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IPT: ID > Block 2 - CNS, SSTI, DFI > Flashcards

Block 2 - CNS, SSTI, DFI Flashcards

1
Q

What AB have good penetration to CNS?

A

Penicillins such as aq. Pen G, Nafcillin, and Ampicillin

Ceph such as ceftriaxone, ceftazidime, and cefepime

Carbapenems

Others such as Bactrim, Vanco, Oxazolidinones, cipro, and moxi

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2
Q

Risk factors of CA meningitis?

A

Lack of vaccinations/Immunocompromised

Asplenic

Dental procedures

Endocarditis

Unpasteurized dairy

CVC or shunts

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3
Q

CA Meningitis Patho?

A

Nasopharyngeal colonization

Transports to blood

Organisms avoid phagocytosis

Infects choroid plexus and bacteria is in CSF

**If in infants, its related to birth

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4
Q

Symptoms of CA meningits?

A

Nuchal rigidity

AMS

Photophobia

N/V

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5
Q

Signs of CA meningitis?

A

Kernig and Brudzinski’s sign

Fever

Skin lesions

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6
Q

What is Kernig’s sign?

A

Cant fully extend leg when hips are flexed

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7
Q

What is Brudzinski’s sign?

A

When neck is passively flexed, hips and knees are flexed as well

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8
Q

Besides blood cultures, what else do you need to diagnose meningitis?

A

Lumbar puncture (risk of hernication)

Strep and Listeria antigen tests

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9
Q

What are some CSF findings for CA meningitis?

A

WBC 100-1000s

Serum glucose ≤0.4

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10
Q

What are the common pathogens found in CA meningitis?

A

1 month to >50yrs old = N. meningitidis + S. pneumonniae

L. mono is found in the extremes only (<1 month and >50 yrs)

Group B strep + E. coli is found on the younger sides (<2 yrs old)

1-23 months have H. influenzae

<1 month have Klebsiella spp.

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11
Q

CA meningitis Tx for adults

Empiric AB

A

Vanco

LD 25-30mg/kg x1

MD 15-20mg/kg q8-12hr

Ceftriaxone 2g q12h

+/- Ampicillin 12g continuous for <1 month or >50yrs old

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12
Q

Adjunctive agents for CA meningitis Tx for adults?

A

Decadron 0.15mg/kg q6h for 2-4 days before 1st dose of AB

**Only for pneumococcal meningitis in adults or haemophilus in pediatrics

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13
Q

H. influenzae, beta-lactamase negative CA meningitis.

Tx?

A

Ampicillin x7 days

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14
Q

H. influenzae, beta-lactamase positive CA meningitis.

Tx?

A

3rd Gen ceph x7 days

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15
Q

L. mono CA meningitis.

Tx?

A

Ampicillin ≥21 days

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16
Q

N meningitidis CA meningitis

Tx?

A

Depends on MIC

Penicillin or ampicillin x7 days

3rd gen ceph x7 days

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17
Q

S. pneumoniae CA meningitis

Tx?

A

Depends on MIC

Penicillin or ampicillin x14 days

3rd gen ceph x14 days

Vanco x14 days

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18
Q

Monitoring parameters for CA meningitis?

A

WBC xday

CSF at baseline and x2-3 days

Vanco - measure UOP daily

Ceftriaxone - dont mix with LR + measure LFTs

Ampicillin - watch for fluid overload

Decadron - measure BP and BG daily

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19
Q

PCV13 vs PCV23

Which one should children get?

A

PCV13

Adults w/ risk factors or anyone ≥65yo can get it too

PCV23 excludes the kids

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20
Q

Who needs the ACWY vaccine?

A

Childhood vaccine, adults with risk factors for N. meningitidis

B = lab personnel or outbreak

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21
Q

Which vaccines are needed to prevent CA meningitidis?

A

S. pneumoniae (PCV13/23)

N. meningitidis (ACWY, B)

H. influenzae B

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22
Q

CA vs HA meningitidis

No instrumentation or trauma

A

CA meningitidis

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23
Q

How does the CDC define HA meningitidis?

A

One of the following from each group:

{fever/headache, meningeal or cranial signs}

+

{CSF, blood cultures, titer (positive findings)}

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24
Q

Risk factors of HA meningitidis?

