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D&D Infectious Disease Midterm > Bacterial Meningitis Part 2 > Flashcards

Bacterial Meningitis Part 2 Flashcards

1
Q

true or false

bacterial meningitis is considered a medical emergency

A

TRUE

if untreated, there is a 100% mortality rate and empiric antibiotics need to be started WITHIN 1 HOUR

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2
Q

as mentioned, empiric antibiotics need to be started promptly - within 1 hour

name 3 things that this antibiotic should be

A

should be bacteriCIDAL
high doses given IV
must penetrate the CNS (low molecular weight, low protein binding, lipophilic)

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3
Q

true or false

in meningitis, it is harder for an antibiotic to penetrate the meninges

A

FALSE - actually easier bc of damage and inflamed meninges

the barrier is slightly disrupted

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4
Q

aside from empiric antibiotics, what else should a patient with bacterial meningitis be given

A

lot of fluids and electrolyes, antipyretics and analgesics
(possible corticosteroids?)

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5
Q

as a recap, name the 3 most likely organisms to cause bacterial meningitis in neonates (less than 1 month)

NAME 2 THERAPIES THAT CAN BE USED

A

group b strep (strep agalactiae)
listeria monocytogenes
enteric gram negatives (e. coli, klebsiella, enterobacter)

Normally, ampicillin + cefotaxime

if cefotaxime not available, can do:
ampicillin + aminoglycoside (BUT NEEDS THERAPEUTIC DRUG MONITORING)

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6
Q

WHY do aminoglycosides need therapeutic drug monitoring

A

cause nephrotoxicity and ototoxicity

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7
Q

as recap, name the 4 most likely pathogens to cause bacterial meningitis in 1 month-23 months

WHAT TREATMENT IS USED TO COVER ALL

A

group B strep (still a little)
neisseria meningitidis
streptococcus pneumoniae
h. influenzae

vancomycin + a 3rd gen cephalosporin like ceftriaxone and cefotaxime

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8
Q

which bacterial meningitis drug CANNOT be used in neonates

A

ceftriaxone - causes hyperbilirubinemia and kernicterus (brain damage) fatally precipitates with calcium

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9
Q

as a recap, which organisms are most responsible for bacterial meningitis in 2-50 years?

what is treatment?

A

neisseria meningitidis
streptococcus pneumoniae

same as for 1-23 months:
vancomycin + 3rd gen cephalosporin (ceftriaxone or cefotaxime)

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10
Q

as recap, what organisms likely responsible for bacterial meningitis in pts greater than 50?

what is treatment?

A

listeria monocytogens
gram negative bacilli (enteric gram negatives - e.coli, klebsiella, enterobacter)
strep pneumoniae
neisseria meningitidis

treatment is vancomycin + 3rd gen cephalosporin (ceftriazone or cefotaxime) + ampicillin

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11
Q

true or false

listeria monocytogenes is a gram negative organism

A

FALSE - gram positive

that’s why ampicillin added to empiric therapy for >50 yrs

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12
Q

empiric therapy for closed head trauma

as recap, what 3 organisms likely to cause?

A

strep pneumoniae
h. influenzae
group A beta-hemolytic strep

vanomycin + 3rd gen cephalosporin (ceftriaxone or cefotaxime)

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13
Q

empiric therapy of choice for penetrating head trauma/post neurosurgery OR CSF shunt

A

vancomycin

+cefepime or ceftazidime (not rly used - bc of resistance) or meropenem (really for ESBL - depends on pt factors)

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14
Q

as recap, what are likely organisms for penetrating head trauma or post neurosurgery

A

staph epi
staph aureus
gram negative bacilli (e. coli, klebsiella, PSEUDOMONAS)

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15
Q

as recap, what are likely organisms in CSF shunt condition

A

staph epi
staph aureus
p. acnes
gram negative bacilli (e. coli, klebsiella, pseudomonas)

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16
Q

is pseudomonas gram (+) or (-)

A

(-)

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17
Q

60 yrs old man admitted to hospital for suspected community acquired bacterial meningitis

which empiric therapy is most appropriate

A

vancomycin + ceftriaxone + ampicillin

NEED ampicillin to cover listeria

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18
Q

21 yr old female college student admitted to hospital for suspected bacterial meningitis

NKA - what empiric therapy?

A

vanco + 3rd gen cephalosporin (ie - ceftriaxone)

no concern with listeria

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19
Q

cefazolin is what generation cephalosporin

A

1st

therefore, cannot be used for 21 y/o with suspected meningitis - need vanco + THIRD GEN

20
Q

3 week old infant brought to ER for refusal to nurse and irritability
suspected bacterial meningitis

what empiric antibiotics? (NKA)

A

ampicIllin + cefotaxime
(COULD BE AMINOGLYCOSIDES IF CEFOTAXIME NOT AVAILABLE)

DO NOT USE CEFTRIAXONE - NEONATE HYPERBILIRUBI

21
Q

If culture comes back and comes streptococcus pneumoniae, what should be started if:

