Exam 1 Flashcards
What temperature is classified as a fever?
> 38ºC (100.4ºF)
What drugs can cause a drug-induced fever?
-beta-lactams
-sulfonamides
-anticonvulsants
What are systemic signs of an infection?
-hypotension
-tachycardia
-tachypnea
-fever
-abnormal WBC count
What four criteria indicate systemic inflammatory response syndrome (SIRS)?
-tachycardia
-tachypnea
-fever
-abnormal WBC count
What are non-infectious causes of an elevated WBC count?
-steroids
-leukemia
What is the most common WBC that fights infections?
mature neutrophils
What are the types of mature neutrophils?
-PMNs
-polys
-segs
What WBC is increased during infections and called a “left shift?”
immature neutrophils (bands)
What WBC is involved in allergic reactions and an immune response to parasites?
eosinophils
What WBC is associated with hypersensitivity reactions?
basophils
What WBC induces humoral and cell-mediated immunity?
lymphocytes
What WBC matures into macrophages and serves as scavengers for foreign substances?
monocytes
What type of infection is associated with leukocytosis?
bacterial infections
What types of infection is associated with lymphocytosis?
viral, fungal, or tuberculosis infections
How should procalcitonin be measured during hospitalization to assess response to therapy and when to discontinue antibiotics?
serial measurements every 1-2 days
minimum inhibitory concentration (MIC)
lowest antimicrobial concentration that prevents visible growth
breakpoint
MIC or zone diameter value used to categorize an organism as susceptible, susceptible-dose dependent, intermediate, resistant, or non-susceptible
What lab test is the gold standard for MIC testing?
broth dilution
What cannot be derived from a disk diffusion assay?
MIC
What is the mnemonic for factors to consider when selecting an antibiotic?
Infections Scare People So Really Practice Memorizing Drugs
What does the mnemonic for factors to consider when selecting an antibiotic stand for?
-indication
-source
-pathogens
-spectrum of activity
-resistance patterns
-PK/PD parameters
-monitoring parameters
-duration of therapy
What are symptoms that may indicate the presence of an infection?
-chills
-rigors
-malaise
-mental status changes
What change in WBC count drastically increases the risk of infection?
neutropenia
What two acute phase reactants indicate inflammation when increased, but do not confirm infection?
ESR and CRP
When are gradient strip tests used for susceptibility testing?
-for newer agents without other means of testing
-for agents that may not be in standard panels for automated testing
What are examples of antimicrobial stewardship strategies?
-antibiotic de-escalation
-prospective audit and feedback
-pre-authorization
-antibiotic timeout
-development of policies and protocols aimed at optimizing antimicrobial use
-creation of order sets aimed at optimal antibiotic selection for different disease states
What are the core elements of an antimicrobial stewardship program?
-leadership commitment
-accountability
-pharmacy expertise
-action
-tracking
-reporting
-education
What color is Gram-positive bacteria stained?
purple
What shapes are Gram-positive bacteria?
cocci and bacilli
How are each of the Gram-positive bacteria shapes further differentiated?
anaerobic vs. aerobic
What is the prefix of bacteria that are Gram-positive, anaerobic cocci?
pepto
How are Gram-positive aerobic bacteria further differentiated?
clusters vs. pairs/chains
Are clusters catalase positive or negative?
positive
How are Gram-positive, aerobic cocci clusters further differentiated?
coagulase +/-
What bacteria is Gram-positive, aerobic cocci clusters that are coagulase positive?
Staphylococcus aureus
What bacteria is Gram-positive, aerobic cocci clusters that are coagulase negative?
Staphylococcus epidermidis
How are Gram-positive, aerobic cocci pairs/chains further differentiated?
alpha, beta, or gamma hemolysis
What bacteria are Gram-positive, aerobic cocci pairs/chains with alpha hemolysis?
-Streptococcus pneumoniae
-Viridans streptococci
What bacteria are Gram-positive, aerobic cocci pairs/chains with beta hemolysis?
-Streptococcus pyogenes
-Streptococcus agalactiae
What bacteria are Gram-positive, aerobic cocci pairs/chains with gamma hemolysis?
Enterococcus species
What bacteria are Gram-positive, anaerobic bacilli?
-Clostridium species
-Clostridioides difficile
-Cutibacterium
-Actinomyces
What bacteria are Gram-positive aerobic bacilli?
-Bacillus
-Corynebacterium
-Lactobacillus species
-Listeria monocytogenes
Which bacteria shape is more medically important for Gram-positive bacteria?
cocci
What bacteria are Gram-negative cocci?
