Gram Positive Infections Flashcards
1
Q
are Group B Streptococcal Infections gram positive or gram negative?
A
positive
2
Q
Group B Streptococcal Infections
Where are these bacteria usually found?
A
normal vaginal flora
3
Q
Group B Streptococcal Infections
why do we test pregnant women for this?
A
- to see if it’s present (normal vagina flora, but want to know potential for infection)
- don’t want to pass bacteria to baby during delivery
4
Q
Group B Streptococcal Infections
what do we do if a pregnant women tests pos?
A
abx treatment for weeks prior to birth
5
Q
Group B Streptococcal Infections
why do we treat pregnant women prophylactically?
A
can spread to baby during birth & the bacteria is much more serious in newborns.
6
Q
Group B Streptococcal Infections
What infections can this lead to?
3 most common, 3 less common
A
Most Common: septic abortion, endometritis, peripartum infection
Less Common: cellulitis, bacteremia, endocarditis
7
Q
Group B Streptococcal Infections
Treatment
A
Penicillin
Vancomycin
8
Q
Group B Streptococcal Infections
Can lead to what in neonates?
3 not so great things
A
- bacteremia
- sepsis
- meningitis
9
Q
Strep Viridans
Are strep viridans hemolytic?
A
No- they are nonhemolytic
10
Q
Strep Viridans
Where are strep viridans typically found?
A
normal oral flora
11
Q
Strep Viridans
What do strep viridans most commonly cause?
A
native valve endocarditis
12
Q
Group D streptococci
Group D streptococci
which bacteria is group D?
A
Streptococcus gallolyticus
13
Q
Group D streptococci
what 2 things do people who become ill from this usually have?
A
GI cancer or cirrhosis
14
Q
Group D streptococci
what is secondary to this infection?
A
endocarditis
15
Q
Group A Streptococcal Infection Types
4 categories
A
- Non-invasive Infections
- Exotoxin Mediated Disease
- Non-supportive Immune Related Sequalae
- Invasive Infections
16
Q
Group A Streptococcal Infection
Example of non-invasive infection
A
Bullous Impetigo
covered in Derm not ID
17
Q
Group A Streptococcal Infection
Example of Exotoxin mediated disease
A
Scarlet Fever
18
Q
Group A Streptococcal Infection
Example of Non-suppurative immune related sequalae
A
Rheumatic Fever
19
Q
Group A Streptococcal Infection
Examples of Invasive Infections
4
A
Cellulitis (covered in Derm not ID)
Abscess
Bacteremia
Infective Endocarditis
20
Q
Scarlet Fever
AKA
A
strep throat
21
Q
Scarlet Fever
people with this have often recently been ______
A
exposed to someone with strep throat
22
Q
Scarlet Fever
signs
5 things
A
- Exudative pharyngitis
- Bright red exanthem
- Flushed face
- Circumoral pallor
- Tongue coated with enlarged red papillae
23
Q
Scarlet Fever
sx
7 things
A
- abrupt onset of fever
- sore throat
- headache
- chills
- nausea
- myalgias
- malaise
24
Q
Scarlet Fever
what causes rash to develop?
A
group A beta-hemolytic streptococci toxin causes rash
25
# Scarlet Fever
Physiology of rash occuring from toxin exposure
- local production of inflammatory mediators and alteration in cutaneous cytokines
- Dilation of blood vessels leads to characteristic scarlet color
26
# Scarlet Fever
Evolution of "Strawberry Tongue"
- Day 1/2: tongue heavily coated with white membrane through which you can see edematous red papillae protrude
- Day 3/4/5: white membrane sloughs off, revealing shiny red tongue with prominent papillae
27
# Scarlet Fever
Rash Characteristics
* diffusely erythematous w/ find red papules (sandpaper consistency)
* greatest in groin and axillae
* blanches (touch it and it goes away, then returns when no touch)
28
# Scarlet Fever
how could texture of rash be described?
| PPP
sandpaper
29
# Scarlet Fever
How long after onset of fever does rash occur?
