Exam 5 - Treatment of Bacteremia

Question 1

How long do you usually treat S. aureus for?

Answer 1

6 weeks, there are a few exceptions that warrant 14 days of treatment

Question 2

What is the term for bacteria in the bloodstream?

Answer 2

BACTEREMIA

Question 3

What metastatic infections are caused by bacteremia?

Answer 3

1) Endocarditis
2) Osteomyelitis
3) Septic joint infections
4) Meningitis

Question 4

What can bacteremia be a complication of?

Answer 4

• Pneumonia
• Cellulitis
• Pyelonephritis

Question 5

What is the number one cause of bacteremia?

Answer 5

S. aureus

Question 6

Name the number 1 cultured organism.

Answer 6

E. coli

Question 7

What ANC value is indicative of the greatest risk of having bacteremia?

Answer 7

<500

Question 8

What lab value differentiates bacterial infections from viral infections?

Answer 8

PROCALCITONIN

Question 9

What does a procalcitonin level do?

Answer 9

If elevated, it differentiates between a bacterial infection and a viral infection

Question 10

How many cc (or mL) are in one blood culture?

Answer 10

20 cc (mL)

Question 11

How many blood cultures are usually drawn?

Answer 11

Two (40 cc or mL)

Question 12

What does it mean when organisms are facultative?

Answer 12

They can grow aerobically or anaerobically

Question 13

T/F: Normal WBC does not rule out bacteremia.

Answer 13

TRUE

Question 14

Name the two types of bacteremia.

Answer 14

1) Intermittent

2) Continuous

Question 15

What is the most common type of bacteremia?

Answer 15

INTERMITTENT

Question 16

Name the 8 real clinical pathogens.

Answer 16

1) S. aureus
2) Gp A strep.
3) H. flu
4) Bacteriodaceae
5) S. pneumoniae
6) Enterobacteriaceae
7) P. aeruginosa
8) Candida spp.

Question 17

Which organisms could be pathogens or contaminants?

Answer 17

• Viridans streptococci
• Enterococcus
• Coagulase-negative staphylococci

Question 18

Name the 3 most frequent blood culture contaminants.

Answer 18

1) P. acnes
2) Corynebacterium spp.
3) Bacillus spp.

Question 19

P. acnes, Bacillus spp., and Corynebacterium spp. are blood culture ________.

Answer 19

P. acnes, Bacillus spp., and Corynebacterium spp. are blood culture CONTAMINANTS.

Question 20

Viridans strep., Coagulase-negative staph., and enterococcus could be ____ or _____.

Answer 20

Viridans strep., Coagulase-negative staph., and enterococcus could be PATHOGENS or CONTAMINANTS.

Question 21

Name the six places positive blood cultures originate from.

Answer 21

1) Skin
2) Urine
3) Trauma
4) Immunosuppression
5) Lungs
6) Catheter-related

Question 22

Name the four common organisms associated with catheters.

Answer 22

1) S. aureus
2) Coagulase-negative staph
3) Enterococci
4) Candida spp.

Question 23

How long do you treat S. aureus catheter infections for?

Answer 23

Almost always 6 weeks

Question 24

When can you treat S. aureus catheter infections for 14 days?

Answer 24

1) Resolution of fever and bacteremia within 72H after catheter removal and appropriate therapy
2) No evidence of endocarditis on TEE or suppurative thrombophlebitis by ultrasound, or metastatic infection by exam and testing
3) No prosthetic device
4) Not immunosuppressed
5) Not diabetic

Question 25

When is day 1 of treatment in S. aureus catheter infections?

Answer 25

When cleared bloodstream results occur

Question 26

What is empiric therapy for bacteremia?

Answer 26

Vancomycin 15-20 mg/kg IV Q12H

Cefepime 1-2 g IV Q8-12H (normal renal function) OR Pip/Tazo 4-5 g IV Q8H

Micafungin 100 mg IV QD

Question 27

What is empiric therapy for Coagulase negative staphylococci, S. aureus, Enterococci (PCN allergic)?

Answer 27

Vancomycin 15-20 mg/kg IV Q12H

Question 28

What is empiric therapy for Gram-negative rods?

Answer 28

Cefepime 1-2 g Q8-12H OR Pip/Tazo 4-5 g IV Q8H

Question 29

What can be added for empiric therapy for Candida spp?

Answer 29

Micafungin 100 mg IV QD

Question 30

T/F: Do not repeat cultures for Gram negative rods.

Answer 30

TRUE

Question 31

What is day 1 of treatment for Gram (-) infections?

Answer 31

1st day of therapy = day 1

-Usually 14 days only

Question 32

What s/s are associated with bacteremia?

Answer 32

• Fever
• Chills
• Maybe hypotension