Going beyond Broad Spectrum Abx for Sample testing - (Feb/26/2019 )

Hi all! Student nurse and total novice here. Need to know more about microbiology as I am very confused. If a patient has repeatedly been admitted and discharged with the same infection four times between now and beginning of January for Chest infection and they have responded to Meropen each time during admission but had readmission each discharge within 48 hours of being off Meropen what further testing could a lab do to get a more definitive idea of what bacteria is causing the issue? Pt is allergic to penicillin and has had 12 admissions for chest infections over the last 12 months. Hx of bilateral pneumonia, Ca tongue and throat, COPD, radiotherapy induced baroreflex. disorder.

Just need some more information on what microbiology tests could be helpful to narrow down what is causing this infection other than just telling us to treat with broad spectrum. Also if a patient has a lot of sputum and chest secretions which are difficult to clear due to restricted access (wired jaw) how do IV abx work to clear the bacteria in the sputum which is sitting in the chest and throat? I know jsystemically the bacteria will be eliminated. Y the immune response and abx but surely if there is bacteria in sputum sitting in the throat and lungs this is not treated systemically. Is there any kind of inhalable prophylactic treatment which could help to reduce the risk that any bacteria in the sputum is killed and this is not the cause of the reoccurring infection once off meropen.

Thanks!

This appears to be homework, so I have moved it to the homework/student section.

You are already treating with a broad spectrum antibacterial agent - meropenem. 

So - what do you know about Meropenem (think, what class is it?)?

Now that you know that, what could you use to treat something like this?

Also, think about the location of the sputum - is it possible that the drug could be delivered there by the cells in the lungs? 

Certainly one would expect the Clinical Microbiology Dept. to have identified the organism from sputum specimens. There are lots of methods I will not list here, but you can Google “bacterial identification.” Also one hopes that after repeated infections and treatment with the same drug they’d be doing tests for drug resistance.  There are older methods like “Kirby-Bauers” (Google it) or newer molecular-based (genetic) methods.  Either or both may be in use in your hospital.  I’d do some research on those tests.