E4 Bloodstream + catheter infxns Flashcards
most important diagnostic tool for SAB
blood cultures
how often do you get blood cultures for SAB
repeat (2 sets) q48-72h until negative
what echocardiography is performed first?
transthoracic echocardiography (TTE)
preferred for MRSA bacteremia
A. TTE
B. TEE
B
what bacteria has many virulence factors for prosthetic devices and catheters
Staph aureus
if you are unable to remove IV catheters and prosthetic devices in pt with SAB infection what can you do?
MAY add rifampin
Catheter management in pts with SAB infection:
short term cath:
long term cath:
-remove asap
- remove unless major contraindication
what would be considered a long term cath
dialysis
what two bacteria do you empirically cover in staph aureus bacteremia
MSSA and MRSA
2 empiric tx options for s. aureus bacteremia
vanc
dapto
what are 3 options you can use for MSSA bacteremia that arent vanc or dapto
- naf
- ox
- cefazolin
2 tx options for MRSA bacteremia
vanc
dapto
may be used in some pts w/ septic pulmonary emboli *
A. vanc
B. dapto
B
3 options for tx of MSSA bacteremia
NAF
OX
Cefazolin
why dont you want to use VANC in MSSA bacteremia
inferior and inc risk of mortality
Do you consider rifampin in MSSA bacteremia? why or why not?
no, no diff in outcome, drug interactions
T or F:
most clinicians decide to do combo therapy for SAB for better outcomes
false, he said most dont*
T or F:
there is no difference in duration of bacteremia or length of stay
true
when may it be reasonable to employ combo therapy w/ vanc or dapto in MRSA bacteremia? what 2 options would you consider?
early in the course, esp if pt is at high risk of tx failure or death.
PBP-1 active B-lactam or ceftaroline
duration of tx for UNcomplicated SAB
14 days of IV therapy from 1st negative blood culture
duration of tx for complicated SAB
4 weeks
duration of tx for complicated SAB w/ metastatic infection
6-8 weeks
when do you use oral options for SAB
never idiot
what are all 5 criteria that MUST be met to be considered uncomplicated SAB?
- 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
main other GP cocci that can cause bacteremia
streptococci
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
two tx options for bacteremia due to S. pyogenes or S. agalactiae
- IV penicillin
- high dose amoxicillin
two tx options for bacteremia due to S. pneumoniae
ceftriaxone
penicillin (if susceptible)
duration of tx for bacteremia due to enterococci
7 days*
2 tx options for bacteremia due to enterococcus faecalis.
First line _
if allergy _
- amp
- vanc or dapto
2 tx options for bacteremia due to entero faecium:
- if vanA and vanB negative -> vanc
- if vanA or vanB positive (VRE) -> dapto or linezolid
duration of uncomplicated GN bacteremia
7 days
T or F:
Blood cultures are recommended every time for both GP and GN bactermia
false, do not always need it for GN
which GN bacteria is the biggest risk for GN bacteremia
pseudomonas
“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
Tx of uncomplicated GN bacteremia:
when going IV -> PO what are the 3 tx options typically chosen?
- TMP/SMZ
- FQ
- B-lactam
