Great doctor starts with adding points

After dinner, Wu Xie politely declined Xu Rong's request to invite him to have a supper after returning from a trip, and went into the study to continue to look up some information.

This Dong Mingliang's situation is very complicated. Even though he has specialized skills in infectious surgery, he still seems to be stretched, especially in terms of understanding of different bacteria and antibiotic choices.

He had to continue to search for information and conduct a comprehensive analysis with some of Dong Mingliang's existing inspection results.

The conditions in the town hospital are limited, and many advanced and high-quality examinations cannot be performed, so the existing examination materials are extremely precious.

Especially the bacterial culture results and drug susceptibility test results——

The results of the last bacterial culture and drug susceptibility test came out five days ago, showing Streptococcus viridans infection.

Streptococcus viridans is a Gram-positive coccus commonly found in normal microbial flora in the oral cavity, digestive tract, and reproductive tract.

Although it is a normal colony, it can become one of the germs for infection when the patient's resistance decreases or after surgery.

Empiric treatment of Streptococcus viridans infection is penicillin,

Commonly used antibiotics for the treatment of Streptococcus viridans postoperative infection include penicillins, cephalosporins, fluoroquinolones, and vancomycin.

Among them, penicillin antibiotics are the first choice for empiric treatment!

Gentamicin is an aminoglycosamine antibiotic, which is not included in the first-line drugs.

However, Dong Mingliang has a drug sensitivity result, which shows that he is not sensitive to penicillins, and is not sensitive to fluoroquinolone antibiotics like levofloxacin.

The more sensitive ones are ceftriaxone and vancomycin.

Ceftriaxone is a commonly used drug in township health centers, and it is not uncommon. However, Xuan County Hospital of Integrated Traditional Chinese and Western Medicine does not have vancomycin in stock, and it is not easy to purchase it halfway, so Wu Xie can only find another way.

Others may think that he chose gentamicin as a random choice and regarded it as a miracle drug, but it is not the case——

The mechanism of action of cephalosporins and penicillins is to kill bacteria by inhibiting the cell wall synthesis of Streptococcus viridans. These antibiotics are able to cross the bacterial cell wall and bind to targets inside the bacterial cell, thereby interfering with its cell wall synthesis, leading to rupture of the bacterial cell wall and death of the bacterium.

Fluoroquinolone antibiotics kill bacteria by interfering with bacterial DNA synthesis.

Vancomycin is a macrolide antibiotic that works by killing bacteria by interfering with bacterial protein synthesis. Vancomycin binds to the 50S subunit of the bacterial ribosome, preventing protein synthesis and causing bacterial death.

Gentamicin is an aminoglycoside antibiotic whose mechanism of action is to kill bacteria by inhibiting bacterial protein synthesis. Gentamicin can bind to the 30S subunit on the bacterial ribosome, preventing protein synthesis, resulting in bacterial death.

It can be seen that there are similarities and differences in the mechanism of action of gentamicin and vancomycin, both of which affect protein synthesis, and the heterogeneity is the different mode of action.

Through the analysis of drug sensitivity test, although gentamicin is only moderately sensitive, it is not as effective as vancomycin.

Moreover, antibiotics inhibit protein synthesis means that antibiotics can target specific links in the protein synthesis process of bacteria, thereby inhibiting protein synthesis of bacteria and leading to bacterial death. Antibiotic interference with protein synthesis refers to the ability of antibiotics to bind to proteins in cells, thereby interfering with the normal process of protein synthesis.

The mechanism of action is slightly different, but in the absence of drug application, it is feasible to choose to replace vancomycin with a slightly blunt gentamicin.

Better than completely ineffective fluoroquinolone antibiotics.

Wu Xie could only choose this way after preliminary investigation of medical records. If there is vancomycin, it must be better.

Combination of vancomycin and ceftriaxone, one for cell wall, one for protein synthesis, complement each other.

but no...

Of course, Wu Xie had other reasons for choosing gentamicin, that is, among Dong Mingliang's previous infections, gentamicin had a good antibacterial effect on them.

Based on these considerations, the choice of gentamicin is actually more rigorous than vancomycin.

Because it is currently uncertain, Dong Mingliang's infection is only Streptococcus viridans, or Streptococcus viridans.

After all, the results of the drug susceptibility test came out five days ago, and the samples were probably collected before the National Day...

Wu Xie continued to check the information for a while, and then began to write and draw in the notebook.

Diagnosis and treatment of this patient is very difficult, it requires a lot of deliberation and thinking, and these are skills that no one else can see...