12-48 hrs
30
# Scarlet Fever
How does rash change over course of illness?
- 12 to 48 hrs: onset, appears on neck
- travels to trunk/extremities
- 2 to 5 days: fades leaving desquamation, peeling occurs
31
# Scarlet Fever
Timeline
**Untreated**: fever peaks by 2nd day, afebrile by days 5-7
**Treated**: fever abates 12-24 hrs after abx initiation
32
# Scarlet Fever
Dx
- primarily a clinical diagnosis
- test: rapid strep test or throat culture
33
# Scarlet Fever
when to do culture vs rapid test?
if rapid test was negative but you still suspect strep, send off for culture.
34
# Strep Throat
do not treat until you have ?
positive test result
35
# Scarlet Fever
Treatment
| 3 options, give med, route, dosage, and duration
**Treat strep pharyngitis**
* Pen VK 500mg PO 2-3x daily for 10 days
* Amoxicillin (tastes better) 500 mg PO 2x daily for 10 days
* PCN G benzathine 1.2 million units IM x 1 (expensive, not readily available)
36
# Scarlet Fever
when to use PCN shot vs amox series?
worried about non-compliance, kids refuse meds, recurrent infections (indicating non-complicance)
37
# Acute Rheumatic Fever
Define
autoimmune inflammatory process that develops after beta-hemolytic streptococcal pharyngitis
*perivascular granulomatous rxn with valvulitis*
38
# Acute Rheumatic Fever
Epidemiology
- Most common in developing countries
- 250,000 deaths worldwide/year
- Peak incidence between ages 5-15
- Predisposition to recurrence
39
# Acute Rheumatic Fever
Complication
Rheumatic heart disease
40
# Acute Rheumatic Fever
Molecularly mimics which other disease?
Scarlet Fever
* immune response aimed at strep antigens
* recognizes human tissue especially on endothelial cells on heart valves
41
# Acute Rheumatic Fever
Clinical Presentation
| sx onset after what?, % of people with groups of presentations
- Typically sx onset is 2-3 wks after strep throat infection
- Variable presentation
- Carditis 50-70%
- Arthritis 35-66%
- Chorea 10-30%
- SubQ nodules 0-10%
- Erythema marginatum < 6%
42
# Acute Rheumatic Fever
what presentation are we most worried about?
| it's the most common
cardiac complications
43
# Acute Rheumatic Fever
Diagnosing
| 5 things
- Troat culture
- ASO titer
- ESR
- CRP
- Echo
## Footnote
**no specific diagnostic tests**
44
# Acute Rheumatic Fever
what does the Jones criteria help a provider determine?
when/whether to treat for strep
45
# Acute Rheumatic Fever
Treatment
| med, dosage, duration, freq
Treat group A strep infection
* Pen VK 500mg PO 2-3x daily for 10 days
* Amoxicillin (tastes better) 500 mg PO 2x daily for 10 days
* PCN G benzathine 1.2 million units IM x 1 (expensive, not readily available)
46
# Acute Rheumatic Fever
Symptomatic Tx
| 1 med, 1 action
Salicylates (ex: Aspirin)
Bed rest for carditis
47
# Acute Rheumatic Fever
Continuous abx prophylaxis for years
| what med/dosage/freq
PCN G benzathine 1.2 mil units IM every 3-4 wks
48
# Acute Rheumatic Fever
Education to provide
risk of infective endocarditis- sx watch
emphasize oral hygiene
49
# Acute Rheumatic Fever
what percentage of people with rheumatic heart disease have a history of rheumatic fever?
