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Pulmonary Critical Care > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

What is considered CAP?

A

symptom onset occuring in the community setting or <48hours after hospital admission

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2
Q

How do you treat CAP with no risk factors?
In the outpatient setting?

A
  • 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
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3
Q

What are the most likely pathogens in CAP?

A

Strep pneumo, M. catarrhalis, H. influenzae, staph aureus, Legionella pneumophilia

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4
Q

How long do you treat CAP?

A

7 days typically

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5
Q

How do you treat CAP for those with APBL susceptible pseudomonas?
How long to treat?

A
  • 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
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6
Q

How do you treat APBL susceptible Pseudomonas when transitioning?
How long to treat?

A
  • levofloxacin 750 mg po q24h
  • 7 days
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7
Q

How do you treat APBL resistant Pseudomonas?

A
  • 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
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8
Q

How do you treat aspiration pneumonia?

A
  • ceftriaxone + azithro + metro
  • used unasyn at Cone
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9
Q

How do you treat pneumonia in someone with a severe PCN allergy?

A

levofloxacin 750 mg IV q24h
or ciprofloxacin 400 mg IV q4h ( cipro does not provide adequate gram positive coverage so may need vanc)

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10
Q

What will ciprofloxacin treat?
What will it not treat?

A
  • Pseudomonas, Enterobacteriaceae, Neisseria, Haemophilus, Moraxella, Pasteurella
  • will not treat anaerobes, most gram positives, Streptococci, Enterococci, Stenotrophomonas, Bacillus anthrasis
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11
Q

What will levofloxacin treat?
What will it not treat?

A
  • 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
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12
Q

What covers Legionella?
Duration of treatment?

A
  • Azithromycin and Levofloxacin
  • with azithro, can treat for 10-14 days, especially in cases of severe illness
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13
Q

How can MSSA pneumonia be treated?

A
  • IV: nafcillin, cefazolin
  • PO: dicloxacillin, cephalexin
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14
Q

What are the Enterobacteriaceae?
How are they treated in pneumonia?

A
  • Escherichia coli, Klebsiella pneumonia, Klebsiella oxytoca, Proteus mirabilis
  • Ceftriaxone
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15
Q

How is Chlamydophila pneumoniae and Mycoplasma pneumoniae pneumonia treated?

A

Azithromcyin or doxycycline

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15
Q

How is Chlamydophila pneumoniae and Mycoplasma pneumoniae pneumonia treated?

A

Azithromcyin or doxycycline

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16
Q

How do you treat critically ill gram negative bacteremia?
In patients with PCN allergy?

A
  • 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
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17
Q

How do you treat Gram negative bacteremia in non-critically ill?

A

ceftriaxone 2 gm IV q24 hr PLUS metronidazole

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18
Q

Antibiotics for non-critically ill non-purulent soft tissue infection?
What po antibiotics do you transition to?
Duration?

A
  • 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)
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19
Q

How do you treat purulent cellulitis in non-critically ill patients?
What are your deescalation options?

A
  • Vancomycin
  • Bactrim 1-2 DS tabs po q12h; doxycycline 100 mg q12h
  • duration 7 days or longer if more severe
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20
Q

How do you treat non-necrotizing skin infection in critically ill?

A
  • Vancomycin PLUS zosyn or cefepime or cipro
21
Q

How do you treat necrotizing fasciitis in critically ill patients

A

Vancomycin PLUS zosyn or cefepime

22
Q

What are the most common organisms in healthcare acquired pneumonia?

A

Pseudomonas aeruginosa
E. Coli
Enteric GNR
MRSA

23
Q

What are the most common organisms in necrotizing skin infection?

A

Group A strep (strep pyogenes)
Staph aureus
Pseudomonas aeruginosa
Clostridium perfringens

24
Q

What are the most common organisms in pyelonephritis?
What should you treat with?

A
  • Klebsiella, E. Coli, Proteus mirabalis
  • cefepime, ceftriaxone, or ciprofloxacin
25
Q

What are the most common causes of meningitis?

