Gram Positive Bacerium Flashcards
staphylococcus
negative are common contanimantes
70-80%
rember cons vs cops
CoNS: fake
Gram + cocci in cluster
staphyloccus auerus
most virulent
pyogenic
Cogulase negative postive staphyloccus :
MSSA
MRSA
cougluase negative staphyloccus
freguent culture contaniminate
staph epidermdis
most common on skin
bacteremia risk
devices and ports
prostetic device infection
endocarditis
treatment options:
resistance and infection:
methicillin sensitive:
Penicillin G or Nafacillin
alternative : cefazolin 2 gramq 8
methicillin resistant:
vancomycin or daptomycin
alternative: xyvox
oral options for skin infections:
methicillin sensitive
doxycycline 100 q 12
methicillin resistant
clindamycin 300-450 TID
streptococcus
Gram positive cocci in chains or pairs:
different classification:
serologic group
A B C G
biochemical
hemolytic pattern
alpha hemolysis (partial)
streptoccus pneumoniae
Beta hemolysis (complete)
group A B C G
associated infections
pharygnitis
scarlet fever
rheumatic heart disease
mirtral valve damage
suppurative complications
sinusitis otitis media mastoiditis pertonsulliar abcess
or cervical lymphaditis
nosupprative:
rheumatic fever or glomerulonephritis
severe infection
endocarditis ,pneumonia , emphysema and necrotizing facitis
streptococcus diagnosis
cannot be dx on clinical grounds
clinical criteria:
Centor Clinical Criteria:
temp > 38 , tender anteroior cervical lymphadectopthy
lack of cough and phaygtonsullar exudate
rapid antigen test:
confirm with culture
if negative and high prevleance
treatment of streptococcus
pencillin G 1.2 mill u IM
penciliin VK 250 mg QID or 500mg BID x 10 D
Amoxcillin 1000 mg PO QD or 500 BID x 10 D
Cephlosporin ( PCN allergie)
cephlexin 500mg po BID 5-10 D
cefdiner 300mg po BID 5-10 D
macrolides ( 2nd line)
less effective than PCN
erythromycin 500mg PO QID x 5 D
azithromycin 500mg PO QD x 5 D
marcolide resistance:
clindamycin 300mg PO TID x 10 D
Streptococcus Pneumoniae
Pneumococci:
spherical gram positive
streptoccus
types based on capsular polysaccharide structure:
protects bacteria from phagocytosis
important determinant of pneumococcal virulence: most common cause of CAP
diagnosis:
urinary antigen testing
lung tissue
sputum culture and GS
Treatment:
pencillin sensitive MIC < 2
vaccination
pencillin allergie
macrolides or cephlasporin
furoquinolone , macrolide and pencillin resistance
Enterococcus
gram positive cocci in chains or pairs
source:
normal bowel flora
+ BC concerning
associate infections:
BSI and UTI
E facalis
less resistant to vancomycin than E Faccium
pencillin resistance is uncommon
E faccium
pencillin amioglycides and vanco resistant
treatment plan:
ampicillin
vancomycin
VRE
Daptomycin and ampicillin
consult ID
Corynebacterium Diphteriae
Gram positive bacillus , unencapsulated , nonmotile and non sporulating
associated infection:
nasophyngeal and skin
toxigenic strains produce protien toxin
systemic toxicity
myocarditis
polneuropathy
toxicgneic strains
phryngeal diptheriae
non toxigenic strains
Cutaneous disease
diagnosis:
clinical signs and symptoms plus labortaory confirmation
Report to CDC
Diphtheriae treatment
droplet precautions
isolation unit x 3 connsucitive cultures at completions of therapy
prompt administration of diptheria antitoxin
effective in reducing extent of local disease
no linger commercially available in USA
obtained from CDC Emergengy operations center
Antibiotics:
prevent transmission to susceptible contacts
prevent further toxin production
reduce severity of local infection
recommend antibiotic tx options
procine pencillin G 600,000 u IM Q 12
penicillin V 250 PO QD x 14 D
Erythromycin 500mg IV Q 6 H