60%
50
# Acute Rheumatic Fever
Describe chronic rheumatic heart disease
* rigid and deformed valve cusps
* fusion of the commissures
* shortening and fusion of the chordae tendinae
51
# Acute Rheumatic Fever
What can Rheumatic Fever lead to in the long term?
| more specific than rheumatic heart disease
valvular stenosis and/or regurgitation
52
# Infective Endocarditis
Describe endocarditis
inflammatory process of the valvular or endocardial surface of the heart
53
# Infective Endocarditis
Clinical Findings
| 5 (1 sx, 1 condition, 1 test result, 2 signs)
* Fever
* Pre-existing organic heart lesion
* pos blood cultures
* Evidence of vegetation on ECG
* Evidence of systemic emboli
54
# Infective Endocarditis
Microbiology
| 3 bacteria, 1 other
* *Staphylococcus*
* *Strep viridans*
* *Enterococcus*
* Fungal
55
# Infective Endocarditis
Which gender is IE more common in?
males
56
# Infective Endocarditis
Which bacteria is most common for IE in IV drug users?
*S. aureus*
> 60% of cases
57
# Infective Endocarditis
Which valves are typically impacted in the general population?
left sided valves (mitral/bicuspid & aortic)
58
# Infective Endocarditis
Which valves for IV drug users?
Right sided valves, especially tricuspid
59
# Infective Endocarditis
The rate of ____ is higher for IE in IV drug users
recurrence
60
# Infective Endocarditis
Cardiac Predispositions
| 6 things
1. valvular heart disease
2. congenital heart disease
3. prosthetic valve
4. history of IE
5. pacemakers
6. hypertrophic cardiomyopathy
61
# Infective Endocarditis
Most Common Clinical Findings
| 2 (1 sx, 1 sign)
Fever (90%)
New/changed murmur (85%)
62
# Infective Endocarditis
Additional Clinical Findings
| 11 sx
chills/night sweats
anorexia, wt loss
arthralgias, myalgias
malaise
dyspnea, cough, pleuritic pain
splenomegaly
63
# Infective Endocarditis
Uncommon findings
| but pathognomonic!
janeway lesions
osler nodes
roth spots
64
# Infective Endocarditis
Janeway lesions
nontender erythematous macules on the palms and soles
65
# Infective Endocarditis
Osler nodes
tender subQ violaceous nodules mostly on the pads of the fingers and toes, which may also occur on the thenar and hypothenar eminences
66
# Infective Endocarditis
Roth spots
exudative, edematous hemorrhagic lesions of the retina with pale centers
67
# Infective Endocarditis
Components of a Diagnosis
Blood cultures
ECG
CXR
Chest CT
68
# Infective Endocarditis
use cation with what diagnostic procedure?
cardiac catheterization
69
# Infective Endocarditis
What would an echo show?
which valves are impacted
70
# Infective Endocarditis
What would the CXR show?
cardiac abnormalities
71
# Infective Endocarditis
What would a chest CT show?
may show emboli
72
# Infective Endocarditis
What criteria help determine if someone has IE?
Duke Criteria
73
# Infective Endocarditis
Duke Criteria thresholds for dx
1. 2+ major criteria
2. 1 major & 3+ minor
3. 5+ minor
74
# Infective Endocarditis
Major Criteria
| Duke's (3)
1. positive blood cultures
2. evidence of endocardial involvement
3. new or worsening **regurgitation** murmur
75
# Infective Endocarditis
Minor criteria
| Duke's (6)
1. predisposition
2. Fever > 100.4
3. Vascular phenomena
4. Immunologic phenomena
5. Microbiologic evidence
6. Echo findings not congruent w/ major criteria
76
# Infective Endocarditis
What would qualify a blood culture to meet major criteria?
| Duke's (3)
1. typical microbe in 2 cultures
2. persistently pos cultures
3. single pos culture for *Coxiella burnetii*
77
# Infective Endocarditis
What would qualify as evidence of endocardial involvement to meet major criteria?
| Duke's (3)
1. definite vegetation
2. myocardial abscess
3. new partial dehiscence of prosthetic valve
78
# Infective Endocarditis
What is included as vascular phenomena meeting minor criteria?
| Duke's (6)
1. major arterial emboli
2. septic pulm infarcts
3. mycotic aneurysm
4. intracranial hemorrhage
5. conjunctival hemorrhage
6. janeway lesions
79
# Infective Endocarditis
What are immunologic phenomena that meet minor criteria?
