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IPFC 5 > Bacteremia on management of SSTI > Flashcards

Bacteremia on management of SSTI Flashcards

1
Q

What is an example of bacteremia for each
Transient
Intermittent
Persistent/sustained

A

Transient
- tooth brushing, biopsy
- quickly cleared

Intermittent (spurts of bacteria into blood)
- Abscess
- UTI, pneumonia, SSTI

Persistent/sustained
- Endocarditis
- infected thrombi’s
- infected mesh wiring

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2
Q

How do we collect blood cultures?
How many bottles?
From where do we collect?

A

2 sets (4 bottles total) (1 for aerobic, other for anaerobic)

Each set collected from different access point (central line, PICC, dialysis, Venipuncture/peripheral, etc..) - to reduce chance of contamination

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3
Q

Which are more common in collecting cultures, false negatives of positive

A

False positive

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4
Q

What are reasons for false negatives in culture (3)

A

Drawn after antimicrobials started
Inadequate volume of blood collected
Slow-growing pathogen (eg. anaerobes)

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5
Q

What are reasons for false positives in culture (2)

A

bad hand hygiene
Collected from colonized venous catheter

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6
Q

Blood culture incubation time? What takes longer?
How to assess the culture?

A

Incubate for 5 days
- Fastidious organisms take longer

CO2 detected with a light sensor, will only be detectable once enough bacteria is making CO2

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7
Q

When do most organisms show growth?
How long do you wait until the results are likely negative?

A

Most will show growth in 48 hours
If nothing in >72 hours - most likely negative

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8
Q

What does a short time to positivity indicate about bacteria

A

The higher the bacterial load

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9
Q

What bugs are gram-positive cocci clusters

A

Staphylococcus auerus

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10
Q

What bugs are gram-positive cocci pairs

A

streptococcus pneumoniae

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10
Q

What bugs are gram-positive cocci chains (2)

A

Streptococcus pyogenes
Streptococcus pneumoniae

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10
Q

What bugs are gram-negative cocci

A

N. Gonorrhea

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11
Q

What bugs are gram-negative bacilli non-lactose fermenter oxidase positive

A

Pseudomonas spp

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12
Q

What do you do if there is no clinical evidence of infection? Especially if (3)

A

Consider contamination
- Time to positivity TTP is 72hrs+
- only one site positive
- Growth is common skin contaminant

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13
Q

Which bugs are common skin contaminant (5)

A

Most bacillus spp
Corynebacterium
Propionibacterium acnes
Coagulase-negative staphylococci

**Staph aureus should never be ruled out

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14
Q

What is an endovascular infection? Give examples (2)

A

bacteria getting stuck to components of the vasculature like a prosthetic valve/vascular stent
causing
- endocarditis
- septic thrombophlebitis

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15
Q

When would you suspect an endovascular infection

A

Persistent bacteremia despite 72 hours of appropriate therapy

16
Q

What is an extravascular infection? aka seeding. Give examples of what it can cause (4)

A

bacteria getting stuck to things OUTISDE the vasculature like bones, joints, brain

Can cause
- Psoas (infection in muscle)
- Osteomyelitis (infection in bones esp. if fractured, hip replacement)
- Pulmonary (infection in the lung)
- Cerebral septic emboli (infection in the brain)

17
Q

When do we suspect an extravascular infection

A

organ-specific symptoms present OR still febrile despite 72 hours of appropriate therapy

18
Q

T/F seeding (extravscular metastic infection) is more common in GAS vs staph aueus

A

False
- seeding is more common in staph aureus

19
Q

T/F it is common to see seeding in gram neg bacteria

A

False

20
Q

What pathogens are more likely to cause bloodstream infections or endocarditis

A
  1. Staph aureus, Candida spp
  2. Streptococcus
  3. Other gram-positives
  4. Other gram-negatives
21
Q

Which bug is the most common cause of bacteremia but risk of endocarditis is low (not sticky) (2)

A

S. pneumonia
S. pyogenes

22
Q

Which bug is the least common cause of bacteremia but risk of endocarditis is high (very sticky)

A

S. mutans

23
Q

What do you do if a culture is positive for staph aureus?

A

Always look for seeding/metastatic infection (extravascular infection)

24
Q

What to do if a patient has an endovascular or metastic infection due to SSTI

A

Drives therapy
- eg. prolonged duration
- additional interventions

25
Q

For patients with hospitalized SSTI do we perform a blood culture or not? What do the results look like?

A

Yes perform blood culture
- likely negative result but could be positive

26
Q

What bugs do we empirically treat for while waiting for blood culture?

A

Group A strep GAS
Staph aureus

  • Add on MRSA if pt has active MRSA risk factors
27
Q

What abx do you give while patient is hospitalized and bacteremia is suspected as you wait for blood culture?
What if MRSA is a concern?

A

Oral therapy if option has high bioavailability (FQs, linezolid, Septra)

MRSA concern:
IV Beta-lactam
Cefazolin or Cloxacillin

28
Q

What case of hospitilization would absolutley require a blood culutre

A

Abscess
- due to risk of S. aureus bacteremia

29
Q

What if the culture results at 48-72 hours is negative:
Positive:

A

Negative: transition to ORAL beta-lactam (duration: 5 to 7 to 10 days)

Positive: may need to continue IV

30
Q

Which bug do we not need to confirm clearance with repeat blood culture in bacteremia

A

Group A strep
Streptococcal bacteremia

31
Q

What does the balance trial say for duration of therapy for SSTI with GAS bacteremia?
Bottom line?

A

Extend SSTI treatment to 7 days, no need for 14 days

Bottom line:
- Treat cellulitis for 5 days. If streptococcal bacteremia due to cellulitis. Use a 7 day duration

32
Q

What is the treatment and duration for SSTI with staph. Aureus MSSA bacteremia.

A

Cloxacillin or cefazolin for
14 days min.

If life threatening beta-lactam allergy
- vancomycin (however inferior for MSSA)
- Clindamycin or Septra

33
Q

What does the ARENSMAN trial say about IV to oral transition in SSTI with GAS bactemeria?

A
  1. Give at least 3 days (72 hours) of IV beta-lactam (as long as some improvement by day 3) before transitioning to oral
  2. Transition to HIGH (maximized) dose oral beta-lactam when you do switch

Stepping down before day 3 is more likely to fail

34
Q

What is the overall steps for management of SSTI with S. aureus bacteremia (3)

A
  1. Consult ID
  2. Always look for endovascular or metastic infection
    - remove IV lines
  3. Repeat culture q48 hours until negative
35
Q

What is ID consult associated with? (2)

A

Decreased mortality and decreased relapse

36
Q

What is the most to least common sites of Staph aureus metastatic infection?

A

Heart valve (infective endocarditis)
Joints (septic arthritis)
Lungs (septic PE)
Bone (vertebral osteomyelitis)
Muscle
Spine (Epidural abscess)

37
Q

What does the SABATO trial tell us about IV- oral switch in SSTI with staph. aureus MSSA bacteremia?
Most commom PO drug used in this trial?

A

Can transition from IV to HIGH oral dose after 5-7 days of IV therapy (14 days total)

  • Cloxacillin or cefazolin are viable IV options

Trial used Sulfatrim as PO abx

38
Q

What is defined as uncomplicated MSSA Bacteremia (4)

A
  • no evidence of metastatic infection
  • no indwelling devices or prosthetic valves
  • clearance of MSSA on culture in ≤48 hours
  • no fever within 72 hours of ABX therapy

IPFC 5 (10 decks)

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