factoids Flashcards
XAMA
oppotunistic grows in neutropenic pts with lots of ppx
PSAR sepsis similar other bugs with the exception that it also causes…
ecthyma gangrenosum
What is ecthyma gangrenosum
small or large, painful, reddish, maculopapular lesionw with a geographic margin. initially pink and then darken to purple finally necrotic
Ecythma gangrenosum pt pop
neutropenic and AIDS
Is monotherapy with an aminoglycoside optimal.
No.
Some of the aminoglycosides
tobra, gent, garamycin, amikacin, kanamycin, neomycin
Toxicites of aminogycosides
kidney and vestibular
What drugs are aminoglycosides synergistic with?
beta lactams and vanc
What do aminoglycosides target?
30s ribosome, protein synthesis
polymixin E
colistin
NNT PSAR pneumonia/ bacteremia mono tx
cepepime of ceftazidime
NNT PSAR combo tx bacteremia/ pneumonia
pip/taz or imi or mero or dori
plus
amikacin
NT PSAR bacteremia/ PNA
cefepime 2g q8 IV
PSAR UTI
cipro 500mg q12 PO
or
levo 750mg q24h
or any aminoglycoside
MDRO PSAR
colistin 100mg q12h IV for shortest possible period
XAMA tx
TMP-SMX 1600/320 mg q12 IV x14d
levo or tigecyclince alternates
BCEP
mero 1 g q8 IV
or
TMP-SMX (1600/320 mg q12 IV x 14 days
dont use these in combo bc of antagonism
Meliodiosis (pseudomallei), glanders (mallei)
ceftazadime
followed by
tmp-smx for 3 months
asian chroninc PSAR colonization
happens is some people from childhood
Most endocarditis
right sided
IVDU endocarditis
left side
PSAR endocartitis can embolize to the
lungs
Vertebral osteomyelitis in elderly can come from origninnaly having a PSAR
uti
Puncture wound
PSAR and Ctet
PSAR high csf conc drugs
ceftazidime
mero
cefepime
green nail sydrome
submerging hands water repeatedly
pyocyanin
PSAR PNA
no lobar predisposition. high frequency is cavitary.
XAMA
must have disruption of normal flora to become infectious
XAMA reistance due to
abx efflux pumps
two beta lactamases L1 and L2
Xams, is it a sig CF pathogen
thought is no
most XAMA infc from
resp or central line
what abx xama typically ss
ticaracillin/clav
sxt
levo
tige
First line empiric for B cep
sxt
mero
doxy
Can use mero and sxt together
no may be antagonistic
B psudomallei causes
meliodosis
B pseudomallei geographics
SE asia
northern australlia
sometimes india and china
(think people returning or military)
Meliodis can be
latent
Meliodosis contracted by
inoculation, inhalation or ingestion
rarely person to person
Most virulent pseudomonads
b pseudomallei, infects immunocompotent
mortality of meliodosis
44%
ds of meliodosis
PNA community aqcuired,
septimcemia
B. mallei (glanders)
equine ds in aftrica, asia and south America. Erradicated from NA and europe decades ago
Is us last case of glander was in 2001 in a
lab worker
B mallei
from horses
not from contaminated soil
risk for horse handler, butchers of horse, veterinarians
B mallei
from horse to human trhough skin puncture
regional lymphadenopathy
from horse to human through inhalation
can be latent
Procalcitonin
can be used to see if abx are working (at least for legionella)
Legionella urinary antigen
detects about 80%
only for serogroup 1
detectable 3 days to 2 months onset
Legionella is intracetlluar so abx that penetrate cells best including…
macrolide quinolone ketolide (telithromycin) tetracycline group sxt rifampin
best choices are macrolide and quinolone
why are quinolones preferred in transplant patient
bc macrolide and rifampin interact with cyclosporine and tacrolimus
how long should give FQ for legionella
3-5 days IV
rest PO for total of 10-14d
critically ill legionella
levo
azithro
rifampin