| Duke's (4)
1. glomerulonephritis
2. Osler's nodes
3. Roth spots
4. rheumatoid factor
80
# Infective Endocarditis
Classifications of Endocarditis
1. acute
2. subacute
81
# Infective Endocarditis
Incubation Period of acute IE
< 6 week incubation, can be very rapid course
82
# Infective Endocarditis
Presentation and findings of acute IE
1. toxic presentation (high fevers, CP, SOB, fatigue)
2. rapid progression, fatal if untreated
83
# Infective Endocarditis
most common bacteria for acute IE
*s. aureus*
84
# Infective Endocarditis
Incubation Period of subacute IE
> 6 wk incubation, can be several months
85
# Infective Endocarditis
Presentation of subacute IE
1. less dramatic presentation (low grade fever, sweats, wt loss)
2. gradual progression
86
# Infective Endocarditis
Most common pathogens for subacute IE
less virulent organisms
*s. viridians, enterococcus*
87
# Infective Endocarditis
are native or prosthetic valve pts at higher risk for IE?
Prosthetic valve pts more susceptible to developing IE
88
# Infective Endocarditis
Treatment for infection only
abx
89
# Infective Endocarditis
tx with valve destruction
surgery
90
# Infective Endocarditis
prevention
prophylaxis abx, hygiene
91
# Infective Endocarditis
Abx Therapy- consult who?
ID
92
# Infective Endocarditis
Abx Therapy- duration
4-6 wks
93
# Infective Endocarditis
Abx therapy- when to begin?
immediately while awaiting culture results
94
# Infective Endocarditis
Abx therapy- bacteria to cover prior to receiving culture/sensitivity results?
MRSA, staph, strep, entero
95
# Infective Endocarditis
Abx therapy- what to initially prescribe?
Vancomycin and Ceftriaxone
96
# Infective Endocarditis
Abx therapy- when to change meds?
only if necessary, once culture results are back!
97
# Infective Endocarditis
Abx therapy- rechecking blood
recheck blood cultures after abx started, q 48 hrs until negative
98
# Infective Endocarditis
Abx for *Streplococcus*
| only give med names, 4 meds
PCN G IV
Ceftriaxone IV
Vancomycin
PCN or Ceftriaxone + Gentamicin
99
# Infective Endocarditis
Dosage/Frequency/Duration for PCN G IV when treating for *Streptococcus*
12-18 mil units, divided doses
Q24 hrs
4 wks
100
# Infective Endocarditis
Dosage/duration/freq for Ceftriaxone IV when treating for *Streptococcus*
2g
Q24 hrs
4 wks
101
# Infective Endocarditis
Dosage/duration/freq for Vancomycin when treating for *Streptococcus*
15 mg/kg
Q12 hrs
4 wks
102
# Infective Endocarditis
Dosage/duration/freq for PCN or Ceft. + Gentamicin when treating for *Streptococcus*
PCN and Ceft are same as previous
Genta: 3 mg/kg, single or divided doses; Q24 hrs, 2 wks
103
# Infective Endocarditis
PCN considerations for *streptococcus*
* renal pts require dose adjustment
* use ceftriaxone if pt has non-severe PCN allergy
* use vancomycin if pt has severe PCN allergy
104
# Infective Endocarditis
Meds to use for PCN resistant *Streptococcus*
1. Vancymycin
2. PCN G IV + Gentamicin
105
# Infective Endocarditis
Dosage/duration/freq of Vancomycin in PCN resistant *Streptococcus*
30 mg/kg
Q24 hrs
4-6 wks
106
# Infective Endocarditis
Dosage/duration/freq of PCN G IV + Genatmicin in PCN resistant *Streptococcus*
PCN
* 18-30 mil. units, divided
* Q24 hrs
* 4-6 wks
Genta
* 3 mg/kg
* Q24 hrs
* 4-6 wks
107
# Infective Endocarditis
Abx for *Enterococcus*
| 2 options
1. PCN G or Ampicillin or Vancomycin
2. Above + Gentamicin
108
# Infective Endocarditis
Which abx is inadequate as monotreatment for *Enterococcus*?
