E4 Bloodstream + catheter infxns Flashcards

1
Q

most important diagnostic tool for SAB

A

blood cultures

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2
Q

how often do you get blood cultures for SAB

A

repeat (2 sets) q48-72h until negative

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3
Q

what echocardiography is performed first?

A

transthoracic echocardiography (TTE)

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4
Q

preferred for MRSA bacteremia
A. TTE
B. TEE

A

B

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5
Q

what bacteria has many virulence factors for prosthetic devices and catheters

A

Staph aureus

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6
Q

if you are unable to remove IV catheters and prosthetic devices in pt with SAB infection what can you do?

A

MAY add rifampin

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7
Q

Catheter management in pts with SAB infection:
short term cath:
long term cath:

A

-remove asap
- remove unless major contraindication

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8
Q

what would be considered a long term cath

A

dialysis

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9
Q

what two bacteria do you empirically cover in staph aureus bacteremia

A

MSSA and MRSA

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10
Q

2 empiric tx options for s. aureus bacteremia

A

vanc
dapto

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11
Q

what are 3 options you can use for MSSA bacteremia that arent vanc or dapto

A
  • naf
  • ox
  • cefazolin
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12
Q

2 tx options for MRSA bacteremia

A

vanc
dapto

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13
Q

may be used in some pts w/ septic pulmonary emboli *
A. vanc
B. dapto

A

B

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14
Q

3 options for tx of MSSA bacteremia

A

NAF
OX
Cefazolin

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15
Q

why dont you want to use VANC in MSSA bacteremia

A

inferior and inc risk of mortality

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16
Q

Do you consider rifampin in MSSA bacteremia? why or why not?

A

no, no diff in outcome, drug interactions

17
Q

T or F:
most clinicians decide to do combo therapy for SAB for better outcomes

A

false, he said most dont*

18
Q

T or F:
there is no difference in duration of bacteremia or length of stay

19
Q

when may it be reasonable to employ combo therapy w/ vanc or dapto in MRSA bacteremia? what 2 options would you consider?

A

early in the course, esp if pt is at high risk of tx failure or death.
PBP-1 active B-lactam or ceftaroline

20
Q

duration of tx for UNcomplicated SAB

A

14 days of IV therapy from 1st negative blood culture

21
Q

duration of tx for complicated SAB

22
Q

duration of tx for complicated SAB w/ metastatic infection

23
Q

when do you use oral options for SAB

A

never idiot

24
Q

what are all 5 criteria that MUST be met to be considered uncomplicated SAB?

A
  • Exclusion of endocarditis (negative TTE, TEE)
  • No indwelling or implantable devices or prostheses (prosthetic heart valve, pacemaker, prosthetic joints, vascular grafts, etc).
  • Follow-up blood cultures drawn 2-4 days after initiating IV therapy and removal of the presumed focus on infection are negative.
  • Patient defervesced with 48-72 hours after initiating IV therapy and removal of the presumed focus on infection
  • No evidence of metastatic infection
25
main other GP cocci that can cause bacteremia
streptococci
26
bacteremia due to other GP cocci: Risk of endocarditis highest risk: (2) lowest risk: (3)
: viridans streptococci, Streptococcus gallolyticus : S. agalactiae, S. pyogenes, S. pneumoniae
27
two tx options for bacteremia due to S. pyogenes or S. agalactiae
- IV penicillin - high dose amoxicillin
28
two tx options for bacteremia due to S. pneumoniae
ceftriaxone penicillin (if susceptible)
29
duration of tx for bacteremia due to enterococci
7 days*
30
2 tx options for bacteremia due to enterococcus faecalis. First line _ if allergy _
- amp - vanc or dapto
31
2 tx options for bacteremia due to entero faecium:
- if vanA and vanB negative -> vanc - if vanA or vanB positive (VRE) -> dapto or linezolid
32
duration of uncomplicated GN bacteremia
7 days
33
T or F: Blood cultures are recommended every time for both GP and GN bactermia
false, do not always need it for GN
34
which GN bacteria is the biggest risk for GN bacteremia
pseudomonas
35
"take home point" for duration of tx in GN and enterobacter-based bacteremia
longer is not always better, 7 days showed same results as 14
36
Tx of uncomplicated GN bacteremia: when going IV -> PO what are the 3 tx options typically chosen?
- TMP/SMZ - FQ - B-lactam