The biggest advantage of cephalosporins over penicillins is that they do not require a skin test. According to the consensus and guidelines of domestic experts, the probability of cephalosporin allergy is one-fifth of that of penicillin allergy, while anaphylactic shock is extremely rare, with an incidence of between 1 in 1 million and 1 in 1,000. Compared with penicillin's 10% allergy rate and 4 per 10,000 anaphylactic shock, cephalosporins do not require a skin test at least under the current expert consensus - not to mention that the skin test results of cephalosporins are not necessarily accurate, and its false positive rate is much higher than that of other antibiotics.

Moreover, compared with the first- and second-generation cephalosporins, because the C7 side chain of the third- and fourth-generation cephalosporins is different from the penicillin side chain, the probability of cross-allergic reaction with penicillin is extremely low. Therefore, it must not be generalized that cephalosporins should not be used in penicillin-allergic patients.

The fourth-generation cephalosporins are now restricted-use antibiotics, and some third-generation cephalosporins are also restricted-use antibiotics. The ceftriaxone suggested by Sun Lien is the only one of the three generations of cephalosporins that does not belong to the restricted use of cephalosporins. It meets the needs of hypoallergenic, susceptible to Streptococcus pyogenes and broad-spectrum antimicrobial against necrotizing fasciitis.

"Is ceftriaxone enough?" Chen Tianyang said to Sun Lien while clipping and cleaning the perineal fascia of the Nigerian soldier, "This infection is more serious. If you're not sure, you can use a restricted-use antibiotic – just ask Dr. Wang to make up for it later in the procedure. ”

Chen Tianyang was a little worried about Sun Lien's medication plan. In his opinion, this degree of perianal necrotizing fasciitis is likely to progress to more severe retroperitoneal necrotizing fasciitis. No matter how clean the surgery is, it is impossible to remove all the pathogenic bacteria. If anti-infective regimens are inadequate for "use restriction" reasons, the situation will only be more troublesome in the future. When necrotizing fasciitis develops into systemic sepsis, it is really difficult to save.

"Ceftriaxone should be enough. His symptoms do not support MRSA (methicillin-resistant Staphylococcus aureus) and other drug-resistant infections. Sun Lien was silent for a while and gave his own answer. He decided to put his faith in the status bar and save some medicine for the level-2 peacekeeping hospital. "But I'm a little concerned about how quickly his disease will progress — has he done the five infectious diseases?"

When the question was asked, there was silence in the operating room. Doctor Wang raised his head and said to Sun Lien, "Five infectious diseases?"

"He's progressing a little bit faster. Sun Lien frowned and said, "This...... If you do the five infectious diseases, at least we can rest assured. He blinked, and asked in disbelief, "You can't have done it, have you?"

"According to the regulations, members of ......the peacekeeping force are required to undergo a physical examination before being stationed," Dr. Wang said in a low voice, and he wanted to say something, but was interrupted by Chen Tianyang, "In other words, you didn't do the five tests for infectious diseases before the patient? You don't know if he is HIV positive?" Chen Tianyang said as he carefully put down the scalpel in his hand and said to the nurse next to him, "Bring saline and two pairs of gloves." ”

HIV is as closely related to Africa as lions, giraffes and savannas are to Africa. As the most likely source of HIV and the most prevalent area in the world, people in Africa have been plagued by HIV for decades. In Southeast Africa, where Polythanvia is located, the average prevalence of HIV is about 9%, much higher than the level of 9 per 10,000 in China. The local HIV prevalence in Nigeria is slightly lower than in South-East Africa, at about 5.4%. But it is still a group of countries that must be careful.

"Everybody check it and take precautions. Dr. Wang shook his head and said to the other doctors and nurses, "Xiao Tian, send a blood sample to the laboratory department for examination." Also, ask the Nelizhia battalion to transfer this soldier's previous medical report. ”

Sun Lien himself is a little unsure, after all, the status bar does not clearly say whether the Nigerian soldier is HIV-positive. But three hours of necrotizing fasciitis led to the necrosis of all the superficial fascia of the gluteus maximus muscles on both sides - at least in terms of Sun Lien's level of knowledge, this does not make sense.

Chen Tianyang washed his hands with saline again, and after making sure that the gloves on his hands were not broken, he put on two new gloves. Then he picked up the scalpel and instruments again and began the subsequent surgery. The patient's perineal fascia needs to be further removed and irrigated, and even if the person is HIV-positive, the surgery must be done. Anyway, Chen Tianyang has not met a patient who is HIV-positive but has concealed his medical history before. It's a big deal to do a good job of protection during the operation, and take blocking medicine while scolding your mother after surgery.

The operation was pronounced over two hours later. Dr. Chen and Dr. Wang made 12 incisions on both sides of the patient's buttocks and around the perianal area. In total, more than 1400 ml of necrotic tissue fluid and pus were discharged. Fortunately, thanks to the efforts of the doctors, the Nigerian soldier was able to save his life and excretory organs and excretory functions for the time being. But unfortunately, the rapid HIV test confirmed Sun's concerns.

HIV positive.

"Banma Rili, what is this doing!" Chen Tianyang carefully took off his gloves in the operating locker room, and then scolded the street like thunder, "This knock to death, I can't figure it out!"

Chen Tianyang was like thunder, and Liu Tangchun's expression was also extremely ugly. After learning that the peacekeeping hospital did not conduct five tests for infectious diseases on patients in advance, he kept a gloomy face. It wasn't until he looked at Chen Tianyang's hands, confirmed that there were no wounds on them, and made sure that Sun Lien didn't operate on them, that he said slowly to Dr. Wang, "Are you okay?"

Dr. Wang also examined his hands, and then replied with a somewhat ugly face, "I'm fine......

"The main responsibility for this matter is not you. Liu Tangchun directly defined the accident - he didn't care whether he was qualified or not. "The soldier did not test positive for HIV during a medical examination a year ago. That means that either the tests were problematic and the Nigerian military falsified the soldiers' HIV test reports. Either...... There was a problem with the management and discipline of the barracks, and the soldier contracted the disease during his mission in Polythanvia. ”

Both of these speculations are terrifying. Either way, it would lead to very serious diplomatic consequences. Liu Tangchun turned to Sun Lien and Chen Tianyang and said, "Don't tell anyone about today's matter. No matter how close the relationship is, you can't reveal a single word. ”

Sun Lien nodded, he didn't feel the need to report today's matter to others. Chen Tianyang, on the other hand, raised his concerns, "This thing is the same as seeing cockroaches." One HIV positive means more people in the barracks who are likely to be positive. Peacekeeping hospitals have a disease prevention responsibility, and they can't put this matter down, right?"

"Report according to the process and regulations, and press down and don't move the rest first. Liu Tangchun thought for a moment and said to Dr. Wang, "You first report to the superior leaders of our Chinese battalion, and then operate according to their opinions." ”