ID Flashcards
UTI in a female - what bacteria are responsible? What is different about proteus?
80% are E. coli
Rest include proteus, klebsiella, staph saprophyticus, enterococcus, candida, pseudomonas, staph, citreus
Proteus and Klebsiella alkalinize urine, ph>8, and raise risk for struvite stones/calculi
What is the treatment for uncomplicated cystitis
Nitrofurantoin x 5 days
TMP-SMX x 3 days
Fosfomycin x1 or ciprofloxacin x3 if resistant or allergy
What is the treatment for complicated cystitis
FQ 5-14 days
What is the treatment for pyelonephritis
FQ as outpatient (cipro, levo)
IV FQ or aminoglycoside as inpatient
How do you diagnose and treat listeria meningitis?
Gram positive bacilli
Tx with ampicillin
When do you treat sinusitis with antibiotics? Which antibiotics?
3-4 days of severe symptoms (fever, purulent drainage, facial pain), worsening of sx initially improving after URI, or symptoms not improving after 10 days
If abx: amox-clavulanate or doxycycline
What the the Centor criteria and what do they predict?
Temp >38.1100.5, tonsillar exudates, tender cervical lymphadenopathy, absence of cough
With all four, 40% chance of having group A beta-hemolytic strep pharyngitis
Proceed to rapid antigen detection test or throat culture
How do you treat otitis externa?
Neomycin, polymyxin B, and hydrocortisone topical for 7-10 days
If granulation tissue – malignant otitis externa, pseudomonas likely, tx with ciprofloxacin or other anti-pseudomonal abxan
If antibiotic - amoxicillin or azithromycin
Lemierre syndrome
Septic thrombosis of jugular vein
Pharyngitis, persistent fever, neck pain, septic pulmonary emboli
Diagnose by CT neck with contrast
Tx with penicillin with beta-lactalmase inhibitor or carbapenem
What should be used to treat pseudomonas-suspected pneumonia?
beta-lactam and aminoglycoside
Piperacillin-tazobactam (zosyn) and amikacin
How do you decide where to treat pneumonia?
CURB65 - confusion, BUN, resp >30, systolic <90/diastolic <60, age >65
If two criteria - admit to hospital
If 3 criteria - admit to ICU, mortality >20%
What is the treatment for outpatient community acquired pneumonia?
If risk factor for resistant S pneumo (age >65, recent abx, comorbidities, alcoholism, peds exposure, immunocompromise): respiratory quinolone (moxi, levo) or betalactam + macrolide (azithromycin)
If no risk factors: azithromycin macrolide, as it covers susceptible S pneumo, H flu, mycoplasma, and chlamydiophila. If need second-line, doxycycline.
What is the treatment for bacteremic susceptible pneumococcal pneumonia?
Start with IV ceftriaxone; if improving, oral amoxicillin to complete 7 days of therapy.
How do you interpret the tuberculin skin test?
5mm or greater: positive in HIV positive, recent exposure to active TB, organ transplant or immunosuppressed
10mm or greater: positive for high risk (IVDU, high prevalence country, jail, nursing home, health care)
15mm or greater: positive for person with no risk factors
If positive, CXR
What is the treatment for latent TB?
Isoniazid for 9 months
May reduce risk of active disease by 90%
What is the treatment for active TB?
2 months of RIPE; 7 months if isoniazid and rifampin
When is prophylactic antibiotics before dental procedure required? What drug is used? What about if the patient is penicillin-allergic?
Prosthetic heart valves
Prior infective endocarditis
Unrepaired congenital heart disease or recently repaired, or with remaining abnormalities
Heart transplant patients with valvulopathy
Dental procedure involving manipulation of gingival tissue, perforation or oral mucosa, or periapical region of teeth
NOT indicated in native valve abnormalities
Tx with amoxicillin or clindamycin if allergic
What do you treat MRSA endocarditis with? MSSA endocarditis?
MSSA: nafcillin, oxacillin
MRSA: IV vancomycin or daptomycin
What is empiric therapy for pyelonephritis?
FQ (ciprofloxacin)
Extended-spectrum cephalosporin
Aminoglycoside
For 7-14 days
What is the definition of recurrent UTI? How do you treat it?
