A 43 year old diabetic woman presents with dyspnea and a dry cough. Her vital signs are: BP 84/42, HR 135 RR 37 T 38.5. Lobar consolidation is seen on chest xray. She decompensates and is intubated, a central line is placed, and IV fluids are started. Her husband reports that they had just returned from a vacation in Thailand one week earlier.
Does the recent travel change your choice of empiric antibiotics?
The patient should also be covered for melioidosis, and infection caused by Burkholderia pseudomallei.
Patients presenting with severe infections and recent travel to an endemic area should receive emperic antibiotics with ceftazidime or a carbapenem until another source is identified.
University of Maryland Section of Global Emergency Health
Author: Jenny Reifel Saltzberg, MD, MPH
Wiersinga WJ, Currie BJ, Peacock SJ. Melioidosis. N Engl J Med. 2012;367(11):1035-44.