PCN
109
# Infective Endocarditis
What do you add for tx because PCN is inadequate for *Enterococcus* spp?
aminoglycoside (streptomycin or gentamicin)
110
# Infective Endocarditis
Dosage/duration/freq of PCN G when used for *enterococcus*
| note: don't use as monotreatment!
18-30 mil units
Q24 hrs
4-6 wks
111
# Infective Endocarditis
Dosage/duration/freq of Ampicillin for *Enterococcus*
2 g
Q4 hrs
4-6 wks
112
# Infective Endocarditis
Dosage/duration/freq of vancomycin when used for *Enterococcus*
15 mg/kg
Q12 hrs
4-6 wks
113
# Infective Endocarditis
Dosage/duration/freq for Gentamicin when used for *Enterococcus*
1 mg/kg
Q8 hrs
4-6 wks
114
# Infective Endocarditis
Define MSSA
Methicillin-susceptible *S. aureus*
115
# Infective Endocarditis
Define MRSA
Methicillin-resistant *S. aureus*
116
# Infective Endocarditis
Abx for MSSA with **Native Valve IE**
| 4
1. Nafcillin/Oxacillin
2. Cefazolin
3. Vancomycin
117
# Infective Endocarditis
Dosage/duration/freq for Nafcillin or Oxacillin when used for MSSA
| Native Valve IE
5-2 g
Q4 hrs (12g/24 hrs)
6 wks
118
# Infective Endocarditis
Dosage/duration/freq for Cefazolin when used for MSSA
| Native Valve IE
2g
Q8 hrs
6 wks
119
# Infective Endocarditis
Dosage/duration/freq for Vanco when used for MSSA
| Native Valve IE
15 mg/kg
Q12 hrs
6 wks
120
# Infective Endocarditis
Abx for MRSA in **Native Valve IE**
| 2
1. vancomycin
2. daptomycin
121
# Infective Endocarditis
Dosage/duration/freq of Vancomycin for MRSA
| Native Valve IE
15 mg/kg
Q12 hrs
6 wks
122
# Infective Endocarditis
Dosage/duration/freq for Daptomycin with MRSA
| Native Valve IE
> / = 8 mg/kg
Q24 hrs
6 wks
123
# Infective Endocarditis
If the pt has **prosthetic valve IE** how do you modify abx therapies?
Triple therapy
124
# Infective Endocarditis
Which abx are added to achieve triple therapy with both MSSA and MRSA in prosthetic valve IE?
Rifampin
Gentamicin
125
# Infective Endocarditis
Abx therapy for MSSA in **Prosthetic Valve IE**
1. Nafcillin/Oxacillin, Ceftriaxone, or Vacno
2. Rifampin
3. Gentamicin
126
# Infective Endocarditis
Dosage/duration/freq of Rifampin for **MSSA or MRSA** in Prosthetic Valve IE
300 mg PO
Q8 hrs
6 wks
127
# Infective Endocarditis
Dosage/duration/freq of Gentamicin for **MSSA or MRSA** in Prosthetic Valve IE
1 mg/kg
Q8 hrs
2 wks
128
# Infective Endocarditis
Do the doses/durations/freqs of Nafcillin/Oxacillin, Ceftriaxone, or Vancomycin differ from Native Valve IE to Prosthetic Valve IE?
No
129
# Infective Endocarditis
Does the dose/duration/freq of Vanco differ from Native Valve IE to Prosthetic Valve IE?