Erythromycin 500mg PO QID x 14 D
exposure management
erythromycin 500mg PO QID X 7 Days
vaccination
Listeria Monocytogenes
facultative anaerobic , non sproulating , gram positive rod
high concentrations found in processed / un processed foods
no evidence to support human to human transmission or waterborne
ubigutious enviromnetal bacterium
Associated infections
pathogenenters via GI tract
gastroenteritis
bacteremia
clinical syndromes:
meningitis and septcemia
high risk groups:
pregnant women and immuncompromised
diagnosis
typically made on blood culture , CSF or aminotic fluid culture
treatment :
ampicillin 2 g IV Q 6 or Bactrim 15-20 IV Q 6-8
add gentamycin 1-1.7 mg kg q8 for synergy
duration of therapy
2 weeks for bacteremia
3 weeks for menigittis
4-6 for endocarditis
6-8 for brain abcess or enchephlitis
tetanus toxin
clostridium tetani
anaerobic , gram positive spore forming rod
highly resileint an survies redily in the enviroment
resitant to boiling water and many disinfectants
survive in intestinal system an dfecal carriage is common
completely preventable by vaccination
organism found througout world
high mortality rate
associated infection and complications:
skeletal muscle spasms and ANS disturbance
caused by tetaus toxin
typical progression of generalized treanus
muscles of face and jaw often affected first
most common inital symptoms
trismus muscle pain and stiffness back pain dysphagia
complete airway obstruction
spasms of respiratory muscle results
respiratory failure
cardiovascular compromise
labile blood pressure
tachy-brady arrythmia and heart block
tetanus diagnosis
clinical findings
C tetani culture
treatment:
flagyl 500mg IV Q 6 x 7 D or 400 PR
identify entry wound
clean and debride necrotic tissue
failure to remove pockets
resutls in recurrent or prolong tetanus
antitoxin:
humna tetnaus immunogolblin
inject portion around wound
equine antitoxin 100000-200000 u IM x 1
controlling spasms
heavy sedation or NMB
respiratoiry depression and failure
penobarbitol and IV mag
securing airway
tracheal spasms and secretions
difficult endotrocheal intubation
potential need for trach
full primary course of immunizaion
inadequate natral immunity
Botulism toxin
anaerobic gram positive spore forming organisms
organism producing toxin
clostridum botulism
clostridiunm aregentinse
clostradium barati
clostridum buytricum
botulimun toxin
seven serologically distinct serotypes
extremely toxic substance
associated infection
food contanimnation
in situ toxin production
wound botulism
infant botulism
adult intesitnal colonizaion botulism
exgenous botulium toxin
possible but unlikley
used for theraputic or cosmetic pruposes
no cases lab confirmed
clinical manifestation
bilater cranial nerve palsies
decending bilateral flaccid paralysis or voluntary muscles
progress to respiratory compromise
botulism toxin
diagnosis
clinical grounds
labratory confirmation
treatment
intensive care
antitoxin early
limit progression of illness
does not reverse exisiting parlysis
available us option:
botulism antitoxin hepatavent
suspected wounds and abcess
prompt debridmen
may increase circulaiting botulism toxin
public health emergency
report to state health department
do not treat with abx can cause worse sysmptoms
Clostridiodes difficile
formerly clostridium difficle
anerobic gram negative rod
associated infection
C diff colitis
persistent diarheea
20-25% relapse
asymptomatic carrier
screening and tx not recomended
PCR + tocxin and Toxin -
negative infx
treatment:
oral vancomycin
fidaxomicin ( dificid)
fecal microbiota transplant
no longer in algroithm
metronindazole
colectomy
medications associated with c diff
abx ( floroquinolones and clindamycin)
PPI
