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Acute Care I > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Common GP Organisms
Staphylococcus

A

Aureus
Haemolyticus
Epidermidis
Hominis

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2
Q

Staph Cocci grow in what?

A

clusters

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3
Q

Common GP Organisms
Streptococcus
alpha-hemolytic

A

Pneumonia

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4
Q

Common GP Organisms
Alpha-hemolytic/Viridans group

A

Mutans
mitis
sanguinis
salivarius
constellatus

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5
Q

Common GP Organisms
Streptococcus (Group A)

A

Pyogenes

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6
Q

Common GP Organisms
Streptococcus (group B)

A

agalactiae

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7
Q

Common GP Organisms
Streptococcus (group C)

A

Equi

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8
Q

Common GP Organisms
Streptococcus (group G)

A

bovis
equinus

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9
Q

Streptococcus cocci grow in what?

A

pairs or chains

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10
Q

Common GP Organisms
Enterococcus

A

Faecium
faecalis

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11
Q

Enterococcus cocci grow in?

A

pairs or chains

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12
Q

Common GP Organisms
GP Rods

A

Bacillus anthracis
Listeria monocytogenes
Clostridium spss.
Corynebacterium diphtheriae

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13
Q

Common GP Organisms
GP Rods: Clostridium spss include?

A

botulinum
perfringens
tetani
difficile

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14
Q

Common GN Pathogens & Environmental Source
Part of human GI flora

A

Escherichia coli
Klebsiella Pneumonia
Proteus mirabilis
Enterobacter spss.
Citrobacter freundii

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15
Q

Common GN Pathogens & Environmental Source
Poultry, cattle, Sheep & GI flora

A

Salmonella spss.

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16
Q

Common GN Pathogens & Environmental Source
Stagnant water & soil

A

Legionella pneumophilia

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17
Q

Common GN Pathogens & Environmental Source
Ubiquitous - soil, water, surfaces

A

Pseudomonas aeruginosa

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18
Q

Common GN Pathogens & Environmental Source
Inside Human Cells

A

Chlamydia spss.

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19
Q

Common GN Pathogens & Environmental Source
Obligate intra-cellular parasites

A

Rickettsia spss.

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20
Q

Common GN Pathogens & Environmental Source
Non-human mammals

A

Ehrlichia chaffeenis

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21
Q

Additional GN Organisms
Anaerobes are what and produce what?

A

Facultative vs Obligate
Generally produce beta-lactamases; only sensitive to specific abx

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22
Q

Additional GN Organisms
Anaerobes - Obligates

A

Bacteroides fragilis
Clostridiodes spss.
Peptostreptococcus
Prevotella

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23
Q

Additional GN Organisms
Anaerobes Facultative

A

Enterobacteracia

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24
Q

Additional GN Organisms
Anaerobes - usually found where?

A

Abscesses, loculated fluid collection

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25
Q

Susceptibility Reporting
S =
I =
R =
SDD =

A

Sensitive
Intermediate
Resistant
Susceptible, dose dependent

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26
Q

Susceptibility Reporting
MIC =?
Determines what?

A

Minimum Inhibitory Concentration
Determines the bacteria’s ability to grow at varying concentrations of abx

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27
Q

MIC 50 =?

A

Concentration required to inhibit growth of 50% of organisms

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28
Q

MIC 90 =?

A

Concentration required to inhibit growth of 90% of organisms

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29
Q

Acute Bacterial Rhinosinusitis
Major Symptoms include?

A

Purulent anterior nasal drainage
Purulent or discolored posterior nasal drainage
Nasal congestions or obstruction
Facial congestion or fullness
Facial pain or pressure
Hyposmia or anosmia
Fever

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30
Q

Acute Bacterial Rhinosinusitis
Minor Symptoms

A

HA
Ear pain, pressure, or fullness
Halitosis
Dental pain
cough
Fever (for subacute or chronic sinusitis)
Fatigue

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31
Q

Acute Bacterial Rhinosinusitis
Conventional criteria for diagnosis of ABRS?

