Bloodstream Infections Flashcards
Define: Bacteremia
presence of viable microorganism in the bloodstream
primary and secondary bacteremias
Define: Fungemia
presence of fungi in the bloodstream
Define: Septicemia
active multiplication of bacteria in the bloodstream resulting in asystemic infection
What are the causes of bloodstream infections?
- central lines
- hemodialysis
- infected heart lines
- urinary tract infections
- poor dentition
- animal/human bites
- IV drug users
- trauma
When would vancomycin be used empirically for blood stream infections?
suspected staphylococcus, streptococcus, enterococcus
remove infection source
vanc is always unless VRE is suspected
What drugs are used empirically for suspected VRE infection?
- daptomycin
- linezolid
- quinupristin/dalfopristin
When would aminoglycosides be added to therapy for blood stream infections?
added empirically for synergy against gram positive pathogens; also makes cell wall inhibitors bacterialcidal against enterococcus
What are the risk factors for pseudomonas blood stream infection?
- immunodeficiency
- age > 90
- antibiotic use in the last 30 days
- CVC
- urinary devices
- cystic fibrosis
- COPD
- ventilator use
- prolonged hospital stay
When should anti-pseudomonal beta-lactams be added to empiric treatment?
- neutopenic
- sepsis
- known colonization with gram negative bacteria
- femoral catheter
- intra-abdominal or urinary tract infection
When should fluconazole or echinocandin be added to empiric treatment?
- transplant patients
- cancer patients
- TPN use
- history of prolonged use of broad spectrum antibiotics
- known fungal colonization
- femoral catheter
When would IV antibiotics be used for blood stream infections?
colonization with staphylococcus or enterococcus; infection source within the body
When would oral antibiotics be used for blood stream infections?
colonization with streptococcus; infection source is UTI
What is the empiric treatment for suspected pseudomonas?
antipseudomonal agents + aminoglycoside
What antipseudomonal drugs may be used in suspected pseudomonas empiric therapy?
- cefepime 2g IV Q8H
- carbapenems (NOT ertapenem!), meropenem 1g Q8H
- ceftazidime 2g Q8H
- piperacillin/tazobactam 4.5g Q6H or 3.375g Q8H
What is the duration of therapy for pseudomonas blood stream infection?
14 days from negative cultures
What is the empiric treatment for fungemia blood stream infection?
- 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
What is the duration of therapy for fungemia blood stream infection?
14 days
What classifies a catheter-related blood stream infection as complicated?
infective endocarditis, osteomyelitis, phlebitis
What is the treatment for complicated catheter-related blood stream infections?
- remove catheter AND…
- IV antibiotics for 4-6 weeks for infective endocarditis and phlebitis or 6-8 weeks for osteomyelitis
What is the treatment for uncomplicated, Staph. epidermidis catheter-related blood stream infection?
- remove catheter & IV antibiotics for 5-7 days
- keep catheter & IV antibiotics + sterilization of infected line (antibiotic lock) for 10-14 days
What is the treatment for uncomplicated, Staph. aureus catheter-related blood stream infection?
remove catheter & IV antibiotics for at least 14 days
What is the treatment for uncomplicated, gram-negative rods catheter-related blood stream infection?
remove catheter & IV antibiotics for 7-14 days
What is the treatment for uncomplicated, candida spp. catheter-related blood stream infection?
remove catheter & IV antifungal for 14 days after the first negative culture
What is the duration of therapy for catheter-related infective endocarditis?
4-6 weeks
What is the duration of therapy for catheter-related phlebitis?
4-6 weeks
What is the duration of therapy for catheter-related osteomyelitis?
6-8 weeks
What is the duration of therapy for uncomplicated, catheter-related blood stream infection, Staph. epidermidis?
5-7 days if catheter removed, but 10-14 days if catheter stays in
What is the duration of therapy for uncomplicated, catheter-related blood stream infection, Staph. aureus?
14 days
What is the duration of therapy for catheter-related, uncomplicated, blood stream infection, gram negative rods?
7-14 days
What is the duration of therapy for catheter-related, uncomplicated, blood stream infection, candida spp.?
14 days after the first negative culture
When should cultures be taken in blood stream infection?
before the start of treatment and every 48h because negatived culture needed for tgreatment duration