≥2 infections in six months or ≥3 infections in one year
Post-coital ciprofloxacin prophylaxis, discontinue spermicide use
What is the treatment for prostatitis?
FQ (ciprofloxacin)
TMP-SMX
Doxycycline
(usually caused by e coli)
What is the treatment for epididymitis?
If sexually active, <35YO - ceftriaxone and doxy/azithromycin
(for chlamydia and gonorrhoeae)
Chancroid
Single or multiple painful ulcers, ragged border, granulomatous base, purulent exudate
Syphilis primary lesion
Single, painless ulcer, raised border
What is the fundoscopic appearance of CMV retinitis?
Fluffy, yellow-white retinal lesions, +/- intraretinal hemorrhage
Tx with gancyclovir, foscarnet, or valgancyclovir and HAART
What are the screening recommendations for HIV?
All patients bw 13 and 75 should be tested at least one by antibody/p24 antigen testing
If risk factors, annual testing
What are guidelines for fluids, antibiotics, pressors and steroids for sepsis?
Early fluid resuscitation with crystalloid, 500-1000 ml bolus to MAP of 65 and CVP of 8-12
Antibiotics empirically within 1 hour
Pressors for septic shock: SIRS, organ dysfunction, hypotension non-responsive to 1L fluids
IV hydrocortisone if hypotension responds poorly to fluids and vasopressors
What are three ways to prevent ventilator associated pneumonia?
Head of the bed at 30 degrees
Daily assessment of patient readiness to wean from vent
Chlorhexidine mouthwash
Which bugs are responsible for osteomyelitis after puncture wounds?
Pseudomonas and staph aureus
How do you treat PCP?
TMP-SMX
With steroids if impaired oxygenation <92%
What is empiric therapy for a central line infection?
Vancomycin
covers coag negative staph and staph aureus
If severely ill, also add cefriaxone, ceftazidime or cefepime for gram negative and pseudomoas
What antibiotics have anti-pseudomonal activity?
Ceftazidime, Cefepime (4th gen cephalosporin)
Merepenem, Imipenem (Carbapenems - NOT erta)
Piperacillin/Tazobactam (anti-pseudo penicillin)
Aztreonam
FQ - Cipro and Levo, NOT moxi
Aminoglycosides (Amikacin > Tobramycin > Gentamicin)
When do you empirically cover for pseudomonas, and how do you cover?
Immunocompromise, cystic fibrosis, burn patient, any nosocomial (line, ventilator, catheter related)
Double coverage – a beta-lactam plus either Fluoroquinolone or Aminoglycoside. Use Aztreonam if PCN-allergic
How do you treat community-acquired pneumonia?
Azithromycin (Macrolide) as single-agent therapy
Combine with ceftriaxone to cover strep pneumo resistance
OR
Levofloxacin or Moxifloxacin
Consider vancomycin or linezolid if suspect MRSA
How do you treat HCAP?
Anti-MRSA antibiotic: Vancomycin or Linezolid
Antipseudomonal Beta-Lactam: Ceftazadime, Cefepime, Piperacillin/Tazobactam, Imipenem, Meropenem, Aztreonam if allergy.
*For severely ill patients, or if high risk of resistant gram negative infection, also consider addition of “double coverage” with Antipseudomonal Fluoroquinolone (Ciprofloxacin or Levofloxacin), or Aminoglycoside.
How do you treat aspiration pneumonia?
Levofloxacin + Metronidazole
Clindamycin (add Levofloxacin if concern for community-acquired pneumonia)
Ampicillin/Sulbactam
What is the causative agent of erysipelas, and how is it treated?
Group A strep
IV cefriaxone or cefazolin
If without systemic symptoms, amoxicillin
Erysipelas
Strep pyogenes
Infection of superficial dermis. Rapid spread, demarcated edges
Cellulitis
S pyogenes or MSSA, MRSA
Deep dermis and subcutaneous infection. Flat edges, poor demarcation, indolent course.
Treat with TMP-SMX or cephalexin; clindamycin to cover MRSA
Endocarditis associated with prosthetic valves, catheters, or pacemakers
S aureus
Coag negative staph
Endocarditis associated with dental procedures
viridans group strep (sanguinis)
Endocarditis associated with nosocomial UTI
enterococcus
Endocarditis associated with IBD
S bovis
Endocarditis associated with IVDU
s aureus
