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ID II: Bacterial Infections Flashcards

1
Q

Which 2 agents are commonly used for prophylaxis before cardiac/vascular surgeries?

A

cefazolin or cefuroxime

*vanco or clinda if allergy

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2
Q

Which agent is commonly used for prophylaxis before joint replacement surgeries?

A

cefazolin

*vanco or clinda if allergy

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3
Q

Which agents are commonly used for prophylaxis before colorectal surgeries?

A

cefoxitin, unasyn, ertapenem OR metronidazole + (cefazolin orceftriaxone)

*clinda + (AG or quinolone or aztreonam) OR metronidazole + (AG or quinolone) if allergy

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4
Q

Which agents are commonly used for prophylaxis before a hysterectomy?

A

cefazolin, cefoxitin or unasyn

*clinda or vanc + (AG or quinolone or aztreonam) OR metronidazole + (AG or quinolone) if allergy

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5
Q

What is meningitis?

A

Inflammation of the meninges that cover the brain and spinal cord

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6
Q

Name the 3 classic sx of meningitis

A

HA, nuchal rigidity, altered mental status

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7
Q

Name the most likely bacterial pathogens of meningitis

A

strep pneumo, Neisseria meningitidis, h. flu, listeria*

*Infants

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8
Q

Empiric therapy for acute bacterial meningitis in infants

A

amp 150-200mg/kg/day + (gent 5-7.5mg/kg/day or cefotaxime 100-200mg/kg/day)

*amp added for listeria coverage

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9
Q

Empiric therapy for acute bacterial meningitis in children and adults aged 1 mo-50 yrs

A

(ceftriaxone or cefotaxime) + vanco

*PCN allergy: quinolone + vanco

For Lindsey - pts aged 1mo -23mo dosing:
ceftriaxone 80-100mg/kg/day or cefotaxime 225-300mg/kg/day + vanco 60mg/kg/day divided q6h

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10
Q

Empiric therapy for acute bacterial meningitis in immunocompromised pts or aged >50 yrs

A

vanco + amp + (ceftriaxone or cefotaxime)

  • amp added for listeria coverage
  • PCN allergy: quinolone + vanco (+/- SMX/TMP for listeria coverage)
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11
Q

Name the common types of upper respiratory infections

A

acute otitis media (AOM), pharyngitis (s. pyogenes), sinusitis (s. pneumo, h. flu, moraxella, staph, anaerobes, some gm- rods), influenza, common cold (rhinovirus, coronavirus)

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12
Q

When do you treat AOM in children 6 mo-2 yrs?

A

Bilateral with or without drainage, unilateral w/drainage, or uni/bilateral w/severe sx (ear pain >48 hrs, T >102.2F)

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13
Q

When do you treat AOM in children >2 yrs?

A

any drainage, uni/bilateral w/severe sx, and possibly bilateral w/out drainage

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14
Q

Empiric therapy for AOM

A

High dose amoxicillin (80-90mg/kg/day divided q12h) or augmentin (90mg/kg/day divided q12h)

*PCN allergy: cefdinir 14mg/kg/day or ceftriaxone 50mg/kg IM/IV

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15
Q

Indications for antibiotic tx in pharyngitis

A

+ rapid antigen diagnostic test OR + s. pyogenes culture

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16
Q

Indications for antibiotic tx in sinusitis

A

> 7-10 days of sx, tooth/face pain, nasal drainage, congestion or severe sx

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17
Q

Tx options for pharyngitis

A

penicillin, amoxicillin, 1st/2nd gen cephalosporin x 10 days

*If beta-lactam allergy: clarithromycin, azithromycin, or clinda

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18
Q

Tx options for sinusitis

A

1st line: augmentin x 5-7 days (children) or 10-14 days (adults)

2nd line or failure of augmentin: oral 2nd/3rd gen cephalosporin + (clinda or doxy) OR respiratory quinolone

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19
Q

Name the common types of lower respiratory infections

A

bronchitis - including: whooping cough; acute COPD exacerbation; community-acquired PNA; hospital-acquired/ventilator-associated PNA; TB

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20
Q

Acute bronchitis typical pathogens

A

90% caused by RESPIRATORY viruses: RSV, adenovirus, rhinovirus, coronavirus, influenza, parainfluenza

Bacterial etiology for more severe cases: mycoplasma, h. flu, bordetella pertussis, chlamydophila pneumoniae

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21
Q

Tx for mild-to-moderate acute bronchitis

A

Supportive tx

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22
Q

Tx for confirmed or suspected bordetella pertussis (whooping cough)