A

At least 2 major symptoms OR
1 major and >/= 2 minor symptoms

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32
Q

Acute Bacterial Rhinosinusitis
Microbiology (common bacteria)?

A

S. Pneumonia (30-40%)
H. influenzae (20-30%)
M. Catarrhalis (12-20%)

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33
Q

Acute Bacterial Rhinosinusitis
Microbiology (common viruses)?

A

Rhinovirus
Influenza virus
Adenovirus

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34
Q

Acute Bacterial Rhinosinusitis
First Line Therapy
Who gets it?
Duration?

A

Amoxacillin/Clavulanate (Standard Dose)
Toxic, Fail topical decongestants, or w/ comorbid conditions, or sx for > 7d
5-7 days

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35
Q

Acute Bacterial Rhinosinusitis
PCN Allergy

A

Levofloxacin
Doxycycline

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36
Q

Acute Bacterial Rhinosinusitis
Risk For Abx Resistance or Failed Therapy

A

Amox/Clav (high dose)
Clindamycin + cefixime OR cefpodoxim
Levofloxacin

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37
Q

Acute Bacterial Rhinosinusitis
When to Use High Dose of Amox/Clav:
What is the High dose?
Duration

A

2g q12 h
10-14d

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38
Q

Acute Bacterial Rhinosinusitis
When to Use High Dose of Amox/Clav?

A

Regions where PNS SPNA is prevalent
Severe infection
Attendance at daycare
Age <2 or > 65
Recent hospitalization
Abx use w/n last mo
Immunocompromised

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39
Q

CAP Pneumonia Criteria

A

Coming in from the community, doesn’t meet HC criteria

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40
Q

Nosocomial Pneumonia Criteria: HAP

A

Occuring > 48 hrs after hospitalization

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41
Q

Nosocomial VAP Criteria: VAP

A

Occring > 48 hrs after intubation

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42
Q

CAP Pneumonia Probable Pathogens

A

Strep Pneumoniae
Mycoplasma pneumoniae
H. Influenzae
Chlamydophilia
Legionella spss.

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43
Q

Nosocomial Pneumonia Probable Pathogens

A

Staphylococcus aureus
Pseudomonas aeruginosa
Enterobacter spss.
Klebsiella spss.
Acinetobacter
E. coli

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44
Q

CAP Outpatient therapy
Previously Health
No recent abx use (w/n 90d)

A

Macrolide Or Doxycycline
Azithro 500mg POx1 then 250mg x 4d
Doxycycline 100mg PO BID x5-7d

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45
Q

CAP Outpatient therapy
Comorbidities including
Chronic heart, lung, liver or renal dz
DM
Alcoholics
Malignancy/Immunosuppression
Previous abx w/n 3 mo

A

Respiratory FQ OR Beta-lactam + Macrolide (or doxycycline)
Amoxicillin 1g PO TID x 5-7d
Amox/Clav 2g PO BID x5-7d
Cefopodoxime 200mg PO q12h x 5-7d
Cefuroxime 500mg PO q12 h x 5-7d
Ceftriaxone 1g IV daily x 5-7d
+
Azithro500mg PO x1 then 250mg x 4d
or doxycycline 100mg PO BID x 5-7d

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46
Q

CAP Inpatient therapy
Non-severe, inpatient (Non-ICU patient)
Beta-Lactam + Macrolide (or doxycycline)

A

Beta-Lactam + Macrolide (or doxycycline)
Ceftriaxone 1g IV daily x 7-10d
Cefotaxime 1g IV q8h x 7-10d
Amp/Sublactam 3g IV q6h x 7-10d
Ertapenem1g IV daily x 5-7d
+
Azithromycin 500mg PO/IV daily x 5d
Doxycycline 100mg PO/IV BID x 5-7d

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47
Q

CAP Inpatient Therapy
Non-severe, inpatient (Non-ICU patient)
Respiratory FQ

A

Moxifloxacin 400mg IV daily x 5-7d
Levofloxacin 750mg IV daily x 7-10d

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48
Q

CAP Inpatient therapy
Severe, inpatient (ICU patient)
Beta-lactam + Macrolide OR Respiratory FQ