A

Catheterization for >5 days

Perioperative steroids

Trauma

d/c of device

CSF shunts

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25
CA vs HA meningitidis Some patients will not present with any signs or symptoms and some will have a very mild, non-specific appearance (new fever and increased wbc)
HA meningitidis
26
What are the pathogens found in HA meningitidis?
Staph, P. acnes E. coli, enterobacter, citrobacter, P. aeruginosa
27
Empiric AB therapy for HA meningitidis?
Vanco for G+ (Staph and p. acnes) + Ceftazidime, cefepime, Merrem** (**can replace with aztreonem or cipro if allergic)
28
MSSA/MSSE HA meningitidis Tx?
Nafcillin or Oxacillin
29
MRSA/MRSE HA meningitidis Tx?
Vanco + Rifampin
30
MRSA w/ >1 MIC HA meningitidis Tx?
Zyvox, dapto, or bactrim
31
P. acnes HA meningitidis Tx?
Pen G
32
P. aeruginosa HA meningitidis Tx?
Cefepime, ceftazidime, Merrem
33
Carbapenem-resistant enterobacteriaceae HA meningitidis Tx?
Colistin or polymyxin
34
When should you put in a new device once CSF cultures are negative?
Not for at least 10 days
35
What are some common pathogens for encephalitis?
HSV
36
Risk factors for encephaltis?
STDs Geographically, travel history Insects or animals Vaccination history
37
What are some diagnostic tests you can do for encephalitis?
Blood, CSF Wound if vesicles are found (HSV, VZV) Biopsy IgG, IgM testing MRI (sensitive and specific), can do CT if MRI is nonexistent Temporal lobe enhancement
38
Encephalitis Tx?
Acyclovir 10mg/kg (IBW) q8h x 14-21 days Give with fluids to reduce nephrotoxicity
39
Risk factors for DFI?
Ulcers >30 days + probe to bone test Uncontrolled DM Renal insufficiency Loss of sensation PVD
40
Risk factors for amputation (related to DFI)?
Male, smoker Previous osteomyelitis, retinopathy PAD WBC>11 Isolation of G- organism
41
What do you need to diagnose DFI?
MRI (preferred) over X-ray Microbiology data BEFORE Deep wound cultures AFTER debridement
42
ISDA severity and DFI?
Uninfected - no signs (outpatient) Infection limited to 0.5-2cm w/ no SIRS - mild (outpatient) >2cm w/ no SIRS - moderate (out/inpatient) w/ SIRS - severe (inpatient)
43
When would you consider moving a patient with moderate DFI to inpatient side?
Severe PAD or lack of home support
44
Mild DFI, what are the bugs?
Staph and strep
45
Moderate DFI, what are the bugs?
P. aeruginosa, MSSA, MRSA
46
Severe DFI, what are the bugs?
Polymicrobial, MRSA, P. aeruginosa, Enterobacteriaceae, anaerobes
47
Risk factors of CA MRSA + DFI?
History of MRSA Mild: > 50% local MRSA Moderate: > 30% local MRSA
48
Risk factors of P. aeruginosa + DFI?
Warm climates Soaking feet Failed non-Pseudomonal therapy
49
Mild, moderate, severe DFI What routes should the Rx go through?
Mild = PO Moderate = IV, then PO Severe = IV
50
What are the treatments for uninfected DFI?
Wound care constantly
51
What are the treatments for mild DFI with no MRSA risk factors?
Amoxicillin- clavulanate Cephalexin x1-2 wks
52
What are the treatments for mild DFI with MRSA risk factors?
Bactrim Clinda Doxy x1-2 wks
53
What are the treatments for moderate DFI?
Ampicillin-sulbactam Ceftriaxone Ertapenem Piperacillin-tazobactam (Levo or Cipro) + Clindamycin x1-3wks
54
What are the treatments for severe DFI?
Anti-pseudo + anti-MRSA Rx 2-4 wks if NO bone involvement
55
What is the goal of wound care?
"create a moist wound environment to promote granulation, autolytic processes, angiogenesis, and more rapid migration of epidermal cells across the wound base" Dry = hydrate Draining = absorb Necrotic = debride
56
What bugs cause contiguous brain abscess?
Strep, Staph Polymicrobial Anaerobes
57
What bugs cause neurosurgical procedures and/or head trauma-related brain abscess?
S. aureus and epidermidis GNR
58
Abscess pathophysiology?
Bacteria enters brain through 3 routes * Contiguous (50%) * Hematogenous (33%) * Unknown (~20%) Necrosis, edema of white matter, and capsule formation (fibroblasts and neovascularization)
59
What bugs cause hematogenous brain abscess?
Staph and strep only
60
S/Sx of brain abscess?
Cranial-nerve palsy, gait disorder, hydrocephalus Seizures (~25%)
61
Empiric Abx for brain abscess are..?
Vanco LD, then MD Ceftriaxone 2g q12h Flagyl 500mg q8h
62
CA Meningitis HA Meningitis Encephalitis Brain Abscess Which one does not use CSF cultures typically?
Brain abscess
63
What is qSOFA?
Identifies sepsis Must meet 2 of 3 criteria SBP≤100 Altered mental status (Glasgow coma scale <15) Respiratory rate ≥ 22
64
Infection depth of Folliculitis, furuncles, carbuncles?
Hair follicles only
65
Infection depth of Impetigo?
Epidermis
66
