Infectious Disease Flashcards
What is considered CAP?
symptom onset occuring in the community setting or <48hours after hospital admission
How do you treat CAP with no risk factors?
In the outpatient setting?
- Ceftriaxone 2 g IV q24h with azithro or doxy (100mg q12h) (if azithromycin can’t be used
- if critically ill add vancomycin
- outpatient or transition to oral is augmentin with or without azithro or doxy
What are the most likely pathogens in CAP?
Strep pneumo, M. catarrhalis, H. influenzae, staph aureus, Legionella pneumophilia
How long do you treat CAP?
7 days typically
How do you treat CAP for those with APBL susceptible pseudomonas?
How long to treat?
- Cefepime 2G IV q8h or zosyn 4.5 g IV q6h with or without azithromycin
Add vancomycin if critically ill - 7 days but can be extended to 10-14
How do you treat APBL susceptible Pseudomonas when transitioning?
How long to treat?
- levofloxacin 750 mg po q24h
- 7 days
How do you treat APBL resistant Pseudomonas?
- consider ID consult
- cefepime 2G IV q8h or zosyn 4.5 g IV q6h
+ tobramycin 5-7.5 mg/kg IV q24h (for double gram negative coverage)
with or without azythro or doxycycline (100 mg po q12h - add vanc for critically ill
How do you treat aspiration pneumonia?
- ceftriaxone + azithro + metro
- used unasyn at Cone
How do you treat pneumonia in someone with a severe PCN allergy?
levofloxacin 750 mg IV q24h
or ciprofloxacin 400 mg IV q4h ( cipro does not provide adequate gram positive coverage so may need vanc)
What will ciprofloxacin treat?
What will it not treat?
- Pseudomonas, Enterobacteriaceae, Neisseria, Haemophilus, Moraxella, Pasteurella
- will not treat anaerobes, most gram positives, Streptococci, Enterococci, Stenotrophomonas, Bacillus anthrasis
What will levofloxacin treat?
What will it not treat?
- Streptococci, MSSA;
- Gram neg: Most Enterobacteriaceae, N. meningitidis, Moraxella, H. influenzae, Legionella, Pasteurella, Pseudomonas
- Anaerobes: non-c.diff clostridia, Prevotella; Peptostreptococci
Other: Mycoplasma, Chlamydophila, atypicals including legionella - does not cover MRSA, many Enterococci, Stenotrophomonas
What covers Legionella?
Duration of treatment?
- Azithromycin and Levofloxacin
- with azithro, can treat for 10-14 days, especially in cases of severe illness
How can MSSA pneumonia be treated?
- IV: nafcillin, cefazolin
- PO: dicloxacillin, cephalexin
What are the Enterobacteriaceae?
How are they treated in pneumonia?
- Escherichia coli, Klebsiella pneumonia, Klebsiella oxytoca, Proteus mirabilis
- Ceftriaxone
How is Chlamydophila pneumoniae and Mycoplasma pneumoniae pneumonia treated?
Azithromcyin or doxycycline
How is Chlamydophila pneumoniae and Mycoplasma pneumoniae pneumonia treated?
Azithromcyin or doxycycline
How do you treat critically ill gram negative bacteremia?
In patients with PCN allergy?
- Cefepime 2gm IV q8h-q12h PLUS metronidazole
or
Zosyn 3.375-4.5 gm IV q6h (will cover obligate anaerobes) - PCN allergy severe: can consider aztreonam, ciprofloxacin, tobramycin, gentamicin
How do you treat Gram negative bacteremia in non-critically ill?
ceftriaxone 2 gm IV q24 hr PLUS metronidazole
Antibiotics for non-critically ill non-purulent soft tissue infection?
What po antibiotics do you transition to?
Duration?
- Nafcillin 1-2G IV q4h or cefazolin 1-2gIV q8h or ceftriaxone 1-2G IV q24h
- po: cephalexin 500 mg po q6h
- duration typically 7 days (or longer if more severe)
How do you treat purulent cellulitis in non-critically ill patients?
What are your deescalation options?
- Vancomycin
- Bactrim 1-2 DS tabs po q12h; doxycycline 100 mg q12h
- duration 7 days or longer if more severe
How do you treat non-necrotizing skin infection in critically ill?