No
130
# Infective Endocarditis
HACEK bacteria
| these are gram neg
*Haemophilus spp.*
*Aggregatibacter actinomycetemcomitans*
*Cardiobacterium hominis*
*Eikenella corrodens*
*Kingella kingae*
131
# Infective Endocarditis
Abx options for HACEK IE
| 6 total
1. Ceftriaxone
2. Ampicillin
3. Cipro
4. Bactrim/Quinolong/Aztreonam
132
# Infective Endocarditis
Early surgical indications
| 7
1. acute heart failure due to valve destruction
2. unresponsive to abx
3. septal abcess
4. sinus of valsalva involved
5. recurrent IE with the same organism
6. embolism despite tx
7. large mobile vegetation
133
# Infective Endocarditis
What would be a late surgery? do we prefer late surgery?
| after what?
abx course completed
prefer this is pt is stable enough
134
# Infective Endocarditis
Surgical considerations of repair vs replacement of valve?
1. extent of damage
2. active infection
3. compliance w/ anti-coags
135
# Infective Endocarditis
What things should be continued post op?
| which meds? how long?
1. abx 1-2 wks post-op
2. anti-fungal 6 wks post-op
136
# Infective Endocarditis
Risk stratification for surgery
| 7 things
1. age
2. EF < 40%
3. pre-op shock
4. CKD on dialysis
5. Paravalvular abscess
6. Dysrhythmia
7. *S. aureus* infection
137
# Infective Endocarditis
Prognosis
| survival rate, surgery rate, recurrance rate
1. almost always fatal if untreated
2. ~70% survival w/ tx
3. 60% require surgery
4. 20-31% have recurrance
138
# Infective Endocarditis
Bacterial IE mortality
| in hospital vs 6-month
1. 18-23%
2. 22-27%
139
# Infective Endocarditis
Fungal IE mortality
| in hospital vs 1 yr
1. 36%
2. 59%
140
# Infective Endocarditis
Overall Complications
| BIG PICTURE (4)
1. valve damage/destruction
2. abscess
3. peripheral embolization
4. therapy-related complications
141
# Infective Endocarditis
What would valve damage/destruction complication lead to?
heart failure
142
# Infective Endocarditis
what would an abscess complication lead to?
conduction disturbance
143
# Infective Endocarditis
What can peripheral embolization lead to?
| 6 things
1. in myocardium, MI
2. in lungs, PE
3. in brain/spinal cord, stroke/paralysis
4. in eyes, blindness
5. in extremities, limb ischemia
6. in spleen/kidney, infarct
144
# Infective Endocarditis
Prevention
1. Basic considerations of risk factors
2. Basic considerations of risk of bacteremia from procedures
3. Basic considerations of risk of adverse outcomes from abx
4. Targeting most likely orgnaisms
145
# Infective Endocarditis
When is prophylaxis indicated?
| 5 things
1. hx of IE
2. cardiac valve disease in transplanted heart
3. unrepaired cyanotic CHD or incompleted repaired
4. CHD repair using prosthetic material
5. prosthetic heart valve
146
# Infective Endocarditis
When is prophylaxis not indicated?
| 7 things
1. hx of rheumatic fever or kawasaki disease w/out valvular dysfuntion
2. acquired valvular dysfunction
3. bixuspid aortic valve
4. simple atrial septal defect
5. mitral valve prolapse w/ regurgitation
6. hypertropic cardiomyopathy
7. valve repair w/out prosthetic materia
147
# Infective Endocarditis
High risk procedures that can lead to IE
| 3
1. dental work (gingival)
2. resp tract incisions
3. surgery for infected skin
148
# Infective Endocarditis
Prophylaxis meds/doses for high risk pts undergoing high risk procedures
| 4
1. Amoxicillin- 2g PO
2. Cephalexin- 2g PO
3. Clindamycin- 600mg PO
4. Azithromycin- 500mg PO
149
# Infective Endocarditis
When to dose prophylatic meds to high risk pts
60 min prior to procedure
150
# Infective Endocarditis
Low risk procedures leading to IE
1. GI/GU
2. c-section
151
# Staphylococcus Aureus
Most common infections associated w/ *S. aureus*
1. skin/soft tissue
2. osteomyelitis (60%)
3. bacteremia
4. endocarditis
5. TSS
152
# Staphylococcus Aureus
what % of population are carriers?