A

Ceftriaxone 1g IV daily x 7-10d
Cefotaxime 1g IV q8h x 7-10d
Amp/Sublactam 3g IV q6h x 7-10d
+
Azithromycin 500mg IV daily x 5d
Moxifloxacin 400mg IV daily x 5-7d
Levofloxacin 750mg IV daily x 5-7d

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49
Q

Empiric Treatment of VAP
Basic Empiric Therapy (No special circumstance)

A

Piperacillin/tazobactam 4.5g IV q6h
Cefepime 1g IV q8h
Ceftazidime 2g IV q8h
Imipenem/cilastatin 500mg IV q6h
Meropenem 1g IV q8h
OR
Aztreonam 2g IV q8h

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50
Q

Empiric Treatment of VAP
Additional Gram-Positive Coverage
(if Unit MRSA rate is >10-20% or if unknown)

A

Vancomycin 15mg/kg q12h
OR
Linezolid 600mg IV q12h

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51
Q

Empiric Treatment of VAP
Double-coverage of Pseudomonas
(RF for resistance, unit where >10% of GN isolates are resistant to monotherapy, or GN resistance is unknown)

A

Ciprofloxacin 400mg IV q8h
Levofloxacin 750mg IV daily
Amikacin 15-20mg/kg IV daily
Gentamicin 5-7 mg/kg IV daily
Tobramycin 5-7 mg/kg IV daily
OR
Polymixin (colistin, polymixin B)

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52
Q

Empiric Treatment of HAP
Not at High Risk for Mortality and No Factors Increasing the Likelihood of MRSA

A

Piperacillin/Tazobactam 4.5g IV q6h
Cefepime 1g IV q8h
Levofloxacin 750mg IV daily
OR
Imipenem/cilastatin 500mg IV q6h + Meropenem 1g IV q8h

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53
Q

Empiric Treatment of HAP
Not at High Risk for Mortality BUT w/ Factors Increasing the Likelihood of MRSA

A

Piperacillin/tazobactam 4.5g IV q6h
Cefepime 1g IV q8h + Ceftazidime 2g IV q8h
Levofloxacin 750mg IV daily + Ciprofloxacin 400mg IV q8h
Imipenem/cilastatin 500mg IV q6h + Meropenem 1g IV q8h
OR
Aztreonam 2g IV q8h
+
Vancomycin 15 mg/kgq 12h
Or
Linezolid 600 mg IV q12h

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54
Q

Empiric Treatment of HAP
High Risk of Mortality or Receipt of IV Abx w/n 90d

A

Piperacillin/tazobactam 4.5g IV6h
Cefepime 1g IV q8h + Ceftazidime 2g IV q8h
Imipenem/cilastatin 500mg IV q 6h + Meropenem 1g IV q8h
+
Levofloxacin 750mg IV daily + Ciprofloxacin 400mg IV q8h
OR
Amikacin 15-20mg/kg IV daily
Gentamicin 5-7 mg/kg IV daily
Tobramicin 5-7 mg/kg IV daily
+
Vancomycin 15mg/kg IV q12h
OR
Linezolid 600mg IV q12h

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55
Q

MRSA Risk Factors

A

Prior IV abx use w/n 90d
Hospitalization in a unit where > 20% of S. aureus isolates are MRSA
MRSA rates are unknown

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56
Q

High Risk for Mortality

A

Ventilator support d/t HAP
Septic Shock

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57
Q

Pneumonia Treatment durations
CAP=
Nosocomial=
Pseudomonal pneumonias=?
MRSA pneumonia=?

A

5-7d
7d
at least 14d (maybe???)
often requires longer duration

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58
Q

When to switch IV to PO abx?