The next day was October 8th, the first working day after the National Day.

Wu Xie got up early. Starting today, Liu Chengshan is about to leave the department for advanced studies, and the current staff of the department has been reduced again.

Counting director Lu Junyin, there are only attending physician He Ling, resident physicians Wu Xie and Zhong Yusheng, and an assistant medical assistant Guo Lixiang.

Although there are not many patients, the average workload will increase, so if you have to go early, you will not be as happy as last month.

But at present, Xiangmei got up earlier, opened the rolling shutter door, sat on a red lacquered wooden chair and combed her hair. After seeing Wu Xie, she said, "Xiao Xie, I didn't make breakfast, you go outside Eat it."

"I'll just go eat a bowl of noodles. How long did you chat with Fourth Uncle and the others yesterday?" Wu Xie nodded and said yes, then asked, while pausing for a while to straighten the wrinkles on his clothes and trousers.

After the National Day, the weather was slightly cold, Wu Xie added clothes, from the previous shirt and thin trousers to a sweater and denim. It has been stored for a long time and needs a little care.

"Your fourth uncle and the others don't go back until one or two o'clock." Xiang Mei yawned as she said.

"I think you can move Brother Lun Wu's hands." Xiang Mei finished yawning, his eyes began to be sly, and his tone had an indescribable pride.

The reset that Wu Xie did the day before yesterday can be moved yesterday. Xiang Mei is really proud of Wu Xie for this feeling and power!

"Brother Wu's dislocation is simple."

"Brother Wu's dislocation recovered quickly, and I even heard people on the street saying that my cousin was acting with me just to give me a hand." Wu Xie first used words to dispel her mother's arrogance.

"Who said that?" Xiang Mei refused immediately, took out the light red comb from her hair, and then pulled the twisted hair vigorously.

Naturally, Wu Xie would not call Xiang Mei by name: "Are you looking for someone else again?"

But Wu Xie knew that Xiang Mei was from Bai Xiaosheng's team in the town, and sooner or later he would know, so he said, "Maybe I bumped into a relative in Brother Lunwu's house, and I was afraid that my uncle and Brother Lunwu would blackmail me."

"It's also human nature."

"Mom, what I mean is, let's stop engaging in the business of Mrs. Wu selling melons." Wu Xie returned to the topic.

Xiang Mei rolled her eyes when she heard this, and said in a humming tone, "I'm not your father, so I'm just making trouble for you..."

It seems that he is still upset that Qin Dahe's uncle caused trouble for him first, and then made trouble for him.

I don't dare to blame Qin Ling and the aunts, I can only let Wu Guonan take the blame.

Wu Xie hurriedly slipped away: "Going to work, Mom, I'm coming back for lunch, buy some small intestines later, why don't you fry them for me. I really want to eat them."

"Oh, by the way, let's go to the county on the tenth, otherwise the National Day event will be over soon, and it may be more expensive to buy bracelets then." Wu Xie said as he walked down the stairs.

"Whoever wants you to buy it for me, hurry up and find me a daughter-in-law, I can buy it for her." Xiang Mei compared the combs to Wu Xie, and cursed with a smile.

Wu Xie has gone away.

When I came to the department, there were a bunch of peaceful people in the department.

Among the crowd, the voice of a little girl emerged.

"I'm (four) years old this year."

"I don't study the senior class, I study the middle class..."

"My grandma asked for leave for me."

"I don't want it, you can eat it yourself, my teeth are so ugly." When Wu Xie passed by, through the crowd, he saw a little girl in plain clothes pointing at her mouth, cute and agile.

Beside her, Zhang Dandan and an old woman were squatting and laughing together, including Guo Lixiang, Dr. Zhong Yusheng, and a group of nurses, including Xu Rong, were watching her performance and praised her non-stop.

It wasn't until nearly eight o'clock when Lu Junyin came that the crowd dispersed...

After the crowd dispersed, Wu Xie was putting on his overalls and pushing out the door from the doctor's lounge. At this moment, under Zhang Dandan's instigation, the little girl brought Wu Xie two meat buns.

The meat buns are placed opposite each other, which is very similar to the face of the little girl.

"Brother doctor, I'll give you something to eat."

She was probably only a little higher than Wu Xie's knees, and she raised her head and reached out to barely reach Wu Xie's palm.

Seeing this, Wu Xie squatted down and looked at Zhang Dandan and the old woman who was somewhat similar to Zhang Dandan...