis(葡萄球菌), osteomyelitis, pneumonia, sepsis, soft tissue infection, enteritis, pseudomembranous colitis(Clostridium)

6.      Cefrom(Cefpirome)：cover G(+)、G(-)，for neutropenic fever、sepsis、pneumonia

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