A

Hemodynamic Stability (SBP > 90mmHg)
Tolerating PO
Normally fxning GI tract
Afebrile for ~48h

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59
Q

Empyema Classifications:
Uncomplicated parapneumonic effusion

A

Exudative effusion
Resolves w/ resolution of pneumonia

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60
Q

Empyema Classifications:
Complicated parapneumonic effusion

A

Bacterial invasion of the pleural space
Increased neutrophils and pleural fluid acidosis
LDH > 1000 IU/L
Cultures are often falsely negative
Anaerobes

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61
Q

Empyema Classification:
Thoracic Empyema

A

Evident bacterial infection of the pleural liquid
Pus and/or presence of bacteria on gram-stain

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62
Q

Empyema Diagnosis:
Pleural Fluid Analysis includes

A

Microbiology
Cell count (w/ diff)
Chemistries (total protein, LDH, glucose)
pH

63
Q

Empyema Diagnosis:
Light’s Criteria includes

A

Total serum protein
Pleural fluid protein
Serum LDH
Pleural fluid LDH
Transudative vs. Exudative effusion
Exudative 1 of the following (LDH > 2/3 ULN for Serum, Pleural fluid: serum Protein > 0.5, Pleural fluid: serum LDH > 0.6)

64
Q

Empyema Microbiology

A

Typically the same pathogens that cause pneumonia
Notable exception - anaerobes
*Fusobacterium
*Prevotella
*Peptostreptococcus
*Bacteroides

65
Q

Empyema Treatment
Abx Treatment

A

Treat Underlying Pneumonia
BUT….add anaerobic coverage (if your primary regimen does not provide anaerobic coverage)
*Clindamycin
*Metronidazole

66
Q

Empyema Treatment
Duration of Treatment

A

Very pt specific
Until clinical improvement
Depends upon other interventions

67
Q

Empyema Treatment
Surgical Interventions: Chest tube placement/drainage if?

A

pH is < 7.2
Positive culture or gram-stain
Purulent

May need more than 1 tube placed if the collections are loculated
Larger bore tubes are necessary for more purulent fluid
Impact on treatment duration

68
Q

Pulmonary Infections: Tuberculosis Diagnostics
Induration >/= 5mm + is positive in which patients?

A

HIV infected-person
Recent contact w/ TB infected person
CXR changes c/w TB
Organ transplant recipients
Immunosuppression

69
Q

Pulmonary Infections: Tuberculosis Diagnostics
Induration >/= 10mm + is positive in which patients?

A

Recent immigrants from high-prevalence countries
Injection drug users
Residents & employees of high-risk congregate settings
Mycobacterial lab personel
Persons w/ clinical conditions that place them at high risk
Children < 4yo
Infants, children & adolescents exposed to adults in high-risk categories

70
Q

Pulmonary Infections: Tuberculosis Diagnostics
Induration >/= 15mm + is positive in which patients?

A

In any person who does not meet any of the other criteria

71
Q

Pulmonary Infections: Tuberculosis Treatment (Latent TB Infection)
Drugs used to treat?

A

Isoniazid and Rifapentine
Rifampin
INH + Rifampin
Isoniazid

72
Q

Pulmonary Infections: Tuberculosis Treatment (Latent TB Infection)
Isoniazid and Rifapentine
Duration
Interval
Minimum Doses

A

3mo
Once weekly
12

73
Q

Pulmonary Infections: Tuberculosis Treatment (Latent TB Infection)
Rifampin
Duration
Interval
Minimum Doses

A

4mo
Daily
120

74
Q

Pulmonary Infections: Tuberculosis Treatment (Latent TB Infection)
INH + Rifampin
Duration
Interval
Minimum Doses

A

3mo
Daily
90

75
Q

Pulmonary Infections: Tuberculosis Treatment (Latent TB Infection)
Isoniazid
Duration
Interval
Minimum Doses

A

9mo
Daily
270

76
Q

Pulmonary Infections: Tuberculosis Treatment (Active TB - Non-HIV)
Initial Treatment Phase
Preferred Regimen
Alternative Regimen 1
Alternative Regimen 2

A

INH, RIF, PZA, & EMB Daily 56 doses (8 weeks)

INH, RIF, PZA & EMB Daily 14 doses (2 weeks) THEN Twice Weekly 12 doses (6 weeks)

INH, RIF, PZA & EMB Thrice Weekly 24 doses (8 weeks)