25%
153
# Staphylococcus Aureus
Rates of ____ are high?
MRSA
154
# Staphylococcus Aureus
Treatment of non-MRSA infections
1. incision & drainage
2. Cephalexin, 500mg PO, QID
155
# Staphylococcus Aureus
Treatment of MRSA infections
1. incision & drainage
2. Clindamycin, 300mg PO, TID
or
3. Vanco, 1gm IV, Q12 hrs
156
# Staphylococcus Aureus Toxins
What infections can *S. aureus* lead to?
| 3 things
1. Scalded skin syndrome
2. TSS
3. Enterotoxin food poisoning
157
# Staphylococcus Aureus Toxins
which population is scalded skin syndrome typically seen in?
children
158
# Staphylococcus Aureus Toxins
describe TSS
quick onset febrile illness w/ diffuse macular erythematous rash and nonpurulent conjunctivitis
159
# Staphylococcus Aureus Toxins
fatality rate of TSS
15%
160
# Coagulase Negative Staphylococcus
most common species?
| 3
1. epidermidis
2. haemolyticus
3. hominis
161
# Coagulase Negative Staphylococcus
are commonly resistant to ____, so they are treated with _____
1. beta-lactams
2. vancomycin
162
# Coagulase Negative Staphylococcus
most common type of infection?
wound infections in those with intravascular and prosthetic devices
163
# Coagulase Negative Staphylococcus
Can cause which complications?
osteomyelitis
endocarditis
164
# Coagulase Negative Staphylococcus
part of which flora normally?
skin flora
165
# Enterococcus
typical species causing infection
1. faecalis
2. faecium
166
# Enterococcus
typical infections
1. wound infections
2. UTIs
3. bacteremia
4. IE
167
# Enterococcus
Treatment options
1. PCN
2. Vanco
3. Linezolid
168
# Enterococcus
when to use vanco rather than PCN?
1. PCN allergy
2. PCN resistance
169
# Enterococcus
dosage/freq of PCN/ampicillin
A: 2g, Q4 hrs
PCN: 3-4 mil units, Q4 hrs
170
# Enterococcus
Vancomycin dosage/freq
15 mg/kg IV, Q12 hrs
171
# Enterococcus
what to use in vanco resistance?
Linezolid
600mg Q12 hrs
172
# Enterococcus
what to do with VRE?
1. culture sensitivity
2. inpatient contact isolation
3. ID consult
173
# Enterococcus
risks of linezolid
1. bone marrow suppression
2. thrombocyotpenia
174
# Pneumococcus
most common cause of?
community acquired bacterial pneumonia
175
# Pneumococcus
what makes a patient high risk?
| 5 things
1. old age
2. multilobar disease
3. hypoxemia
4. bacteremia
5. extrapulm complications
176
# Pneumococcus
Dx
1. sputum culture
2. rapid urine antigen test for *s. pneumoniae*
177
# Pneumococcus
sens/spec of rapid urine antigen test
1. sens: 70-80%
2. spec: 95%
178
# Pneumococcus
complications
| 4
1. parapneumonic effusions
2. pericarditis
3. endocarditis
4. meningitis
179
# Pneumococcus
Outpatient tx
| first line & in PCN allergy
1. Amoxicillin, 750mg PO, Q24
2. Azithromycin, 500mg day 1, followed by 250mg daily for 4 days
180
# Pneumococcus
inpatient tx
| first line & PCN allergy
1. PCN G, 2 mil units IV, Q4 hrs
2. Vanco, 1g IV, Q12 hrs
181
# Bacillus
most common species causing infection
*B. cereus*
182
# Bacillus
which pts are most likely to become ill with this?
| 3 populations
1. immunocomp
2. IVDU
3. indwelling/implanted catheters
183
# Bacillus
most common infections
1. food posioning
2. bacteremia
3. endocarditis
4. ocular infections
184
# Bacillus
most commonly resistant to what? so we use what?
1. PCN and cephalosporins
2. Vanco