-Neisseria
-Moraxella
What shapes are Gram-negative bacteria?
-cocci
-coccobacilli
-bacilli
What bacteria is Gram-negative coccobacilli?
Haemophilus
How are Gram-negative bacilli further differentiated?
anaerobic vs. aerobic
What bacteria are Gram-negative anaerobic bacilli?
-Bacteroides
-Veillonella species
-Fusobacterium
-Prevotella
How are Gram-negative aerobic bacilli further differentiated?
-fastidious
-non-enteric
-enterobacterales
What bacteria are Gram-negative, aerobic, fastidious bacilli?
-Campylobacter
-Helicobacter
-Bartonella
-HACEK
What bacteria are Gram-negative, aerobic bacilli that are lactose fermenters?
-Vibro cholerae
-Aeromonas hydrophilia
-Pasteurella multocida
What bacteria are Gram-negative, aerobic bacilli that are non-lactose fermenters?
-Acinetobacter species
-Alcaligenes species
-Burkholderia cepacia
-Pseudomonas species
-Stenotrophomonas maltophilia
How are Gram-negative, aerobic, enterobacterales bacilli further differentiated?
lactose vs. non-lactose fermenters
What bacteria are Gram-negative, aerobic, enterobacterales bacilli that are lactose fermenters?
-Citrobacter species
-E. coli
-Enterobacter species
-Klebsiella species
What bacteria are Gram-negative aerobic, enterobacterales bacilli that are non-lactose fermenters?
-Morganella morganii
-Proteus species
-Providencia species
-Salmonella species
-Shigella species
-Serratia marcescens
What is an acronym to remember the Gram-negative, aerobic, enterobacterales bacilli that are lactose fermenters?
CEEK lactose
What are the types of Amber Class A beta-lactamases?
-narrow spectrum beta-lactamases
-extended spectrum beta-lactamases (ESBLs)
-serine carbapenemases
What are the Amber Class B beta-lactamases?
metallo-beta-lactamases
What are the Amber Class C beta-lactamases?
cephalosporinases
What are the Amber Class D beta-lactamases?
OXA-type
What is the most common type of ESBL in the U.S.?
CTX-M
What bacteria are CTX-M most prevalent in?
-E. coli
-Klebsiella pneumoniae/oxytoca
-Proteus mirabilis
What is the treatment of choice for ESBLs?
carbapenems
What is the most common type of carbapenemase?
KPC
What bacteria are KPC found in?
-K. pneumoniae
-K. oxytoca
-E. coli
-E. cloacae
-E. aerogenes
-P. mirabilis
What are the treatment options for carbapenemases?
-beta-lactam with beta-lactamase inhibitor
-plazomicin
-eravacycline
-omadacycline
What is the most common type of metallo-beta-lactamase?
NDM
What are the treatment options for metallo-beta-lactamases?
-cefiderocol
-aztreonam + ceftazidime/avibactam
What bacteria are OXA-type found in?
-Acinetobacter baumannii
-Pseudomonas aeruginosa
What are the treatment options for OXA-type?
-cefiderocol
-sulbactam/durlobactam
What is the acronym for bacteria that AmpC is present in?
HECK YES MA’AM
What bacteria have AmpC present?
-Hafnia alvei
-Enterobacter cloacae
-Citrobacter freundii
-Klebsiella aerogenes
-Yersinia entercolitica
-Serratia marcescens
-Morganella morganii
-Aeromonas hydrophila
What is the first-line treatment for AmpC?
cefepime
What is an example of an altered cell wall precursor resistance mechanism?
vancomycin resistance in Enterococci species
What two genes mediate vancomycin resistance in Enterococci species?
VanA and VanB
What gene produces altered penicillin binding proteins?
mecA
What are two examples of resistance mechanisms due to changes in efflux pumps?
-P. aeruginosa against carbapenems
-S. pneumoniae against macrolide antibiotics
What are two examples of resistance mechanisms due to changes in porin channels?
-Enterobacterales
-carbapenem-resistant P. aeruginosa
Are beta-lactams time- or concentration-dependent?
time-dependent
Are fluoroquinolones time- or concentration-dependent?
concentration-dependent
Are aminoglycosides time- or concentration-dependent?
concentration-dependent
What is vancomycin PK/PD dependent on?
AUC/MIC
What are strategies to optimize beta-lactam dosing?
-increase dose, same interval
-same dose, shorter interval
-continuous infusion
-prolonged infusions