77
Q

Pulmonary Infections: Tuberculosis Treatment (Active TB - Non-HIV)
Continuation Treatment Phase
Preferred Regimen
Alternative Regimen 1
Alternative Regimen 2

A

INH & RIF Daily 126 doses (18 weeks) OR INH & RIF Twice Weekly 36 doses (18 weeks)

INH & RIF Twice Weekly 36 doses (18 weeks)

INH & RIF Thrice Weekly 54 doses (18 weeks)

78
Q

Intraabdominal Infections: Secondary Peritonitis
Microbiology

A

Polymicrobial!!
Aerobes: E. colis, Klebsiella, P.mirabilis, Enterobacter, Pseudomonas, Enterococcus, Staphylococcus
Anaerobes: Baceroides spss., Fusobacterium, Clostridium, Eubacterium

79
Q

Secondary Peritonitis Community Acquired

A

Not usually related to any surgical or medical intervention - usually the result of an underlying disease state
Typically mild-moderate infections

80
Q

Secondary Peritonitis Health-Care Associated

A

Usually r/t iatrogenic perforation or GI contamination during surgery or invasive procedures
Caused by more resistant organisms: P. aeruginosa, Enterobacter, Proteus, MRSA, Enterococci, & Candida

81
Q

Secondary Peritonitis High Risk Patients

A

APACHE II score > 15
Extremities of age (>65 yo)
Immunosuppression from medical therapy
*Transplantation
*Malignancy
*Inflammatory diseases
Immunocompromised states

82
Q

Secondary Peritonitis High-Severity Infections

A

Hypotension, Shock

83
Q

Secondary Peritonitis Treatment
Single Agent for Mild/Moderate Community Acquired

A

Cefoxitin
Ertapenem
Moxifloxacin
Tigecycline
Ticarcillin/Clavulanate

84
Q

Secondary Peritonitis Treatment
Single Agent for High-Risk/High Severity Community Acquired

A

Piperacillin/Tazobactam
Imipenem/Cilastatin
Doripenem
Meropenem

85
Q

Secondary Peritonitis Treatment
Combination Agents for Mild/Moderate Community Acquired

A

Cefazolin
Cefuroxime
Ceftriaxone
Ciprofloxacin
Levofloxacin
+
Metronidiazole

86
Q

Secondary Peritonitis Treatment
Combination Agents for High-Risk/High Severity Community Acquired

A

Ceftazidime
Cefepime
Ciprofloxacin
Levofloxacin
+
Metronidazole

87
Q

Secondary Peritonitis Treatment
Single Agent Health-care Associated

A

Piperacillin/Tazobactam
Imipenem/Cilastatin
Doripenem
Meropenem

88
Q

Secondary Peritonitis Treatment
Combination Agents Health-care Associated

A

Ceftazidime
Cefepime
Ciprofloxacin
Levofloxacin
+
Metronidazole

89
Q

Enterococcal Coverage for Health-care Associated Secondary Peritonitis if the patient has one of the following

A

Post-op infections
Previous therapy w/ cephalosporins w/n 90d
Immunocompromised pts
Valvular heart disease

90
Q

Secondary Peritonitis Duration of Therapy
Typical?
Will need to be longer if pts are what?

A

5-7d
in critical condition or slow to respond to therapy

91
Q

Abscesses - Treatment

A

Cover for anaerobic organisms - thrive in abscesses
Otherwise, treat as if a Health-care Associated infection

92
Q

C. difficile Associated Diarrhea
what type of organism is it?

A

Anaerobic, gram-positive, spore-forming rod

93
Q

C. difficile Associated Diarrhea
Abx thought/known to cause this?

A

Clindamycin
3rd gen cephalosporins
B-lactam/B-lactamase inhibitor combinations (Pip/Tazo, Amox/Clav, Amp/Subl)
Fluoroquinolones (Levo, moxi)
Carbapenems

