Anti-infective use in the ICU Flashcards
T/F: Empiric antibiotic therapy improves survival in septic shock
True
Why is the broadest spectrum of antibiotics not started for every patient
Toxicity and resistance development
What are some of the antimicrobial threats patients must be looked out for
Carbapenem- resistant acinetobacter and enterobacteriaceae, vancomycin reistant enterococcus, pseudomonas
What is antimicrobial stewardship
coordinated program that promotes the appropriate use of antibiotics to improve patient outcomes, reduce microbial resistance, and decrease the spread of infections caused by multidrug resistant organisms
What are the guideline recommendations for antimicrobial use in patients who have spesis and septic shock
IV antibiotics should be initiated AS SOON AS POSSIBLE after recognition or within ONE HOUR for both sepsis and septic shock
What are the most common pathogens isolated in the ICU setting
Klebsiella spp, E. coli, P. aeruginosa, enterobacter spp
Risk factors for pseudomonas aeruginosa
Mechanical ventillation, significant burn injury, surgery, indwelling catheters, IV drug abuse, PREVIOUS PSEUDOMANS AERUGINOSA, porlonged hositalization and ICU stay, immunosuppression
Which antibiotics have activity against pseudomonas aeruginosa
Pip/Taz, Ceftazidime, cefepime, ceftolozane/tazo (multi-drug resistant good), aztreonam, imipenem, meropenem, doripenem, amikacin and tobramycin, ciprofloxacin and levofloxacin, colistin and polymyxin B
What is a big risk factor for candidiasis
USe of broad-spectrum antibiotics
What should be given if candida species is considered the infection, descalation
Echinocandin (especially if critically ill or recent fluconazole exposure), fluconazole
If there is an intraabdominal source for infection which class of bacterial pathogens may be the cause
Eneterobacteraciae and anaerobes
For enterobacter, citrobacter freundii, serratia what are the drugs of choice for resistant phenotypes
Cefepime (preferred), carbapenems, fluroquinolones, bactrim
For enterbacteriaceae (E. coli, klebsiella, salmonella, shigella, yersinia pestis) what are the drugs of choice for resistant phenotypes
Carbapenems, Pip/Taz (likely less effective)
For entrobacteriaceae and non-lactose fermenters (acinetobacter and pseudomonas)
Ceftaz/avi and mero/vabo (KPC mechanism), polymyxins, aminoglycosides
For staph aureus what are the drugs of choice for resistant phenotypes
Vancomycin