A

azithromycin x 5 days or
clarithromycin x 7 days or
SMX/TMP x 14 days

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23
Q

Tx for acute bacterial COPD exacerbation

A

Tx w/ antibiotics for the following 3 sx: increase in dyspnea, sputum volume, and sputum purulence (or if MV is required)

supportive tx + augmentin or azithromycin, or doxycycline x 5-10 days

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24
Q

Common causes of CAP

A

Outpatient: STREP PNEUMO, h. flu, Moraxella catarrhalis, mycoplasma, chlamydophila pneumonia

Inpatient: + legionella, gm- bacilli, staph aureus, pseudomonas

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25
Outpatient empiric tx of CAP
If previously healthy + no abx use in past 3 months: 1. macrolide (azith, clarith, eryth) OR 2. doxy If comorbidities (chronic heart, lung, liver or renal dz, DM, alcoholism, malignancies, asplenia, use of abx w/in past 3 months, immunosuppressed) OR risk for drug-resistant strep pneumo: 1. beta-lactam + macrolide (HD amox or augmentin preferred) 2. Respiratory quinolone monotherapy
26
Inpatient empiric tx of CAP
Non-ICU 1. beta-lactam + macrolide (ceftriaxone or cefotaxime preferred) 2. Respiratory quinolone monotherapy (IV or PO) ICU 1. beta-lactam + (azith or respiratory quinolone) - (ceftriaxone, cefotaxime or unasyn preferred) * PCN allergy: aztreonam + respiratory quinolone Suspected pseudomonas: use zosyn/cefepime/imipenim/or meropenem for beta-lactam + (cipro or levo) Suspected MRSA: + vanco or linezolid
27
Common causes of early onset HAP or VAP
strep pneumo, MSSA, h. flu, e. coli, proteus, klebsiella, enterobacter, serratia
28
Empiric tx for early onset HAP or VAP
ceftriaxone or unasyn or ertapenem or levo/moxi/cipro
29
Common causes of late onset HAP, VAP, or HCAP
strep pneumo, MRSA, pseudomonas, CAPES
30
Empiric tx for late onset HAP/VAP/HCAP
antipseudomonal beta-lactam (cefepime, ceftazidime, zosyn, imipenem/cilastatin, meropenem) + 2nd antipseudomonal agent (gent, tobra, amikacin, levo, cipro) + Anti-MRSA if pt has risk factors (vanco or linezolid)
31
Length of tx for HAP/VAP/HCAP
7-8 days* *14 days if caused by pseudomonas or acinetobacter
32
Length of tx of CAP
5-7 days
33
What organism causes TB?
mycobacterium tuberculosis (aerobic, non-spore forming acid fast bacillus)
34
Describe the 2 phases of TB
Latent: no sx seen; NOT contagious; diagnosed via PPD intradermal test Active: HIGHLY contagious (through aerosolized droplets) w/sx (cough, hemoptysis, purulent sputum, fever); diagnosed via sputum culture
35
Tx of latent TB
1. isoniazid (INH) 300mg daily x 9 months 2. rifampin 600mg daily x 4 months if INH resistant/INH-intolerant 3. INH + rifapentine once weekly x 12 weeks* *Cannot use in HIV+ pts, children
36
Tx of active TB
``` Initial Phase (tx for 8 weeks): RIPE rifampin + INH + pyrazinamide + ethambutol ``` Continuation Phase (tx depends on resistnance) 1. susceptible to INH and rifampin: continue INH + rifampin daily x 18 wks 2. resistant to INH: rifampin + pyrazinamide + ethambutol +/- moxifloxacin x 18 wks 3. resistant to rifampin: INH + ethambutol + quinolone x 12-18 mo + pyrazinamide x 2 mo 4. MDR-TB: quinolone (levo or moxi) + pyrazinamide + ethambutol + AMG (streptomycin or amikacin or kanamycin) +/- alt agent x 18-24 mo
37
Common SE from RIPE tx of TB
orange-red discoloration of body secretions, flu-like syndrome, GI upset, rash, increase in LFTs, HA, hyperuricemia, optic neuritis, drug-induced lupus erythematosus
38
CI to rifampin
concurrent use w/ protease inhibitors* *Pts on protease inhibitors (e.g. HIV pts) may replace rifampin with RIFABUTIN to avoid DDI
39
BBW for INH
severe and fatal hepatitis
40
CI to pyrazinamide
acute gout, severe hepatic damage
41
CI to ethambutol
optic neuritis, use in young children, use in any pt who cannot discern and report any visual changes
