Bacterial Infections II Flashcards
Actinomyces
Clostridia
Peptostreptococcus
Propionibacterium
Are all considered gram +/-
Gram +
Bacteroides
Fusobacterium
Prevotella
Porphyromonas
Are all considered gram +/-
Gram -
_____ are common in head and neck infections
Actinomyces (Actinomycosis)
____ and ____ are common in intra-abdominal infections
Actinomyces (Actinomycosis)
Peptostreptococcus
_____ are common in aspiration pneumonia
Actinomyces (Actinomycosis)
_____ are common in oral infections
Peptostreptococcus
_____ are common in foreign body infections
Propionibacterium
-Abscess formation with tissue necrosis
-Suppurative/purulent
-Foul odor of pus or infected tissue
Site of infection typically near where anaerobic flora reside
Mouth, jaw and neck (from dental roots)
Abdomen/pelvis (from GI tract)
Lungs (from aspiration)
Often polymicrobial
Gram + and - anaerobic infection
Gram + anaerobic infections that show air fluid levels within circumscribed infiltrate = _____
What is the dx?
lung abscess
aspiration pneumonia
How do you diagnosis a gram + anaerobic infection?
clinical suspicion
gram stain
culture
What is the treatment for Gram + Anaerobic Infections?
drainage and debridement
abx based on the site
What abx do you give for Gram + Anaerobic Infections around the oral/throat/neck?
clindamycin
Augmentin
Unasyn
What abx do you give for Gram + Anaerobic Infections around the GI/Pelvic/abscess? Give both oral and IV therapy
Oral therapy: moxifloxacin
IV therapy:
Mod/Severe Infection
ertapenem or ceftriaxone + metronidazole (cover for B. frag, Gram -)
What abx do you give for a severe Gram + Anaerobic Infections?
Imipenem
what abx do you give for a Gram + Anaerobic Infections for a lung abscess?
Beta-lactam plus a beta-lactam inhibitor
ampicillin-sulbactam (Unasyn)
Carbapenem (imipenem or meropenem)
what abx do you give for a Gram + Anaerobic Infections for a lung abscess that is allergic to beta-lactams?
Clindamycin
what abx do you give for a Gram + Anaerobic Infections for aspiration in the outpatient setting?
Augmentin or doxycycline
what abx do you give for a Gram + Anaerobic Infections for aspiration in the inpatient setting?
Beta-lactam plus a beta-lactam inhibitor
ampicillin-sulbactam (Unasyn)
metronidazole plus either Amoxil or pen G
What abx do you give prophylaxically for abscess prevention or patients with joint implants?
PCN or amoxicillin
What abx do you give for dental and minor procedures for Endocarditis prophylaxis?
Amoxicillin
What do you give prophylaxis for colorectal surgery?
Metronidazole (Flagyl) PLUS 2 or 3 gen cephalosporin or Cipro
Carbapenems
What bacteria is the most common species for clostridial soft tissue infections?
C. perfringens
_____ infections produce cellulitis, myositis, and clostridial myonecrosis (gas gangrene)?
C. perfringens
What bacterial infection causes Pain, edema, erythema, tissue crepitus (gas formation), foul smelling
Progress to shock, renal failure, possibly death
C. perfringens
Gastroenteritis
Where is C. perfringens typically found?
throughout the environment, usually in the soil
_____ are rapid producers and may be positive in 6 hrs
Clostridia
Describe the Clostridial Soft Tissue Infection Treatment.
Drainage and debridement
Pip/taz plus clindamycin to cover strep and clostridium; then change to PCN plus clindamycin if only the later
hyperbaric therapy
Where are C. perfringens typically found?
Found in feces, soil, air, water
C. perfringens produces an _____ that can become ingested
enterotoxin
Mild gastroenteritis
Watery diarrhea
Vomiting and fever unusual
Self limiting (24hrs)
Above s/s are associated with ______
C. perfringens
Produces spores
Found in soil
Transmitted after injury via wound or burns
IVDU (intravenous drug use)
Above characteristics are associated with _____
C. tetani (Tetanus)
Spore enters wound and travels to peripheral nerve endings
Causes muscle stimulation
Tonic spasticity
Generalized or local
Once bound, cannot be neutralized
^ is the pathophys associated with ______
Tetanus
What is the incubation period of tetanus?