-penicillin susceptible
-penicillin ressitant

WHAT IS DURATION

A

penicillin suceptible: pen G or ampicillin

pen resistant - vanco + cefotaxime or ceftriaxone

10-14 days

22
Q

culture comes back as group B strep

what is 1st line antibiotics and for what duration

A

14 - 21 days

pen g or ampicillin

23
Q

culture comes back staph aureus

1st line antibiotic if:

MSSA
MRSA

what duration

A

14-21 days

MSSA - nafcillin or oxacillin
MRSA - vancomycin

24
Q

culture comes back staph epi

what is 1st line antibiotics and for how long

A

14-21 days

vancomycin

25
Q

culture comes back listeria monocytogenes

what are 1st line ab and for what duration

A

21+ days, pen g or ampicillin

26
Q

culture comes back neisseria meningitidis

pen susceptible
pen ressitant

what is treatment and for how long

A

7-10 days

susceptible - pen g or ampicillin

resistant - cefotaxime or ceftriaxone (3rd gen)

27
Q

culture comes back pseudomonas

what is treatment and for how long

A

cefepime or ceftazidime (not rly used bc resistance)

21 days

28
Q

culture comes back enteric gram negative

what are AB and for how long

A

21 days

cefotaxime or ceftriaxone (3rd gen)

29
Q

culture comes back h. influenzae

-b-lactamase negative
-b-lactamase positive

what is treatment and for how long

A

7-10 days

negative - ampicillin
positive - cefotaxime or ceftriaxone

30
Q

role of dexamethasone in bacterial meningitis and why is it a little controversial

A

used as adjunctive to antibiotics to modulate the inflammatory response – inflammation causes a lot of the morbiditiy like hearing loss, neurologic complications, and even mortality

little controversial because there’s some concern that using dexamethasone reduces the penetration of the antibiotic into the CNS by reducing the meningeal inflammation

BUT GUIDELINES STILL RECOMMEND DEXAMETHASONE - -NOT ENOUGH EVIDENCE

31
Q

Give 3 patient scenarios in which the IDSA recommends giving dexamethasone

A

-infants and children with H. Influenzae meningitis

-infants and children with pneumococcal meningitis (weigh risks and beneftis)

-adults with pneumococcal meningitis

32
Q

when is dexamethasone administered in bacterial meningitis patients

A

before or with the 1st dose of antibiotics

33
Q

dose of dexamethasone for bacterial meningitis

A

0.15mg/kg every 6 hours for 2-4 days

MAX IS 10MG A DAY

34
Q

what should be monitored when bacterial meningitis patient is on dexamethasone? they should be discontinued if what?

A

monitor for GI bleed and hyperglycemia

discontinue if other pathogens are identified - dont NEED ot continue for the 2-4 days

35
Q

antimicrobial chemoprophylaxis is recommended for whom and for what meningitis

A

MENINGOCOCCAL MENINGITIS

for close contacts

36
Q

name some things that consider a person as a “close contact” and should get antimicrobial chemoprophylaxis

A

-directly exposed to oral secretions during 7 days before symptom unset and until 24 hrs after starting AB

-day care contacts, hosehold members, roomates, kissing, mouth-mouth, endotracheal intubation (whoever performed it)

37
Q

when should antimicrobial chemoprophylaxis for close contacts to meningococcal meningitis patients be intiated?

A

ASAP

ideally less than 24 hrs after indentifying the OG pt

38
Q

3 drug and doses used for antimicrobial chemoprophyalxis for close contacts to meningococcal meningitis patients

A

cipro - 500mg ONCE

rifampin - 600mg Q12 x 2 days

ceftriazone - 250mg IM ONCE (FOR PREGNANCY)

39
Q

true or false

adjunctive use of corticosteroids is NOT recommended for streptococcus pneumoniae in children

A

FALSE

recommended in strep pneumoniae for both kids and adults

40
Q

true or false

adjunctive corticosteroids are recommended for meningitis due to H. influenzae in children

A

TRUE

41
Q

true or false

adjunctive corticosteroids are NOT recommended in adults with meningitis due to nisseria monocytogenes

A

TRUE - not recommended

only for adults with pnemococcal meningitis (strep pneumoniae)

42
Q

someone was in contact with index patient of bacterial meningitis. they drove them to work for a 10 min car ride 2 weeks ago

is prophylactic chemotherapy warrented?

A

NO

43
Q

69 year old brought to ER with altered mental status. lumbar puncture with CSF analysis showed elevated white blood cells, elevated protein, and low glucose

what empiric therapy should be started

A

vanomycin
ceftriaxone
ampicillin
dexamethasone

we use dexamethasone still. only used for strep pneumoniae bacterial meningitis, but we can still start empirically, if the cultures come back and its NOT strep pneumoniae, then we can discontinue

44
Q

patient was started on vancomycin, ceftriaxone, ampicillin, and dexamethasone empirically

cultures come back as neisseria meningitidis PENICILLIN RESISTANT

what is appropriate course of action

A

de-escalate to CEFTRIAXONE - 3rd gen cephalosporin - good against gram negative

discontinue dexamethasone (not strep pneumoniae) and start chemoprophylaxis for ciprofloxacin for close contact

45
Q
A

D&D Infectious Disease Midterm (26 decks)

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