Bacteremia Flashcards
What is the most common pathogen in bacteremia?
Staph aureus
When do you stop taking blood cultures
Until negative for bacterial growth
When do you preform endocardiography for patients with SAB?
All patients with SAB
Which endocardiography tests are preformed in patients with SAB?
TTE preformed first then TEE (TEE preferred for MRSA bacteremia)
What does it mean if urine cultures are positive for Staph. aureus?
-Staph aureus is not a common UTI pathogen
-Most likely means SAB is present and has infected the kidneys
-If kidneys are infected then other organs are most likely infected as well
-Associated with increased mortality
What should you do with catheter and prosthetic devices in SAB?
-Consider all IV catheters and prosthetic devices to be infected in patients with SAB unless infection is ruled out
-Attempt to remove all prosthetic devices to prevent risk of relapse
-If device can not be removed then you may add rifampin to the drug regimen
When can you replace catheters in a patient with SAB?
When blood cultures are negative for 48-72 hours
What empiric therapy would you use for SAB?
-Vancomycin
-Daptomycin
When is daptomycin preferred over vancomycin?
In patients with septic pulmonary emboli or right-sided endocarditis
Would you want to add gentamicin or rifampin to vancomycin for empiric therapy?
No unless the patient has a pacemaker or any sort of device that cannot be removed, then you would want to add rifampin
When would you use empiric combo therapy of a MRSA and MSSA covering agent?
In critically ill patients or patients who are not improving on monotherapy
What drugs would you use to treat MSSA bacteremia?
-Nafcillin
-Oxacillin
-Cefazolin
What drugs should you not use for the treatment of MSSA bacteremia?
-Vancomycin
-Combo with rifampin (drug interactions)
-Combo with aminoglycosides (increased toxicity)
When is day 0 when deciding length of treatment
First negative blood culture
Treatment duration of uncomplicated SAB
14 days from day 0
What criteria must be met for SAB to be uncomplicated?
-No endocarditis
-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 starts improving after 48-72 hours of initiating IV therapy and removal of presumed focus on infection
-No evidence of metastatic infection
Treatment duration of complicated SAB
4 weeks
Treatment duration of complicated SAB with metastatic infection
6-8 weeks
When should oral antibiotics be administered in SAB?
Never
Treatment duration of streptococci bacteremia
14 days then transition from IV to PO
Treatment options of streptococci bacteremia
-Penicillin IV then to PO amoxicillin
-Ceftriaxone or penicillin (if susceptible) (only for strep pneumo)
Treatment duration of enterococci bacteremia
7 days
E. faecalis bacteremia treatment
-Ampicillin
-Vanco or dapto if amp resistant or allergic to beta-lactams
E. faecium bacteremia treatment
-Vancomycin if no resistance
-Daptomycin if VRE
Treatment duration of uncomplicated gram-negative bacteremia
7 total days of therapy not starting from first negative blood culture
Should you increase length of therapy to increase efficacy?
No
