Bacteremia and Catheter related infections

Question 1

Staph aureus bacteremia potpurri

Answer 1

• most common cause of bacteremia
• consider source of bacteremia question about metastatic infection symptoms
• blood cultures always clinically significant regardless of number of bottles, also get an EKG

Question 2

Signs of systemic endocarditis symptoms

Answer 2

• nodes on pads of fingers

- bloody painnless lesions on palms of hands or feet

Question 3

what do positive urine cultures for Staph Aureus indicate

Answer 3

• increased mortality and the organism has been seeded there from the blood

Question 4

• how do we manage catheters and IV lines in Staph. aureus infections

Answer 4

• consider all infected and attempt to remove, try short term catheters

Question 5

• Empiric treatment of Staph. Aureus bacteremia

Answer 5

• Vanc or Dapto

- may add additional MSSA covering agent in patients with highest mortality risk

Question 6

Treatment of MSSA Bacteremia

Answer 6

• Nafcillin, Oxacillin, and Cefazolin

- Do not use Vanc, combinations with rifampin, or combinations with aminoglycosides

Question 7

Cefazolin versus anti-staph penicillin in MSSA Bacteremia

Answer 7

• lower mortality, and no difference in recurrence or toxicity

Question 8

Treatment of MRSA bacteremia

Answer 8

• vancomycin
• daptomycin
• do not add gentamicin or rifampin to vanc

Question 9

in- vitro Combination therapies for SAB

Answer 9

• think in relation to daptomycin. PBP-2 agents like cefazolin, nafcillin, and meropenem enhance anti-MRSA effect of dapto
• combinations of vanc with cefazolin, cefepime, ceftaroiline, and nafcillin showed better killing than vanc alone

Question 10

clincial data for SAB combination data

Answer 10

• vancomycin or daptomycin + a beta-lactam has a shorter duration of bacteremia
• ceftaroline + dapto or vancohas been used as salvage therapy in patients with refractory and persistent MRSA bacteremia
• daptomycin plus ceftaroline within 72 hours of inde blood cultures reduces mortality
• consider combination therapy for the first 7 days then de-escalate to vanc monotherapy afterwards to reduce the risk of AKI

Question 11

• oral stepdown in patients with uncomplicated SAB

Answer 11

• may consider stepdown in patients with oral linezolid between days 3-9 of therapy as this has little difference in relapse rates

Question 12

oral stepdown in patients with MRSA bacteremia

Answer 12

• linezolid may be used in patients with bacteremia from pneumonial causes

Question 13

uncomplicated SAB must meet all the following criteria

Answer 13

• no endocarditis
• no indwelling or implantable devices
• follow-up cultures taken after 2-4 days of IV therapy
• no more fever after 48-72 hours of initiating IV therapy
• no metastatic infection

Question 14

Duration of treatment for uncomplicated SAB

Answer 14

• 14 days

Question 15

Complicated SAB duration of treatment

Answer 15

4-6 weeks

Question 16

Oral gents to be considered for oral step-down therapy in enterobacteriacea in bacteremia

Answer 16

• Ciprofloxacin, Levofloxacin, and Bactrim

Question 17

Clinical difference in treatment duration for enterobaacteriacea bacteremia less than 10 days versus greater than 10 days

Answer 17

• no difference

Question 18

Is there a difference in mortality in long course versus short course P. Aeruginosa Bacteremia

Answer 18

• no