94
Q

C. difficile Associated Diarrhea
Complications that make the infection severe are?

A

hypotension/shock
ileus
megacolon

95
Q

C. difficile Associated Diarrhea
Initial Episode Recommended Treatment
Preferred?
Alternative

A

Fidaxomicin 200mg PO BID x 10d

Vancomycin 125mg PO QID x 10d

96
Q

C. difficile Associated Diarrhea
First Recurrence Recommended Treatment
Preferred?
Alternative?
Adjunctive?

A

Fidaxomicin 200mg PO BID x 10d OR BID x 5d, followed by once every other day x 20d

Prolonged (6 or 8 week) PO vancomycin taper

Bezlotoxumab 10mg/kg IV given ONCE during SOC treatment

97
Q

C. difficile Associated Diarrhea
Second or Subsequent Recurrence Recommended Treatment
Preferred?
Alternative?
Alternative?
Adjunctive?

A

Fidazomicin 200mg PO BID x 10d OR BID x 5d, followed by once every other day x 20d

Prolonged (6 or 8 week PO vancomycin taper

Vancomycin 125mg PO QID x 10days, followed by rifaximin 400mg TID x 20d

Bezlotoxumab 10mg/kg IV given ONCE during SOC treatment

98
Q

C. difficile Associated Diarrhea
Initial Episode, fulminent

A

Vancomycin 500mg PO or NGT QID + Metrondiazole 500mg IV q8h

If ileus, consider vancomycin enemas

99
Q

Lower UTI Laboratory Tests

A

Bacturia, Pyuria, Nitrate (+)
Leukocyte Esterase (+)

100
Q

Upper UTI Laboratory Tests

A

Leukocytosis, Hyaline Casts (UA)

101
Q

Uncomplicated UTI Criteria

A

Females of childbearing age
Age 15-45
No structural/neurological abnormalities interfering w/ urine flow

102
Q

Complicated UTI Criteria

A

Don’t meet any of the uncomplicated criteria

103
Q

Community Acquired Microbiology Uncomplicated
Gram-Negatives

Gram-Positives

A

E.coli
Klebsiella pneumoniae
Proteus spss

Staphylococcus saprophytiicus
Enterococcus

104
Q

Community Acquired Microbiology Complicated
Gram-Negatives

Gram-Positives

A

E.coli
Proteus spss.
other GN

Staphylococcus saprophytiicus
Enterococcus

105
Q

Nosocomial Microbiology
Gram-Negatives

Gram-Positives

Fungal

A

E. Coli
Proteus spss.
Enterobacter
Acinetobacter
Pseudomonas aeruginosa

Enterococcus

Candida

106
Q

Cystitis Uncomplicated Treatment

A

SMZ/TMP 3d
Trimethoprim 3d
Fluoroquinolones (Cipro, Levo) 3 d
Nitrofurantoin 3d
Fosfomycin 1 dose
B-lactams (Amox/Clav) 3d

107
Q

Pyelonephritis Treatment
Consider hospitalization if?

A

pt is unable to tolerate PO
Has severe symptoms: high temp, elevated WBC, severe pain, dehydration
No improvement on outpatient therapy

108
Q

Uncomplicated Pyelonephritis Treatment
Treat empirically with:
If the organism is susceptible -?
If the organism is susceptible -?
If gram-positive is the causative agent?
Duration?

A

PO cephalosporins
SMZ/TMP
Amoxicillin or Amox/Clav
14d

109
Q

Complicated Pyelonephritis Treatment
Nosocomial Infections
1st line?
Consider what if no improvement?

A

Ciprofloxacin or Levofloxacin

Pseudomonas or Enterococcus coverage

110
Q

Complicated Pyelonephritis Treatment
Agents and Duration?
Gram-positive organisms?

A

Levofloxacin or Ciprofloxacin 14d
Aminoglycoside +/- Ampicillin 14d
Extended spectrum Cephalosporin 14d

Amp/Sublact +/- AG

111
Q

Complicated Pyelonephritis Treatment
Possible Alternative Regimens
PCN allergic?
Others?

A

Aztreonam
B-lactam/B-lactamase inhibitors
Carbapenems

112
Q

GU Infections
Relapse:
Failed Short course (3 days) treatment is?
Failed Longer course (10-14d) treatment is?