5-30 days
What is the clinicial presentation of tetanus?
Jaw stiffness
difficulty swallowing
stiff neck, arms and legs
HA
Tonic muscle spasms
Trismus
Respiratory failure due to spasm of diaphragm/
laryngeal spasm
What is trismus?
Difficulty of opening jaw
How do you diagnosis tetanus?
clinical suspension
Cultures are NOT sensitive
What is the treatment for tetanus?
Hospitalization
Supportive care
Respiratory care
Drugs for muscle spasms
Wound debridement
Tetanus immune globulin (HTIG) IM within 24 hrs of presentation
Full series of tetanus vaccine
PCN or metronidazole
What are some common sources of Botulism?
Contaminated Food
Home-canned foods - most common
All types of commercial foods
Direct injection (needles) or through wound
there are ____ different subtypes of botulism
What is the CDC classification?
8
CDC A
Respiratory failure
Due to diaphragmatic paralysis
Dry mouth, slurred speech, dysphagia
Blurred vision, drooping eyelids
^ s/s of _____
botulism
What is the timeframe associated with botulism? Which s/s show up first?
18-36 hrs after toxin ingestion
N/V/abdominal cramps precede neurologic symptoms
Where do you culture botulism if the source was ingested? Injected?
stool- if ingested
wound- if injected
What is the treatment for botulism?
hospitalization
supportive care: respiratory, NG tube
Antitoxin
if wound: PCN G or metronidazole
Clostridioides and referred to as ______
Pseudomembranous Colitis
C. Difficile diseases occur due to ????
overgrowth of organism in the colon
Most common - after antibiotic use that alters normal GI flora
Immunocompromised person who encounters organism
Diarrhea, frequent, watery and sometimes bloody (very smelly)
Abdominal cramping, tenderness and bloating
N/V is rare
Typically begins 5-10 days after abx use, can take up to 2 months
what type of infection?
C. difficile - Antibiotic Associated Colitis
What steps do you take to correctly dx C. difficile?
Stool sample for C. diff toxin
Fecal leukocytes present
Sigmoidoscopy
imaging: may show ileus or distended colon
When would you order a sigmoidoscopy when dx C. diff? What would it reveal?
If culture is negative or nondiagnostic and high suspicion of disease
Reveals the presence of pseudomembranes
What do you treat mild-moderate C diff with?
Fidaxomicin 200 mg PO BID
Vancomycin 125 mg PO QID
What do you treat severe C diff with?
Vancomycin 125-500 mg PO QID
Can also do by enema (rare)
Fidaxomicin 200 mg PO BID
May add metronidazole to the above Ab
What do you treat recurrent C diff with?
Fidaxomicin or vancomycin 500 mg PO q6hrs
What do you treat resistant C diff with?
fecal transplant
Of the gram - anaerobes what two are normal in oral and large bowel flora?
Prevotella and Fusobacterium
______ are prevalent in intra-abdominal infections
Bacteroides fragilis
Gram + and - can lead to _____ however shock is usually absent
bacteremia
Gram - anaerobic infection on the oral/throat/neck region, what abx?
clindamycin or metronidazole
Gram - anaerobic infection on the GI/pelvic abscess, what abx?
Extended spectrum PCNs
pip/taz (Zosyn) or
carbapenems or
metronidazole (Flagyl) plus cephalosporin (ex. cefepime)
____ is the most common cause of vaginal discharge
bacterial vaginosis
Gardnerella - most prevalent
Prevotella, Peptostreptococcus, Bacteroides
Mycoplasma hominis and Ureaplasma urealyticum (not anaerobes)
are all considered _______
polymicrobial anaerobes
What is a risk factor of bacterial vaginosis?
sexual activity
Presence of clue cells and positive whiff test indicate ____
bacterial vaginosis
Thin, off-white to grayish vaginal discharge
Vaginal odor: “fishy smell”
Characteristic vaginal discharge
Elevated pH of vaginal discharge
Presence of clue cells on microscopy
Positive “whiff test”
^ all indicate _____
bacterial vaginosis
What is a positive whiff test?
What is the treatment for bacterial vaginosis?
metronidazole (Flagyl)
oral or vaginal
clindamycin (Cleocin)
oral or vaginal
tinidazole
oral
