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,
, PNN (/mm3
, Lymphocytes (/mm3
,
,
,
, Calcul de la clairance selon la formule de Cockroft et Gault (ml/min
, TP
, Plaquettes (/mm3
Antibiothérapie : DCI Posologie : Modalités d'administration : ? perfusion continue ? perfusion intermittente si perfusion intermittente : sur quelle durée chaque perfusion ? nb d'administration quotidienne ? ? IVSE ? pompe ? perfusion classique Date de début : _ _/_ _/_ _ à _ _ h_ _ Si perfusion intermittente : date et heure du début de la dernière perfusion : _ _/_ _/_ _ à _ _ h_ _ Si perfusion intermittente ,
, Nombre de ligne d'antibiotiques : Type d'antibiothérapies antérieures