A

continue same therapy for 14d

continue same therapy for 6 weeks

113
Q

GU Infections
Re-infection:
Different Pathogen involved treatment is?

A

treat for 14 days

114
Q

GU Infections: Catheter Associated Infections
Do we need to treat?
Remove what?
Bags should be drained how often?
Start abx only if? (Treat as what?)
Administering abx to prevent infection is or is not recommended?

A

the catheter
q4-6h
only if symptomatic; complicated cystitis
not recommended

115
Q

Genitourinary Infections: Asymptomatic Bacturia
Only time this is treated is in who?
20-40% of this population w/ asymptomatic bacturia will develop what?
Duration for ASB is?
Safest agents/agents of choice is?

A

pregnant women
pyelonephritis
3-7d
B-lactams

116
Q

Cellulitis Microbiology

A

Skin flora - Group A, B, C, G Streptococci
Strep pyogenenes
Staphylococcus aureaus

117
Q

Treatment of Non-purulent Cellulitis
Mild Options are
Duration of therapy?

A

Penicillin VK 250-500mg PO q6h
Cephalexin 500mg PO q6h
Dicloxacillin 500mg PO q6h
Clindamycin 300-450mg PO q6h

x7 days (can be 5d IF NOT Staph or Strep)

118
Q

Treatment of Non-purulent Cellulitis
Moderate Options are
Duration of therapy?

A

Penicillin G 2-4million units IV q4-6h
Ceftriaxone 1g IV daily
Cefazolin 1g IV q8h
Clindamycin 600mg IV q8h

x7 days (can be 5d IF NOT Staph or Strep)

119
Q

Treatment of Non-purulent Cellulitis
Severe Options are
Duration of therapy?

A

RULE OUT NECROTIZING PROCESS
Empiric Therapy
Vancomycin 15-20mg/kg q12h
+
Cefepime 2gm q12h
+
Metronidazole 500mg IV TID

x7 days (can be 5d IF NOT Staph or Strep)

120
Q

Treatment of Purulent SSTIs
Mild Options are
Duration of therapy?

A

Incision and drainage alone
*Drainable lesions usally < 5cm diameter

121
Q

Treatment of Purulent Cellulitis
Moderate Options for Empiric Therapy are?
Duration of therapy?

A

Incision & Drainage w/ Culture and Sensitivity PLUS
TMP/SMZ 1 DS tabs PO q12h
OR
Doxycycline 100mg PO q12

122
Q

Treatment of Purulent Cellulitis
Moderate Options for Definitive Therapy MRSA are?
Duration of therapy?

A

Incision & Drainage w/ Culture and Sensitivity PLUS
TMP/SMZ 1DS tabs PO q12h

123
Q

Treatment of Purulent Cellulitis
Severe Options for Empiric Therapy are?
Duration of therapy?

A

Incision & Drainage w/ Culture and Sensitivity PLUS
Vancomycin 15-20mg/kg q12h
Linezolid 600mg IV q12h
Daptomycin 6mg/kg IV q12h
Ceftaroline 600mg IV q12

123
Q

Treatment of Purulent Cellulitis
Moderate Options for Definitive Therapy MSSA are?
Duration of therapy?

A

Incision & Drainage w/ Culture and Sensitivity PLUS
Dicloxacillin 500mg PO q6h
Cephalexin 500mg PO q6h

124
Q

Treatment of Purulent Cellulitis
Severe Options for Definitive Therapy MRSA are?
Duration of therapy?

A

Incision & Drainage w/ Culture and Sensitivity PLUS
Vancomycin 15-20mg/kg q12h
Linezolid 600mg IV q12h
Daptomycin 6mg/kg IV q12h
Ceftaroline 600mg IV q12

125
Q

Treatment of Purulent Cellulitis
Moderate Options for Definitive Therapy MSSA are?
Duration of therapy?

