Gram + organisms Flashcards
Where are s. epidermis infections found?
Skin
Hospital acquired infections
Where are s. saprophyticus infections found?
UTI
Where are s. lugdunensis infections found?
Foreign body/prosthetic device infections
What are the coagulase positive staphs?
S aureus
What are the coagulase negative staphs?
S epidermis, s saprophyticus, s lugdunensis
How do you treat staph skin infections?
Low risk MSSA:
Keflex
Dicloxacillin
High risk MRSA:
Clindamycin
Doxycycline/minocycline
Bactrim
Inpatient:
Vancomycin
How do you treat staph osteomyelitis?
Broad: Vancomycin and 3/4 cephalosporin
MSSA: nafcillin, oxacillin, cefazolin
MRSA: vanc
What are the causes of TSS?
Staph or GABHS
Vagina/tampon use, nasopharynx/packing, wound/abscess packing
What is the clinical presentation of TSS?
Fs, hypotension, myalgias, N/V/D
Shedding rash on palms and soles
Hepatic damage, thrombocytopenia, confusion
Renal impairment, syncope, shock
What is the treatment for TSS?
Admission
Vanc + clindamycin + pip/taz or cefepime or carbapenem
What are the symptoms of scalded skin syndrome?
Widespread bullae with sloughing
fs, malaise
sepsis, electrolyte abnormalities
What is the treatment for scalded skin syndrome?
MSSA: nafcillin or oxaxillin
MRSA: vancomycin
What are the symptoms of staph food poisoning?
N/V/D cramping that start 2-8 hours after ingestion and resolve in 12 hours
What are the treatment for coagulase negative staphylococcal infections?
Vancomycin
What types of infections is Strep pyogenes associated with?
Pharyngitis
Skin infections
What types of infections is strep agalactiae associated with?
Septic abortion, illness in neonates
Normal flora in intestine and vagina
What type of infections is s. bovis associated with?
endocarditis
What condition does scarlet fever accompany?
Sore throat due to strep pharyngitis 2/2 strep pyogenes
What is the treatment for strep pharyngitis?
PCN G
PCN K
Amoxicillin
(if allergic Keflex or Omnicef, then last choice z-pack)
What is the classic presentation of scarlet fever?
A sunburn like sandpaper rash, strawberry tongue
What is impetigo caused by?
GABHS (or staph aureus)
What is the presentation of impetigo?
Focal vesicular pustular lesions with honey-colored crust
What is the treatment for impetigo without concern for MRSA?
Topical Bactroban
Keflex
Dicloxacillin
What is the treatment for impetigo with concern for MRSA?
Bactrim
Doxycycline
Clindamycin
What is erysipelas?
A painful superficial cellulitis with dermal lymphatic involvement that typically involves the face
What is erysipelas caused by?
GABHS (or staph aureus)
What is the outpatient treatment for erysipelas?
Penicillin
Amoxicillin
(also dicloxacillin, cephalexin, clinda/erythromycin)
What is the inpatient treatment for erysipelas?
Vancomycin (covers s aureus)
cefazolin (Ancef)
ceftriaxone (Rocephin)
Clindamycin
What is cellulitis caused by?
GABHS or staph
What does group B/ strep agalactiae cause?
neonatal sepsis
What is the treatment for a strep B+ mother?
PCN G
Ampicillin
Cefazolin
(or Clinda/Vanc)
What does streptococcus pneumoniae cause?
Otitis Media
Sinusitis
Pneumonia
Meninges
Endocarditis
What is the most common cause of CAP?
Strep pneumoniae (pneumococcal pneumonia)
What are the most common causes of otitis media?
S. pneumo
M cat
H influenza
What are risk factors for otitis media?
Smoking in the house
Family history
Bottle feeding
What is the treatment for otitis media?
Amoxicillin
Augmentin/Omnicef
Rocephin (daily shot for 3 days)
What causes acute sinusitis?
S aureus
S pneumoniae
M cat
H influenza
What is the treatment for sinusitis?
Augmentin
Doxycycline/clinamycin
What colored sputum is pneumococcal pneumonia?
Rust colored
What x-ray findings would you suspect for someone with pneumococcal pneumonia?
lobar consolidation, sometimes with effusion
When should you obtain a sputum culture for pneumonia?
For admission or if the patient has comorbidities
What is the treatment for uncomplicated outpatient pneumonia?
Amoxicillin
Doxycycline
Azithromycin
What is the treatment for complicated outpatient pneumonia?
Levofloxacin
Augmentin/cephalosporin + zmax/doxycycline
What is the inpatient treatment for pneumonia?
Levofloxacin
Zmax + amoxicillin/ceftriaxone
What are the most common causes of meningitis for children and young adults?
Baby - group B strep
kiddo - s. pneumoniae
Teen - neisseria meningitidis
S aureus with head trauma
H flu is rare but possible outside US bc HIB vax
What is the most common cause of meningitis for adults?
S. pneumoniae
S aureus
N meningitidis (less common here)
What is the most common causes of meningitis for elderly?
S. pneumoniae
S aureus
Listeria monocytogenes
What are the most common infections associated with enterococcus?
UTI
Bacterimia
Endocarditis
Intra-abdominal infections
Wound infections
What is the treatment for endocarditis?
ampicillin + gentacmicin
What is the treatment for skin/wounds and UTIs?
Ampicillin or vanc (regardless of complexity)
What if the patient has VRE? What is the treatment?
Linezolid
Daptomycin
What are the three ways to get bacillus anthracis
Cutaneous
Ingestion
Inhalation
What are all the CDC category A agents we discussed?
Bacillus anthracis
What are the symptoms of cutaneus anthrax?
Painless black eschar
LAD
Fever, malaise, HA
What are the symptoms of ingested anthrax?
Fevers, N/V, bloody diarrhea
GI bleed
Mouth/GI ulcers
Obstruction
Perferation
What are the symptoms of inhaled anthrax?
Flu-like leading to severe hypoxemia and shock
What is the treatment for anthrax?
Cipro
(doxycycline if you cant)
What are the two types of infections that b cereus can cause?
Diarrheal and emetic
What is commonly associated with b cereus?
Rice and leftovers
What is the treatment for b cereus?
Nothing, usually self limiting and harmless
What foods are associated with Listeria Monocytogenes?
Dairy
Raw Veggies
Meat
What is the presentation of Listeria?
Bacteremia
Meningitis
Dermatitis
Oculoglandular symptoms
What is the treatment for Listeria?
Ampicillin and gentamicin (inpatient)
amoxicillin (outpatient)
What does corynebacterium diphtheriae cause?
Pharyngeal diphtheria
Nasal infection
What is unique about pharyngeal diphtheria infections?
Cause a grey tonsillar/pharyngeal membrane
What is the treatment for diphtheria?
Diphtheria equin antitoxin
PCN or erythromycin