- Vancomycin PLUS zosyn or cefepime or cipro
How do you treat necrotizing fasciitis in critically ill patients
Vancomycin PLUS zosyn or cefepime
What are the most common organisms in healthcare acquired pneumonia?
Pseudomonas aeruginosa
E. Coli
Enteric GNR
MRSA
What are the most common organisms in necrotizing skin infection?
Group A strep (strep pyogenes)
Staph aureus
Pseudomonas aeruginosa
Clostridium perfringens
What are the most common organisms in pyelonephritis?
What should you treat with?
- Klebsiella, E. Coli, Proteus mirabalis
- cefepime, ceftriaxone, or ciprofloxacin
What are the most common causes of meningitis?
N. meningitidis
Strep pneumo
H. influenzae
Listeria monocytogenes
What will vancomycin cover?
Gram positives (MRSA, MSSA, Strep, Enterococci)
Oral anaerobes
What does augmentin cover?
- Anaerobes: bacteroides & oral anaerobes
- gram negative rods except pseudomonas
- Gram positive: MSSA, streptococci
What does zosyn cover?
- Gram positive: everything except MRSA (so MSSA, Strep, and Enterococci
- All the gram negatives
- Anerobes: oral anaerobes and bacteroides
What does Aztreoname cover?
- not gram positives
- Gram negative rods, all of them
- Not anaerobes or atypicals
What does ceftriaxone cover?
Gram positives: MSSA & streptococci (not enterococci)
Gram negative rods: not pseudomonas
- not anaerobes or atypicals
Which -penem covers pseudomonas?
- meropenem
- ertapenem does not
What does cefepime cover?
MSSA, Strep (not enterococci)
all gram negative rods
not anaerobes
What does azithromycin cover?
MSSA, Strep
Atypicals (legionella)
What does doxycycline cover?
- MSSA, Strep
- not Gram negative rods
- Atypicals: legionella and rickettsia
What does metronidazole cover?
nothing except for gut anaerobes and bacteroides
What does cefazolin cover?
MSSA, Strep
E. Coli, Klebsiella
Which carbapenem does not cover pseudomonas?
ertapenem
What are your common bugs in respiratory infection?
Strep pneumo
Haemophilus influenzae
Mycoplasma pneumonia
staphylococcus aureus
Legionella
Chlamydia pneumoniae
Moraxella catarhalis
What are your common urine bugs?
E. Coli
Klebsiella pneumonia
Proteus mirabilis
Staph saprophyticus
What are your common CNS bugs?
Strep pneumo
Neisseria meningitidis
Listeria monocytogenes
aerobic gram negatives
Streptococcus agalactiae (Group B Strep)
What are your common intraabdominal bugs?
Enterobacteriaceae (E. coli, Klebsiella, Proteus, Citrobacter, Enterobacter, Morganella, Providencia
Anaerobes (bacteroides, fusobacterium, actinomyces, clostridium, Prevotella)
Enterococci
Streptococci
What are the gram positive bacilli anaerobes?
Clostridium, Propionubacterium, Actinomyctes, Lactobacillus
What are the gram negative bacilli anaerobes?
Bacteroides fragilis, Fusobacterium, Prevotella, Porphyromonas
Gram stain of Enterococcus faecalis? Where is it found?
What treats it?
Gram positive cocci in GI tract
- penicillins, Augmentin, Vancomycin, linezolid
- cephalosporins do not cover enterococcus
What are risk factors for coagulase negative staph being real and not contaminant?
if they have hardware, if more than one culture is positive
- often methicillin resistant if true pathogen
What is the big adverse effect of linezolid?
thrombocytopenia
How do you treat strep pneumo, Group A strep (strep pyogenes) and Group B strep (strep agalactiae)?
penicillins and cephalosporins
How do you treat Enterococcus faecalis?
Ampicillin - agent of choice
zosyn will treat empirically
vanc if wanting to cover for other organisms
How do you treat Enterococcus faecium at Prisma?
- has high resistance to ampicillin and vanc
- treat with daptomycin or linezolid
Which bugs are high risk for AmpC Beta Lactmase? What does this mean?
How do you treat with these bugs?
- It means they can develop resistance after treatment starts
- SPACE bugs (Serratia, Pseudomonas, Proteus, Providencia, Acinetobacter, Citrobacter freundii, Enterobacter cloacae,) but also Klebsiella and Morganella morganii
- if MIC <2, can treat with cefepime; if MIC is >4, treat with carbapenem
