*cricket*

[ambulance driver]

I am just saying the wording of your statement implies Gram positives are capable of releasing endotoxin, which they aren't. I think switching the wording around to something like, "Gram negatives are more likely to be associated with septic shock due to their ability to produce endotoxin" is a more precise and clear statement. I'm probably just being nit-picky since pre-hospitally it doesn't really matter because septic shock is septic shock in the back of an ambulance, whether it is caused by Gram positives or Gram negatives.

[chbare]

Sounds good. However, one or two of the Gram + bacteria can release endotoxin like substances. That should please the articulation nazis.

Take care,
chbare.

[leviathan]

Cipro eh? I take it he had a UTI? Then, he developed urosepsis, possibly pyelonephritis?

He was on cipro for the prostate biopsy. During that procedure bacteria almost always spills into the blood, so patients are put on abx prophylactically.

[chbare]

Is Cipro a common med for urinary therapy in your area? I understand the resistance to it is so bad down here a few hospitals no longer even carry it and recommend placing people of Levaquin. (Talking about E. Coli) In any event, it was poor judgment at best for him to stop his ABO.

Tae care,
chbare.

[leviathan]

Resurrecting an old thread, but with a bit more knowledge from med school, there are a few gram positive bacteria which release endotoxin. Listeria monocytogenes is one of them. Where I'm from we normally use levo for broader spectrum coverage as well, so I'm not sure why they used cipro in this case. This was a real case that I grabbed from one of our interesting case rounds.

[ambulance driver]

Resurrecting an old thread, but with a bit more knowledge from med school, there are a few gram positive bacteria which release endotoxin. Listeria monocytogenes is one of them. Where I'm from we normally use levo for broader spectrum coverage as well, so I'm not sure why they used cipro in this case. This was a real case that I grabbed from one of our interesting case rounds.

L. monocytogenes is one of the gram +'s that releases an endotoxin like substance but isn't actually endotoxin. It is capable of gelling a limulus assay (test commonly used to detect endotoxin). However, further chemical methods have shown that it is not acutally endotoxin. http://aem.asm.org/cgi/reprint/52/3/510

Cipro is commonly used in UTI because it concentrates in the urine enough to overcome most(but not all) simple UTI. It is also used in prostatitis and after manipulation of the prostate due to the penetrance into the prostate tissue. One must not only worry about the transient bacteremia but also the introduction of bacteria into the prostate. The prostatic fluid is acidic in nature and cipro can penetrate and then also concentrate in the prostate.