CPS statements - ID Flashcards
Azole antifungals
- important to remember
- monitor liver enzymes
- drug drug interactions
- may prolong QT interval
Benefits of reducing antimicrobial use
- decrease adverse events
- decrease superinfections
- costs savings
- possible association between preivous abx therapy and development of obesity and allergies
Duration of antibiotics: (CPS AMS) - strep pharyngitis - children > 2 for uncomplicated AOM - uncomplicated PNA - UTIs
- Strep: 10 days
- AOM: 5 days > 2 yr (10 days if < 2 yr, recurrent or perforated TM)
- PNA: 7 days
- UTIs: 7-10 days
Risk factors for AOM
- young age
- frequent contact with other children
- household crowding
- cigarette smoke
- pacifier use
- shorter duration of breastfeeding
- prolonged bottle feeding while lying down
- family hx
- First Nations or Inuit
- low levels of IgA or biofilms in middle ear
Most common bacteria causing AOM
- S. pneumo
- H. flu
- M. catarrhalis
Less commonly: GAS (strep pyogenes)
Watchful waiting in AOM if:
- > 6 months of age
- no perforated TM with purulent drainage
- mildly ill (T<39, <48h of illness)
Risk factors for spread of CA-MRSA
- close skin-skin contact (cuts and abrasions)
- contaminated items
- crowded living conditions
- poor hygiene
- high risk populations: Athletes, daycare, Indigenous, military, IVDU, MSM, prisoners)
CA-MRSA reasons to use antibiotics after drainage
- child < 3 months of age
- significant associated cellulitis, fever or systemic signs of illnesses
(abx usually for a 7 days course after drainage e.g. septra) - child with serious medical problems
C. diff risk factors
- increased duration of hospital stay
- older age
- antibiotics
- chemotherapeutic agents
- immunosuppression
- HIV
- Hypogammaglobulinemia
- manipulation of Gi tract e.g. surgery, tube feeding
- mixed evidence for PPIs
C. diff recurrence rate
25%
C. diff mild illness vs. moderate vs. severe
Mild: watery diarrhea without systemic toxicity and < 4 abN stools
Moderate: 4+ abN stools per day, no systemic toxicity (+/- low grade fever, mild abdo pain)
Severe: high-grade fevers, rigors, hypotension, shock, peritonitis, colitis, megacolon
C. diff initial episode treatment
Mild: - discontinue antibiotic - follow up and reassess Mild/Mod: - metronidazole x 10-14 d Severe: - vancomycin PO x 10-14d First recurrence = repeat regimen for initial episode 2nd recurrence = vanco in a tapered or pulsed regimen
Features of congenital CMV
90% = asymptomatic At birth: IUGR CNS: microcephaly, seizures GI: hepatosplenomegaly Heme/Derm: petechial rash, jaundice
Treatment of congenital CMV
1) asympto
2) mildly symptomatic
3) moderate to severe
Asymptomatic (+/- SNHL): regular audiologic , no evidence for antiviral (awaiting trials for isolated SNHL)
Mild (+/- SNHL, no CNS or chorioretinitis): individualized management, consult ID
Moderate to severe: ID consult, antiviral agents, oral valgan x 6 months (IV ganciclovir can be for first 2-6 weeks if very ill)
Treatment for cCMV
and adverse events of treatment
- valganciclovir x 6 months (IV gancyclovir for first 2-6 weeks if really sick) to commence in first month
adverse events: neutropenia, thrombocytopenia, transaminases, elevated BUN and Cr
Varicella exclusion policy
- return as soon as well enough to participate normally (regardless of state of rash)
Maternal and neonatal risk factors for early onset bacterial sepsis
Maternal GBS+ Maternal GBS bacteriuria during pregnancy Previous GBS infant Maternal fever pROM > 18hrs
Adequate intrapartum antibiotic prophylaxis
- Pen G at least 4hr before birth (or cefazolin)
not clinda/erythro/vanco
Markers of early onset sepsis
WBC < 5 or >30 ANC <1.5 I:T ratio > 0.2 Procalcitonin CRP can be helpful serially
GBS +, not adequate IAP,
no other RFs (risk = 1-2%)
- examine, observe closely (VS q3-4)for at least 24hr
- reassess and counsel before discharge
GBS+ and other RFs (risk > 1-2%)
- At minimum, observe closely (Vs q3-4hrs) for at least 24hrs
- reassess and counsel before discharge
GBS negative or unknown with multiple risk factors of maternal chorioamnionitis
- At minimum observe closely VS q3-4hr for at least 24hrs
- consider CBC after 4hrs
HIV vertical transmission rate
< 2% in Canada
without intervention can be as high as 25%
Risk factors for HIV vertical transmission
- late or no prenatal care
- injection drug use
- recent illness suggestive of HIV seroconversion
- regular, unprotected sex with a partner known to be living with HIV or with sig risk for HIV
- diagnosis of STIs during pregnnacy
- emigration from an HIV-endemic area or recent incarceration