Immunocompromise & Anti-Infectives Flashcards
Meningitis
Path:
S/sx:
Dx:
Tx:
Meningitis
Path: Bacterial infxn (Strep, listeria)
S/sx: HA, stiff neck, fever
Dx: Lumbar puncture w/ many neutrophils
- Opening pressure, WBC w diff, glu (down), protein (up), culture
Tx: Ceftriaxone and Vanco, then narrow based on culture
- Ampicillin for listeria / immunocompromised
Brain Abscess
Path:
S/Sx:
Dx:
Tx:
Brain Abscess
Path: Otitis media, sinusitis, neurosurgery, heme spread -> mass effect
S/Sx: Fever, HA, focal neuro deficit
Dx: Sterotactic abscess culture (likely polymicrobial)
Tx: 6 Weeks empiric tx with 3rd generation cephalosporin and flagyl (treating MSSA, strep, enterobacteria, anaerobes)
Mucocutaneous Candidiasis
Path:
S/Sx:
Dx:
Tx:
Mucocutaneous Candidiasis
Path: Immunosuppression -> normally commensal organism takes hold
S/Sx:
- Pseudomembranous thrush: painless, creamy white plaques on buccal/oropharyngeal surface (can be scraped off easily)
- Erythematous thrush: easier to miss erythema patches on anterior or posterior upper palate / tongue
- Angular chelitis / stomatitis: red, cracked painful skin at corners of mouth with crusts and bleeding
Dx: Clinical
Tx:
- Fluconazole 100mg PO daily x 7-14d
- Monitor cross rxn with other treatments (Clotrimazole, miconazole, nystatin)
Candida Esophagitis
Path:
S/Sx:
Dx:
Tx:
Candida Esophagitis
Path: CD4 < 200 in AIDS pt (50%)
S/Sx: Retrosternal burning, odynophagia, white plaques with ulceration on endoscopy, +/- oral thrush, +/- fever
Dx: Clinical vs. endo with culture vs. trial of tx
- DDx includes herpes simplex, CMV, HIV
Tx:
- (+) Candida: systemic antifungal x 10-14d (PO or IV -azole)
- Resistent: Voriconazole, vaspofungin, micafungin
- (+) HSV or CMV: antiviral tx
- (+) HIV esophagitis: Corticosteroids
Vulvovaginal Candidiasis
Path:
S/Sx:
Dx:
Tx:
Vulvovaginal Candidiasis
Path: Immunocompromise -> fungal infxn
S/Sx: Creamy discharge with burning, itching
Dx: Clinical or KOH Prep
Tx: Fluconazole 150mg PO x1 dose (caution: Many DDIs)
- Alternative: Topical -azole +/- suppository for 3-7days at HS
Doxycycline
Benefits:
CIs:
Doxy
Benefits: Gram positive skin and soft tissue infection
CIs: Allergy
Ceftaroline
Benefits:
Clindamycin
Benefits: Use in MRSA bacteremia if Dapto not an option
Televancin
Benefits:
Pearls:
Televancin
Benefits: VISA
Pearls: VRSA not sensitive
Clindamycin
Benefits:
CIs:
Pearls:
Clindamycin
Benefits: Sinus, dental, skin, soft tissue gram positives
CIs: Allergy
Pearls: Increasing resistance; Increased risk for C Diff infection
TMP/SMX
Benefits:
CIs:
Pearls:
TMP/SMX
Benefits: Gram positive skin and soft tissue infection
CIs: Severe renal dysfunction; sulfa allergy
Pearls: Local resistance patterns vary
Linezolid
Benefits:
CIs:
Pearls:
Linezolid
Benefits: MRSA pneumonia, gram positive skin and soft tissue infection; also available in PO
CIs: Avoid if using SSRI or SNRI -> can lead to Seratonin Syndrome
Pearls: 2nd line for MRSA bacteremia
Daptomycin
Benefits:
CIs:
Pearls:
Daptomycin
Benefits: Low Vd ; best for gram positive bacteremia and endocarditis; use for salvage therapy
CIs: Allergies; NOT for pneumonia d/t pulmonary surfactant
Pearls: Option for VRSA
Vancomycin
Benefits:
CIs:
Pearls:
Vancomycin
Benefits: 1st line tx MRSA; High Vd and good penetration to most tissues
CIs: Allergy or severe renal dysfunction
Pearls: MIC <1.5 use Vanco; MIC > 2 will be resistant
Vancomycin Resistant Organisms
Vanco Sensitive MIC:
VISA MIC:
VRSA MIC:
Alternate treatment for MRSA cSSI:
Vancomycin Resistant Organisms
Vanco Sensitive MIC: <1.5
VISA MIC: 4-8
VRSA MIC: >8
Alternate treatment for MRSA cSSI:
- MIC < 4: Dalbavancin, oritavancin, tedizolid
- MIC > 4: Tedizolid (but limited data)
Commonly Abx-Resistant Bugs
E
S
K
A
P
E
Commonly Abx-Resistant Bugs
Enterobacter
Staph aureus
Klebsiella
Acinetobacter
Pseudamonas
Enterococcus
