Fever/Antimicrobial Resistance Flashcards
what degree is the “temp” of a fever?
> 101 or 38.3 degrees Celsius (some people say 100.4 or 100.8)
what is normal body temp? how many times does it peak during the day?
97-99.5 (36.0-37.4); peaks twice diurnally
what is hyperthermia?*
conditions or drugs that induce a BREAKDOWN of thermoregulatory systems, which results in elevated body temp
what is a fever?*
conditions that change the HYPOTHALAMIC SET POINT so that thermoregulatory systems create a higher body temp
fever pathophys: when __________ and __________ are stimulated by invading organisms, they put out ___________ ___________ that cause elevation in basal ______ __________
monocyte and macrophages; pyrogenic cytokines; body temperature
cytokines that affect ________ can be produced in ___________ situations: fever _____ _______ always = infection
temperature; noninfectious; does not
does degree of fever elevation correlate with severity of illness?
NO
children tend to have ________ fevers, compared to elderly who may ______ get a fever
higher; not
what type of medications may reduce febrile response?
anti-cytokine (esp interleukins)
what happens if fever is over 106?
can get irreversible brain damage
when should you treat a fever? what is the tx?
treat if over 104; antipyretics most helpful (acetaminophen or aspirin)
2nd line: warm water baths, ice packs
when would you treat fever at a lower temp (less than 104)?
to improve comfort or if pt is hemodynamically unstable (temp inc HR)
how to define a classic fever of unknown origin
adults: an illness lasting more than 3 weeks with temps greater than 101
* dx has not been made despite a good eval (3 hospital days or 3 outpatient visits)
a diagnosis eventually can be made in ______- _____% of FUO cases
70-90%
how to define a nosocomial FUO
fever greater than 101 on multiple occasions in hospitalized pt; infection not incubating on admission; uncertain dx after 3 day eval (including 2 day culture incubation)
definition of neutropenic FUO
Fever ≥38.3°C (101°F) on multiple occasions
Absolute neutrophil count <500/μL
Uncertain diagnosis after 3-day evaluation, including 2-day microbiologic culture incubation
definition of HIV associated FUO
Fever ≥38.3°C (101°F) on multiple occasions
Confirmed diagnosis of HIV infection
Fever >1mo (outpatients) or >3 days (inpatients)
Uncertain diagnosis after 3-day evaluation, including 2-day microbiologic culture incubation
what is the most common cause of FUO?
infections (1/3)
what is the most common systemic bacterial cause of FUO?
TB
besides infections, what also causes 1/3 of FUOs? what accounts for 20% of cases? what % of FUOs remain undiagnosed?
neoplasms; Rheumatologic diseases account for 20%; 10% remain undiagnosed
which patients usually get neutropenic fever?
pts on cytotoxic chemotherapy tx
neutropenic fever: with absolute neutrophils <1000/ul, pts are at ___ ____ for infection, but _______ if below 500/ul
high risk; critical
HIV patients who have a FUO are usually infected with….
MAC- mycobacterium avium complex
usual cause of elderly patients’ FUO
UTI
hospitalized pts’ FUO are usually from….
central line infections
fever in a neutropenic patient should be considered ________
URGENT: give broad spectrum ABX
do dental abscesses always cause fevers?
no
what do you NOT give to someone to tx FUO?
steroids
PEARL: evidence for ______ from reducing fever is _________
benefit; limited
who causes ABX resistance?
humans
3 mechanisms of ABX resistance
1) . enzyme degradation (beta lactamase)
2) . structural modifications
3) . drug “pumps” remove drug from cells (multidrug resistance)
presence of cough for suspected strep pharyngitis is _____ strep
NOT
rapid strep test is _____% sensitive: if positive, _____ pt. if negative, ________
90%; pos- treat, neg- culture
most bronchitis is _______; even _________ will resolve in most cases
viral; bacterial (may tx if pt is toxic)
what is first choice for tx of AECB and pertussis?
macrolides (mycins)
how to tx drug resistant S pneumo (DRSP)
needs higher PCN levels (augmentin XR, with 2 g BID amoxicillin)
what test might aid in whether or not to tx a suspected S pneumo infection?
urine antigen test
what disease do you suspect for cellulitis/abscess that doesn’t respond to Keflex or dicloxacillin?
community acquired MRSA
MRSA pneumonia is associated with ________
influenza
what drug do you NOT use first line for community acquired MRSA? what IS first line?
vancomycin; Bactrim (minimal resistance)
vancomycin-resistant enterococcus is what type of bug?
hospital/healthcare associated bug
what two antivirals does the CDC no longer recommend to tx influenza A? which two SHOULD be used now?
amantadine and rimantadine (zanamivir or oseltamivir should be used)
what is now the tx of UTI (uncomplicated cystitis)
nitrofurantoin, Bactrim, or fosfomycin are preferred (NO longer cipro)
first line tx of C diff
oral vancomycin (or fidaxomicin or rifaximin)
goal of ABX prescribing
use the narrowest spectrum ABX possible
what is the most important tx step before giving ABX?
drainage of abscesses
how to tx bronchitis?
since most viral- symptomatic
-bronchodilators, maybe cough suppression
