My father is 76 years old. He has been in ICU for two days as he was diagnosed with LRTI (CAP - community acquired pneumonia). Four years back he had TB. His vitals such as BP, temperature, renal and heart tests are fine. He is not responding to antibiotics and his condition is deteriorating. His saturation has dropped to 82% and put on oxygen. On the third day, he was given Amoxicillin 1000 IV and 5x nebulization and then switched to Piperacillin-tazobactam IV which I have read is for Pseudomonas. Pseudomonas aeruginosa is a commonly acquired hospital bacterium. Doctors admit they have not identified the bacteria yet from the sputum culture and told it will take more than 5 days to identify the bacteria. Please help.
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Your father is suffering from acute exacerbation of COPD (chronic obstructive pulmonary disease) with CAP (community acquired pneumonia) and sepsis. Currently he is on appropriate antibiotics. But, he needs systemic steroids to cope up the exacerbation along with inhaled steroids.
Though his x-ray (attachment removed to protect patient identity) appears normal, CT thorax is suggestive of bilateral consolidation.
Sputum culture should ideally tell us the exact bacteria and sensitive antibiotics for it. Supportive treatment like nutrition, supplemental oxygen or noninvasive ventilation must be given.
There is no worry as other vital organs are functioning normally. But, definitely he will take time to recover from this exacerbation. He also had tubercular effusion 5 years back, but now it does not seem to be a relapse of TB (tuberculosis). So, no anti-TB medicines are required at present.
Definitely it is CAP with COPD exacerbation. Even after he gets well, he should take consultation from pulmonologist for inhaler treatment. Sputum culture report should be sought for at earliest or if not available, fiberoptic bronchoscopy can be performed for taking endobronchial sampling for cultures.
Steroids should be tapered in appropriate doses.
Bacterial Infection.Investigations to be done:
Sputum culture or bronchoscopic sampling for culture.Differential diagnosis:
CAP with sepsis.Probable diagnosis:
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