Bacteremia

Question 1

Staph aureus bacteremia
empiric treatment

Answer 1

Source control (If something is causing the infection remove it)

Empirically cover MSSA and MRSA
Vancomycin IV
Daptomycin IV

Question 2

treatment for MRSA bacteremia

Answer 2

Vancomycin IV
Daptomycin IV (can use in patients with septic pulmonary emboli)

Question 3

Treatment of MSSA bacteremia

Answer 3

Nafcillin IV
Oxacillin IV
cefazolin IV

Question 4

Uncomplicated SAB

Answer 4

Patient must meet all criteria to be considered uncomplicated*

exclusion of endocarditis (negative TTE or TEE)

no indwelling or implantable devices or prostheses

follow up blood cultures drawn 2-4 days after initiating IV therapy and removal of the presumed focus on infection are negative

patient lost fever with 48-72 hours after initiating IV therapy

no evidence of metastatic infection

Question 5

Duration of treatment - SAB

Answer 5

Uncomplicated SAB - 14 days of IV therapy from first negative blood culture

Complicated SAB- 4 weeks

Complicated SAB with metastatic infection - 6-8 weeks

current recommendations: IV therapy for full duration - EXAM Q ONLY IV

Question 6

Bacteremia due to streptococci (other gram positive cocci)
treatment duration and treatment

Answer 6

Duration of treatment is 14 days and YOU CAN SWITCH PATIENT FROM IV TO PO

S. pyogenes, S. Agalactiae: penicillin IV to High dose amoxicillin PO

S. pneumoniae: ceftriaxone or penicillin (only if susceptible)

Question 7

Bacteria due to enterococci

Answer 7

Duration 7 days

E. faecalis tx: ampicillin (if patient allergic can use vancomycin or daptomycin)

E. Faecium tx:
if VanA and VanB negative - vancomycin
if VanA or VanB positive - daptomycin, linezolid

Question 8

Treatment of uncomplicated gram negative bacteremia

Answer 8

Duration: generally 7 days (THIS IS TOTAL NOT AT START OF NEGATIVE TEST)

can switch patient from IV to PO once clinically stable
PO options include bactrim, FQ, or B lactam

Psuedomonas coverage - zosyn, Cefepime, meropenem