A

N. meningitidis
Strep pneumo
H. influenzae
Listeria monocytogenes

26
Q

What will vancomycin cover?

A

Gram positives (MRSA, MSSA, Strep, Enterococci)
Oral anaerobes

27
Q

What does augmentin cover?

A
  • Anaerobes: bacteroides & oral anaerobes
  • gram negative rods except pseudomonas
  • Gram positive: MSSA, streptococci
28
Q

What does zosyn cover?

A
  • Gram positive: everything except MRSA (so MSSA, Strep, and Enterococci
  • All the gram negatives
  • Anerobes: oral anaerobes and bacteroides
29
Q

What does Aztreoname cover?

A
  • not gram positives
  • Gram negative rods, all of them
  • Not anaerobes or atypicals
30
Q

What does ceftriaxone cover?

A

Gram positives: MSSA & streptococci (not enterococci)
Gram negative rods: not pseudomonas
- not anaerobes or atypicals

31
Q

Which -penem covers pseudomonas?

A
  • meropenem
  • ertapenem does not
32
Q

What does cefepime cover?

A

MSSA, Strep (not enterococci)
all gram negative rods
not anaerobes

33
Q

What does azithromycin cover?

A

MSSA, Strep
Atypicals (legionella)

34
Q

What does doxycycline cover?

A
  • MSSA, Strep
  • not Gram negative rods
  • Atypicals: legionella and rickettsia
35
Q

What does metronidazole cover?

A

nothing except for gut anaerobes and bacteroides

36
Q

What does cefazolin cover?

A

MSSA, Strep
E. Coli, Klebsiella

37
Q

Which carbapenem does not cover pseudomonas?

A

ertapenem

38
Q

What are your common bugs in respiratory infection?

A

Strep pneumo
Haemophilus influenzae
Mycoplasma pneumonia
staphylococcus aureus
Legionella
Chlamydia pneumoniae
Moraxella catarhalis

39
Q

What are your common urine bugs?

A

E. Coli
Klebsiella pneumonia
Proteus mirabilis
Staph saprophyticus

40
Q

What are your common CNS bugs?

A

Strep pneumo
Neisseria meningitidis
Listeria monocytogenes
aerobic gram negatives
Streptococcus agalactiae (Group B Strep)

41
Q

What are your common intraabdominal bugs?

A

Enterobacteriaceae (E. coli, Klebsiella, Proteus, Citrobacter, Enterobacter, Morganella, Providencia
Anaerobes (bacteroides, fusobacterium, actinomyces, clostridium, Prevotella)
Enterococci
Streptococci

42
Q

What are the gram positive bacilli anaerobes?

A

Clostridium, Propionubacterium, Actinomyctes, Lactobacillus

43
Q

What are the gram negative bacilli anaerobes?

A

Bacteroides fragilis, Fusobacterium, Prevotella, Porphyromonas

44
Q

Gram stain of Enterococcus faecalis? Where is it found?
What treats it?

A

Gram positive cocci in GI tract
- penicillins, Augmentin, Vancomycin, linezolid
- cephalosporins do not cover enterococcus

45
Q

What are risk factors for coagulase negative staph being real and not contaminant?

A

if they have hardware, if more than one culture is positive
- often methicillin resistant if true pathogen

46
Q

What is the big adverse effect of linezolid?

A

thrombocytopenia

47
Q

How do you treat strep pneumo, Group A strep (strep pyogenes) and Group B strep (strep agalactiae)?

A

penicillins and cephalosporins

48
Q

How do you treat Enterococcus faecalis?

A

Ampicillin - agent of choice
zosyn will treat empirically
vanc if wanting to cover for other organisms

49
Q

How do you treat Enterococcus faecium at Prisma?

A
  • has high resistance to ampicillin and vanc
  • treat with daptomycin or linezolid
50
Q

Which bugs are high risk for AmpC Beta Lactmase? What does this mean?
How do you treat with these bugs?

A
  • 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

Pulmonary Critical Care (5 decks)

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