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Therapeutics 3 > Bloodstream Infections > Flashcards

Bloodstream Infections Flashcards

1
Q

Define: Bacteremia

A

presence of viable microorganism in the bloodstream

primary and secondary bacteremias

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2
Q

Define: Fungemia

A

presence of fungi in the bloodstream

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3
Q

Define: Septicemia

A

active multiplication of bacteria in the bloodstream resulting in asystemic infection

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4
Q

What are the causes of bloodstream infections?

A
  • central lines
  • hemodialysis
  • infected heart lines
  • urinary tract infections
  • poor dentition
  • animal/human bites
  • IV drug users
  • trauma
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5
Q

When would vancomycin be used empirically for blood stream infections?

A

suspected staphylococcus, streptococcus, enterococcus

remove infection source

vanc is always unless VRE is suspected

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6
Q

What drugs are used empirically for suspected VRE infection?

A
  • daptomycin
  • linezolid
  • quinupristin/dalfopristin
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7
Q

When would aminoglycosides be added to therapy for blood stream infections?

A

added empirically for synergy against gram positive pathogens; also makes cell wall inhibitors bacterialcidal against enterococcus

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8
Q

What are the risk factors for pseudomonas blood stream infection?

A
  • immunodeficiency
  • age > 90
  • antibiotic use in the last 30 days
  • CVC
  • urinary devices
  • cystic fibrosis
  • COPD
  • ventilator use
  • prolonged hospital stay
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9
Q

When should anti-pseudomonal beta-lactams be added to empiric treatment?

A
  • neutopenic
  • sepsis
  • known colonization with gram negative bacteria
  • femoral catheter
  • intra-abdominal or urinary tract infection
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10
Q

When should fluconazole or echinocandin be added to empiric treatment?

A
  • transplant patients
  • cancer patients
  • TPN use
  • history of prolonged use of broad spectrum antibiotics
  • known fungal colonization
  • femoral catheter
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11
Q

When would IV antibiotics be used for blood stream infections?

A

colonization with staphylococcus or enterococcus; infection source within the body

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12
Q

When would oral antibiotics be used for blood stream infections?

A

colonization with streptococcus; infection source is UTI

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13
Q

What is the empiric treatment for suspected pseudomonas?

A

antipseudomonal agents + aminoglycoside

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14
Q

What antipseudomonal drugs may be used in suspected pseudomonas empiric therapy?

A
  • cefepime 2g IV Q8H
  • carbapenems (NOT ertapenem!), meropenem 1g Q8H
  • ceftazidime 2g Q8H
  • piperacillin/tazobactam 4.5g Q6H or 3.375g Q8H
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15
Q

What is the duration of therapy for pseudomonas blood stream infection?

A

14 days from negative cultures

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16
Q

What is the empiric treatment for fungemia blood stream infection?

A
  • echinocandins (micafungin 100mg daily, caspofungin 70mg on day one then 50mg daily, anidulafungin 200mg on day one then 100mg daily)
  • amphotericin 3-5mg/kg/day
  • voriconazole 400mg BID for 2 doses then 200-300mg BID

IV only therapy

17
Q

What is the duration of therapy for fungemia blood stream infection?

A

14 days

18
Q

What classifies a catheter-related blood stream infection as complicated?

A

infective endocarditis, osteomyelitis, phlebitis

19
Q

What is the treatment for complicated catheter-related blood stream infections?

A
  • remove catheter AND…
  • IV antibiotics for 4-6 weeks for infective endocarditis and phlebitis or 6-8 weeks for osteomyelitis
20
Q

What is the treatment for uncomplicated, Staph. epidermidis catheter-related blood stream infection?

A
  • remove catheter & IV antibiotics for 5-7 days
  • keep catheter & IV antibiotics + sterilization of infected line (antibiotic lock) for 10-14 days
21
Q

What is the treatment for uncomplicated, Staph. aureus catheter-related blood stream infection?

A

remove catheter & IV antibiotics for at least 14 days

22
Q

What is the treatment for uncomplicated, gram-negative rods catheter-related blood stream infection?

A

remove catheter & IV antibiotics for 7-14 days

23
Q

What is the treatment for uncomplicated, candida spp. catheter-related blood stream infection?

A

remove catheter & IV antifungal for 14 days after the first negative culture

24
Q

What is the duration of therapy for catheter-related infective endocarditis?

A

4-6 weeks

25
Q

What is the duration of therapy for catheter-related phlebitis?

A

4-6 weeks

26
Q

What is the duration of therapy for catheter-related osteomyelitis?

A

6-8 weeks

27
Q

What is the duration of therapy for uncomplicated, catheter-related blood stream infection, Staph. epidermidis?

A

5-7 days if catheter removed, but 10-14 days if catheter stays in

28
Q

What is the duration of therapy for uncomplicated, catheter-related blood stream infection, Staph. aureus?

A

14 days

29
Q

What is the duration of therapy for catheter-related, uncomplicated, blood stream infection, gram negative rods?

A

7-14 days

30
Q

What is the duration of therapy for catheter-related, uncomplicated, blood stream infection, candida spp.?

A

14 days after the first negative culture

31
Q

When should cultures be taken in blood stream infection?

A

before the start of treatment and every 48h because negatived culture needed for tgreatment duration

Therapeutics 3 (19 decks)

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