2nd to last lecture Flashcards
Pathogens causing community acquired sepsis:
Gram positives:
S. pyogenes
S. pneumoniae
S. aureus
G negatives:
E. coli
N. meningitidis
L. pneumophila
Pathogens causing nosocomial sepsis
G positives:
S. aureus, MRSA
S. epidermidis, MRSE
Enterococcus species
G negatives E coli. Klebsiella pneumoniae Pseudomonas Acinetobacter baumannii
Funig:
Candida
Aspergillus
Sepsis treatment
Surgical cleaning/removal of infection site
Antimicrobial therapy for target organism. Early start to treatment is essential and drastically affects survival, even hours make big difference.
Bactericidal antibiotics should be used.
Therapy to maintain organ functions
Steroids to minimize the inflammatory damage (low dose, still need to immune system)
Sepsis outcome is decided in the first 1-3 days. Changes in AB therapy after that do not affect mortality. So the most effective/strongest/accurate therapy needs to be given immediately. ‘De-escalation therapy’ begin with most effective and strogest therapy, and then step down once patient is managed or sensitivity is determined.
types of MIC for drugs
Cmax:MIC a certain maximum plasma concentration must be reached, the Ratio between Cmax and MIC must be maximized for best response. Amyinoglycosides target ratio is 10. higher ratio is even better. Once daily administration.
ex: Aminoglycosides, fluorquinolones
AUC:MIC The total area under the curve above a certain plasma concentration is what indicates the MIC
Fluoroquinolones
target values: G-positives: AUC:MIC above 30
G-negatives, above 125.
T>MIC a certain amount of time spent above the MIC is what matters.
Beta-lactams (penicillins)
Macrolides - Erythromycin, Clarithromycin.
Community acquire pneumonia, main bacteria pathogens
Typical pneumonia
S. pneumoniae 20-50%
H. influenzae 5-10%
Klebsiella pneumoniae 1-3%
Atypical
Mycoplasma pneumoniae 10-30%
Chlamydia pneumoniae 5-10%
Legionella pneumophila 1-5%
Main viral pathogens for pneumonia
orthomyxo, paramyxo
rhinoviruses
coronaviruses