42
What are the 3 most common causative organisms of infective endocarditis (IE)?
staph (MRSA & MSSA), strep viridans, enterococcus
43
What is infective endocarditis?
Infection of the inner tissue of the heart - most commonly the heart valves
44
Empiric tx of IE
vanco + ceftriaxone +/- gentamicin for synergy x 4-6 wks
45
Preferred tx for viridian group strep IE
PCN, amp, or ceftriaxone +/- gent for synergy *bet-lactam allergy: vanco monotherapy
46
Preferred tx for MSSA IE
nafcillin or cefazolin + gent if prosthetic valve *bet-lactam allergy: vanco
47
Preferred tx for MRSA IE
vanco + gent if prosthetic valve
48
Preferred tx for enterococci IE
PCN or amp + gent *beta-lactam allergy or resistance: vanco
49
IE prophylaxis
Pt at risk of IE should use abx before dental procedures for IE prophylaxis High risk pts: hx of endocarditis, heart transplant w/abnormal valve fxn, some congenital heart defects Ex regimens: amoxicillin 2 g, clinda 600mg, azith 500mg, cefazolin 1 g IM/IV
50
Common types of intra-abdominal infections
spontaneous bacterial peritonitis (SBP), secondary peritonitis (caused by trauma e.g. ulceration, ischemia, obstruction or surgery), cholecystitis (inflammation of gallbladder), cholangitis (inflammation of bile duct)
51
Tx of SBP
DOC: ceftriaxone x 5-7 days *SMX/TMP or cipro can be used for primary or secondary prophylaxis
52
Tx of secondary peritonitis and cholangitis
mild-to-moderate infection: cover PEK, anaerobes, strep, enterococci Ex. regimen: cefoxitin, ertapenem, moxi high-severity infections/ICU pts: cover PEK, CAPES, anaerobes, strep, enterococcus Ex. regimen: carbapenem or zosyn or (cefepime or ceftazidime) + metronidazole
53
Common types of non-purulent SSTIs
Cellulitis, erysipelas, necrotizing infections
54
Common types of purulent SSTIs
Furncle, carbuncle, absess* Further categorized into mild, moderate and severe infections
55
Common pathogens associated with cellulitis
strep pyogenes (group A strep), staph aureus (CA-MRSA)
56
Empiric tx of mild non-purulent SSTIs
Target strep PCN, cephalexin, clinda x 5 days
57
Empiric tx of moderate non-purulent STTIs
OR penetrating mild non-purulent infections - target strep +/- MSSA ceftriaxone, cefazolin, clinda x 5 days
58
Empiric tx of severe or necrotizing non-purulent SSTIs
BROAD coverage vanco + beta-lactam (zosyn, imipenem/cilastatin, meropenem) *Tx of choice for group A strep necrotizing fasciitis = pen G + clinda
59
Empiric tx of moderate purulent SSTIs
Target CA-MRSA 1. I&D 2. SMX/TMP or doxy/minocycline or clinda or linezolid After C&S narrow to: - MSSA: cephalexin or dicloxacillin - MRSA: SMX/TMP
60
Empiric tx of mild purulent SSTIs
I&D only
61
Empiric tx of severe purulent SSTIs
Target MRSA Start with IV abx and when pt is stable transition to PO 1. I&D 2. vanco or dapto or linezolid or telavancin or ceftaroline or tedizolid or dalbavancin x 7-14 days *BITE infections require addition of aerobic gm- and anaereobes (e.g. unasyn or augmentin)
62
Name the predominant gm+ pathogens associated with diabetic foot infections (DFI)
aerobic: staph (including MRSA), group A strep, viridans group strep, staph epidermidis anaerobic: peptostreptococcus, clostridium perfringens
63
Name the predominant gm- pathogens associated with diabetic foot infections (DFI)
aerobic: e. coli, klebsiella, proteus, enterobacter, pseudomonas anaerobic: baceroides fragilis
64
Empiric tx of moderate-to-severe DFI
Monotherapies: unasyn, zosyn, timentin, imipenem/cilastatin, meropenem, ertapenem, tigecycline, moxifloxacin Combos: vanco + (ceftazidime, cefepime, zosyn, aztreonam or a carbapenem) Tx length: 7-14 days; more severe = 2-4 wks; osteo = 4-6 wks
65
Name the most common sx associated with lower UTI
dysuria, urgency, frequency, burning, nocturia, suprapubic burning, +/- hematuria *fever is UNCOMMON
