Blood Stream and CNS infections Flashcards
1. difficult to accesses infected tissue compartment pre-mortem 2. pretreatment with antimicrobials 3. organisms burden blelow limit of qualification 4. unable to be cultured with standard techniques
which organisms are usually involved in catheter related blood stream infections? CRBSI
- staphylococcus aureus
- staphylococcus epidermidis
- viridans streptococcus
- PEK
- Pseudomonas aerigonosa
- Candida
what is the empiric treatment for CRBSI?
Vancomycin +/- [cefepime or ceftazidime or pip/tazo] +/- antifungal
The vancomycing is for S.A, S. epi, viridans strept. The cefepime/ceftazidime/piptazo are for PEK and pseudomonas a.. The anti fungal would be for candida
which organisms are usually involved in bacterial meningitis (central nervous infection)
Community acquired:
- streptococcus pneumoniae
- neisseria menigiditis
- H. influenza
- Listeria (immunocompromised)
what is the empiric treatment for bacterial meningitis
Vancomycin + ceftriaxone +/- ampicillin
Vancomycin is for the streptococcus pneumoniae. The cefriaxone is for neisseria meningditis and H. Influenza and s. pneum. The ampicilling would be for the listeria.
what is bacteremia?
bacteria in the blood
what is fungemia?
fungi in the blood
what is viremia?
viruses in the blood
what is septicemia?
microorganisms in the blood plus signs/symptoms of sepsis syndrome:
tachycardia
hypotension
elevated WBC etc
what are the complications of CRBSI?
- organism enters blood stream and it leads to SIRS or sepsis syndrome
- metastasis: seeding of other organs like heart valves, cps, liver, kidney, blood vessels, eye
what are the signs and symptoms of CRBSI?
local: redness tenderness warmth pain at catheter site Systemic: fever chills increased WBC
how do they diagnose CRBSI?
they perform blood cultures by taking samples of blood through the catheter and via peripheral venipuncture (another area on the opposite side of where catheter is). If both samples are positive for bacteria. determine if catheter is the source.
- do a differential time to positivity: if the catheter culture turns + greater than 2 hours before the peripheral line (then catheter is the source)
- Do a quantitative culture count: if the catheter culture CFU is greater than 3 fold greater than peripheral (then catheter is the source)
what conditions make the invading organism to be more like likely PEK, pseudomonas, enteroccocus or candida in CRBSI?
- hospitalization >5 days
- they had antibiotics within 7 days
- high risk/high severity patient: immunocompromised and SIRS/sepsis
how long should therapy be for uncomplicated CRBSI infections? what about for complicated infections?
s. epidermis: 5-7 days
s. aureus and PEK and Pseudomonas: 14 days
Candida: 14 days
Complicated infections: 4-6 weeks
what does it mean to have complicated CRBSI?
it means that you have another complication such as septic throbophlebitis, endocardidts, osteomyelitis, or persistently positive blood culture on therapy
what are the signs and symptoms of bacterial meningitis?
Fever headahce altered mental status (AMS) Stiff neck photophobia nausea/vomiting seizure brudzinki's sign kerinig's sign
for bacterial meningitis, what is the onset time?
12-24 hours
for viral meningitis, what is the onset time/
1-5 days
for fungal meningitis, wat is the onset time?
days to weeks
for mycobacterial meningitis ,what is the onset time?
days to weeks
what is the Empiric treatment of bacterial meningitis for a person <1month old?
cefotaxime + ampicillin
what is the Empiric treatment of bacterial meningitis for a person 1-23 months old?
[cefotaxime or ceftriaxone] + vancomycin
also add:
dexamethasone 0.15mg/kg q6h with or before first dose of antibiotics. Continue for x2-4 days unless: cultures are negative for H.influenzae or strep pneumo. Make sure there are no contraindications to dexamethasone
what is the Empiric treatment of bacterial meningitis for a person 2-50 years old?
[cefotaxime or ceftriaxone] + vancomycin
also add:
dexamethasone 0.15mg/kg q6h with or before first dose of antibiotics. Continue for x2-4 days unless: cultures are negative for H.influenzae or strep pneumo. Make sure there are no contraindications to dexamethasone
what is the Empiric treatment of bacterial meningitis for a person >50 years old or immunocompromised?
[cefotaxime or ceftriaxone] + vancomycin + ampicillin
also add:
dexamethasone 0.15mg/kg q6h with or before first dose of antibiotics. Continue for x2-4 days unless: cultures are negative for H.influenzae or strep pneumo. Make sure there are no contraindications to dexamethasone
who should get a vaccine for S. pneumoniae?
children 2-15 mos Age >65 Chronic disease immunocompromised Asplenia: absence of spleen function
who should get a vaccine for H. influenza
children 2-15mos
asplenia
who should get a vaccine for n. meningiditis?
children 11-12years college freshmen in dorms military recruits travelers to endemic areas asplenia
who should get bacterial meningitis prophylaxis?
close contact with people who had documented n. meningidits: roommates, family, health care workers with exposure to oral secretions.
Exposure must be 7 days before symptoms and 24 hours after antibiotic treatment
what are the regimens for N. meningiditis prophylaxis ?
rifampin 600mg po bid x 2 days
ceftriaxone 125mg iv x 1
ciprofloxacin 500mg po x 1
what are the most likely pathogens in Bacterial meningitis in patients <1mo?
Group B strep
E and K
listeria
what are the most likely pathogens in Bacterial meningitis in patients 1-23mos?
Group B strep strept pneumoniae E N. meningiditis H. influenza
what are the most likely pathogens in Bacterial meningitis in patients 2-50years old?
S. pneumoniae
N. Meningiditis
what are the most likely pathogens in Bacterial meningitis in patients >50yo?
Strept pneumoniae
N. mengiditis
Gram N bacilli
listeria
what are the most likely pathogens in bacterial meningitis in post surgical patients?
Staphylococcus
Gram N rods
pseudomonas