Infection depth of Cellulitis & abscesses?
Epidermis, dermis, and/or hypodermis
67
Infection depth of Necrotizing fasciitis?
Hypodermis
68
What are the nonpurulent severity cases?
Mild = Typical cellulitis/erysipelas Moderate = Mild + systemic signs of infection Severe = Ppl who failed incision and drainage + oral Abx OR ppl with systemic signs of infection OR they are immunocompromised OR someone with deeper infections
69
What are the purulent severity cases?
Pretty much the same as nonpurulent, but severe criteria doesnt include the deeper signs of infection part
70
What are the nonpurulent skin conditions?
Necrotizing Cellulitis Erysipelas
71
What are the purulent skin conditions?
Furuncles Carbuncles Abscess
72
Mild nonpurulent Tx options?
Pen VK Cephalosporin Dicloxacillin Clindamycin x5 days
73
Moderate nonpurulent Tx options?
Penicillin Ceftriaxone Cefazolin Clindamycin x5 days
74
Severe nonpurulent Tx options?
Empiric = Vanco + Zosyn or merrem or imi/cilastatin x5 days
75
Mild purulent Tx options?
Incision and drainage
76
Moderate purulent Tx options?
Incision and drainage; culture and sensitivity Empiric: Bactrim or Doxy Targeted MRSA: Bactrim MSSA: Cephalexin or Dicloxacillin x5 days
77
Severe purulent Tx options?
Incision and drainage; culture and sensitivity Empiric: Vanco, dapto, zyvox, telavancin, ceftaroline MRSA = Empiric MSSA = Nafcillin, cefazolin, clindamycin x5 days
78
What are the systemic signs of infection?
>38 degree celsius >24 breaths per min <400 or >12K WBC count
79
Impetigo general information
Affects epidermis Contagious and affects children Nonbullous and bullous forms S. pyogenes and S. aureus
80
When should you use oral therapy on impetigo?
If it involves the face
81
Empiric therapy on impetigo (non oral)?
Topical mupirocin or retapamulin if mild (5 days)
82
Empiric therapy on impetigo (oral)?
Non-bullous = dicloxacillin or cephalexin Bullous = something that covers MSSA and MRSA x 7 days
83
Targeted therapy on impetigo?
Strep? Penicillin Strep + MSSA? dicloxacillin or cephalexin MRSA? Clinda, Doxy, Bactrim x 7-10 days
84
What is Ecthyma?
Deep impetigo, treat the same way as impetigo
85
What is Erysipelas
Form of cellulitis that has red burning pain lesions caused by S. pyogenes
86
How do you treat Erysipelas?
Mild/Moderate = Pen G IM or Pen VK, or clinda Severe = aq Pen G IV followed by PO PCN x7-10 days
87
What is the dose for dapto for MRSA?
6 mg/kg IV once daily x 5 days
88
Non-Pharm for Cellulitis?
Elevation and immobilization of involved area to decrease local swelling COLD compress, follow with moist heat
89
What causes type 1 NF?
Strep, enterobacteria, anaerobes Trauma/surgery, IVDU
90
What causes type 2 NF?
S. pyogenes Blunt trauma, muscle strain, now more in younger people
91
What causes type 3 NF?
C. perfringens Trauma/surgery
92
How do you treat type 1 NF?
Vanco + Zosyn
93
How do you treat type 2 NF?
Pen + Clinda
94
How do you treat type 3 NF?
Pen + Clinda
95
Which NF spreads the fastest? Slowest?
Fastest = 3 (hours) Slowest = 1 (3-5 days)
96
Non pharm treatment of NF?
Surgical debridement on all types
97
Why is penicillin and clindamycin given for type 2 and 3 NF?
Clindamycin: Suppresses streptococcal toxins and cytokine production PCN: Added in case of bacterial resistance to clindamycin
98
What is folliculitis, furuncle, and carbuncle?
Folliculitis = looks like severe acne, superficial, affect epidermis only Furuncle = affects hair shaft to SQ area, generally develop in areas of friction and perspiration Carbuncle = furuncles that combine into one, usually on the back of neck and in diabetics
99
What causes folliculitis, furuncle, and carbuncle?
Usually S. aureus
100
How do you treat folliculitis?
Warm compress Clindamycin, erythromycin, mupirocin, or benzoyl peroxide; 2-4 times daily for 7 days
101
How do you treat furuncle, and carbuncle?
Moist heat Bactrim, doxy, or mino for 5-10 days
102
Human bite bugs?
``` Viridans Streptococci Anaerobes Eikenella corrodons Staphylococcus spp. ```
103
Dog/Cat bite bugs?
``` Viridans Streptococci, Anaerobes Pasteurella multocida (esp. cat) Staphylococcus spp ```
104
DOC for bites?
Augmentin
105
(T/F) Wound closure is expected for bites?
False Except for the face, just irrigate, cautious debridement, and use preemptive antibiotics
106
Treatments for bites with PCN allergy
Moxi or doxy Bactrim or Levo or Cipro AND Flagyl or Clinda
107
Treatments for bites with someone who is pregnant?
Augmentin 2nd or 3rd Gen ceph + Flagyl or Clinda Ertapenem Bactrim (2nd trimester only) + Clinda

IPT: ID (11 decks)

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