Exam 4: Bloodstream + Catheter-Related Infections Flashcards
Staph aureus Bacteremia (SAB) is the leading cause of what?
Community-acquired and Hospital-acquired bacteremia
How do we diagnose Staph Aureus Bacteremia?
Blood Cultures*
-repeat (2 sets) every 48-72 hours until they come back negative
-day they come back negative becomes Day 0 of antibiotic therapy
Echocardiogram (in all SAB patients)
-Transthoracic echoocardiography (TTE) performed first
-Transesophageal echocardiography (TEE) is not first since it is more evasive but it is more sensitive
Who should receive a TEE?
All patients with community-acquired SAB
True or False: Staph aureus is a common organism in UTIs
False
True or False: if a patient has staph aureus in their urine there is a high likelihood that they have it other places too
True
(likely got translocated from the blood to the urine)
What assumption should we make regarding all IV catheters and prosthetic devices in patients infected with SAB?
Assume all catheters and prosthetic devices are infected
If a prosthetic device is not able to be removed in a patient with SAB, how should treatment be adjusted?
May add rifampin (not with vanc)
May need long-term suppressive therapy
When can we replace a catheter after removing it in someone with SAB?
Replace when blood cultures are negative for 48-72 hours
What is the empiric therapy used in SAB to cover MSSA and MRSA?
*Vancomycin
or
Daptomycin
What other therapy can we add onto Vancomycin in SAB for patients with a very high risk of mortality (sepsis, endocarditis, intravascular device)?
Add an MSSA-specific agent to vanco
(nafcillin, oxacillin, cefazolin)
True or False: we should deescalate to beta-lactam therapy in SAB patients with MSSA
FALSE
-this has worse outcomes than starting with two initial agents
What is the treatment for MRSA Bacteremia?
Vancomycin
or
Daptomycin
True or False: We can add gentamicin or rifampin with vancomycin if a prosthetic device cannot be removed
FALSE
-never add these with vanc, it is not recommended and can lead to worse outcomes
What is the treatment for MSSA bacteremia?
Nafcillin
Oxacillin
Cefazolin
What drugs should not be used in Methicillin Sensitive S. aureus (MSSA) Bacteremia?
Vancomycin (inferior)
Rifampin combo (no benefit)
Aminoglycosides (gentamicin, tobramycin, amikacin, plazo)
What criteria must SAB meet to be considered Uncomplicated? (must meet all)
No endocarditis
No indwelling or implantable devices or prosthetics
Follow-up blood cultures drawn 2-4 days after initiating IV therapy are negative
Patient’s fever goes away within 48-72 hours after initiating IV therapy
No evidence of metastatic infection
What is the duration of uncomplicated SAB therapy?
14 days from first negative blood culture
What is the duration of therapy of complicated SAB?
4 weeks
What is the duration of therapy of complicated SAB with metastatic infection?
6-8 weeks
What is the current recommendation regarding drug dosage forms?
IV therapy for full treatment duration
How does streptococci bacteremia differ from S aureus?
These patients CAN be transitioned to oral therapy
How long is the duration of treatment for streptococci bacteremia?
14 days
What organisms are considered “enterococci”
E. faecalis
E. faecium
What is the duration of enterococci bacteremia treatment?
7 days
(note that this is half the time of other kinds)
What is the treatment for E. faecalis bacteremia (enterococci)?
Ampicillin
*if amp or B-lactam allergic: vanco or daptomycin
What is the treatment for E. faecium bacteremia (enterococci)?
If vanA and vanB negative: Vancomycin
If vanA or vanB positive (VRE): Daptomycin or Linezolid
How does the duration of therapy for treatment of Uncomplicated Gram Negative Bacteremia (pseudomonas) differ from Staph aureus?
Duration is 7 days
this is total days of therapy, it does not start at day 0
Can we use po therapy for treatment of Uncomplicated Gram Negative Bacteremia (pseudomonas)?
YES
-when clinically improved and able to take po
What is the take home point regarding bacteremia therapy?
Longer duration of therapy is not always better
(for uncomplicated infection)
Which forms of bacteremia require repeat blood cultures until negative?
S aureus only!
What is an important take home message about dosage forms in s aureus bacteremia?
DO NOT CONVERT TO PO THERAPY
ONLY USE IV