66
Name the most common sx associated with upper UTI
flank pain, abdominal pain, FEVER, N/V, malaise
67
What is a lower urinary tract infection?
Infection of the bladder (cystitis) and urethra
68
What is an upper urinary tract infection?
Infection of the kidney (pyelonephritis) or upper urinary tract
69
What is considered a complicated UTI?
- Pregnancy - Infection resulting from neurogenic bladder (spinal cord injury, MS) - Infection resulting from an obstruction (kidney stone, enlarged prostate)
70
Target and empiric tx of uncomplicated cystitis in females
Common pathogens: e. coli, klebsiella, proteus, enterococcus nitrofurantoin 100mg BID x 5 days OR SMX/TMP DS BID x 3 days OR cipro 500mg daily x 3 days OR levofloxacin 250mg daily x 3 days
71
Target and tx of uncomplicated pyelonephritis
Common pathogens: e. coli, enterococcus, proteus, klebisella, pseudomonas Moderate (PO): cipro 1,000mg daily x 7 days OR levofloxacin 750mg daily x 5 days Severe (IV): ceftriaxone or amp/gent or cipro/levo or zosyn x 14 days total
72
Target and tx of complicated UTI
Common pathogens: e. coli, klebsiella, enterobacter, serratia, pseudomonas, enterococcus, staph ceftriaxone or amp/gent or cipro/levo or zosyn x 7-14 days *If ESBL use a carbapenem
73
Tx of UTI in pregnancy
Bacteriuria MUST BE TREATED even if pt is asymptomatic ( x 3-7 days) 1st line: beta-lactams (augmentin or cephalosporins) 2nd line: nitrofurantoin or SMX/TMP - contraindicated in last 2 weeks of pregnancy *Quinolones are CI!
74
What agent can you use to tx dysuria associated with UTI?
phenazopyridine (Azo, Pyridium, Uristat) x 2 days max *may cause orange-red discoloring of urine and other body fluids
75
Name the common sx of clostridium difficile infection
cramps, profuse diarrhea (+/- blood), fever
76
Why should antimotility agents be avoided for c. difficile infections?
Increased risk of toxic megacolon from toxins released from c. difficile
77
Tx of 1st c. difficile infection
Mild-moderate :metronidazole 500mg po TID x 10-14 days Severe: vanco 125mg QID x 10-14 days Severe, complicated (hypotension, shock, ileus, toxic megacolon): vanco 500mg QID + metronidazole 5000 mg IV q8h
78
Tx of 2nd c. difficile infection (1st recurrence)
SAME as 1st tx if infection is of the same severity
79
Tx of 3rd c. difficile infection (2nd recurrence)
vanco taper/pulse tx for all severities *fidaxomicin or fecal stool transplants may be considered
80
Common pathogens associated with travelers' diarrhea (TD)
e. coli, campylobacter jejuni, shigella, salmonella
81
Tx of TD
*MOST cases are benign and resolve in 3-5 days cipro 500mg BID x 1-3 days OR rifaximin (Xifaxan) 200mg TID x 3 days + loperamide
82
DOC for tx of syphilis
pen G benzathine
83
DOC for tx of neurosyphilis
pen G aqueous
84
DOC for tx of congenital syphilis
pen G aqeous
85
DOC for tx of gonorrhea
ceftriaxone 250mg IM + azithromycin 1 g (or doxy)
86
DOC for tx of chlamydia
azithromycin 1 g
87
DOC for tx of bacterial vaginosis
metronidazole or metrogel
88
DOC for tx of trichomoniasis
Metronidazole 2 g (or tinidazole)
89
Name the most common rickettsial diseases
Rocky mountain spotted fever, typhus, lyme disease, ehrlichiosis, tularemia
90
What pathogen causes rocky mountain spotted fever?
rickettsia rickettsii
91
Tx of rocky mountain spotted fever
doxycycline 100mg BID x 5-7 days
92
What pathogen causes typhus?
rickettsia typhi
93
Tx of typhus
doxycycline 100mg BID x 7 days
94
What pathogen causes lyme disease?
borrelia burgdorferi
95
Tx of lyme disease
doxycycline 100mg BID x 10-21 days OR amoxicillin 500mg TID x 14-21 days OR cefuroxime 500mg BID x 14-21 days
96
How do humans contract rickettsial diseases?
Bites from ticks, fleas and lice
97
Supplement to take to prevent peripheral neuropathy while on INH tx?
Pyridoxine

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