A

Incision & Drainage w/ Culture and Sensitivity PLUS
Nafcillin 2g IV q4h
Cefazolin 1g IV q8h
Clindamycin 600mg IV q8h

126
Q

Bite Wounds from Animals
Microbiology

A

Pasturella multocida
S. Aureus
anaerobes
polymicrobial

127
Q

Bite Wounds from Animals
Treatment Options are

A

Amox/Clav
Cefuroxime +/- Metronidazole OR Clinda
Doxycycline
Pen VK + Dicloxacillin
FQ +/- Metronidazole OR Clinda
Bactrim +/- Metronidazole OR Clinda

128
Q

Bite Wounds from Animals
Treatment duration is?
Prophylaxis duration is?

A

5-10d
3-5d

129
Q

Bite Wounds Humans
Microbiology

A

Streptococcus spss.
S. aureus
Haemophilus spss.
Eikenella corrodens
anaerobes

130
Q

Bite Wounds Humans
Treatment Options

A

Amp/Sulbact
Amox/Clav
Ertapenem
Meropenem
Imipenem/Cliastatin
Cofoxitin

131
Q

Bite Wounds Humans
Treatment duration?
Prophylaxis duration?

A

7-14d
3-5d

132
Q

Necrotizing Fasciitis
Type I
Typically after what?
May involve what bugs?
More common in?
Skin may be spared and infection is spread

A

surgery or trauma
Bacteroides, Peptostreptococcus, Streptococci, and enterobacterales
IVDAs
slower

133
Q

Necrotizing Fasciitis
Type II
Typically caused by?
Referred to as?
_____ extending necrosis of subQ tissues and skin,gangrene severe local pain, and systemic toxicity
Early onset waht?

A

S. Pyogenes
Streptococcal gangrene (“Flesh-eating Disease”)
Rapidly
shock and organ failure

134
Q

Empiric Therapy For Type I Necrotizing Fasciitis

A

Vancomycin + [GN & anaerobic coverage]*

*Piperacillin/tazobactam
*Imipenem
*Meropenem
*Ertapenem
**D/t resistance, would avoid FQ here

135
Q

Empiric Therapy For Type II Necrotizing Fasciitis

A

Vancomycin + B-Lactam* + Clindamycin

*Penicillin G
*1st or 3rd gen cephalosporin

136
Q

Definitive Therapy for Streptococcal Necrotizing Fasciitis

A

Penicillin G 2-4million units IV q4-6hrs
+
600-900mg IV q8h

137
Q

Definitive Therapy For MSSA necrotizing fasciitis

A

Nafcillin 1-2g IV q4h OR
Oxacillin 1-2g IV q4h OR
Cefazolin 2g IV q8h

138
Q

Definitive Therapy For MRSA necrotizing fasciitis

A

Vancomycin 15mg/kg IV q12h
+
Clindamycin 600-900mg IV q8h

139
Q

Medications to consider if patient is not responsive to or cannot tolerate vancomycin for necrotizing fasciitis?

Duration?

A

Daptomycin
Ceftaroline
Linezolid

14d (could be shorter or longer depending on surgery, Clinda may only need to be on-board for 3-5d)

140
Q

Septic Arthritis
Microbiology

A

S. aureus
Streptococcus spss.
N. gonorrheae
E. coli
P. aeruginosa

141
Q

Septic Arthritis
Treatment
Duration?

A

Ceftriaxone + Vancomycin tailor as needed
2-3 weeks

142
Q

Osteomyelitis
Microbiology

A

Streptococcus spss.
S. aureus
GN
anaerobes

143
Q

SSTIs Infection Severity
Presence of >/=2 manifestations of inflammation (purulence or erythema, pain, tenderness, warmth, or induration), but area of cellulitis or erythema around an ulcer is </= 2cm and the patient has NO SIRS criteria

A

Mild

144
Q

SSTIs Infection Severity
Meets criteria for mild infection, but erythema extends > 2cm, or involves structures deeper than the skin and subQ tissue (abscesses or fasciitis) and has NO more than 1 SIRS criteria is present

A

Moderate

145
Q

SSTIs Infection Severity
Meets criteria of either Mild or Moderate Infection, but also meets SIRS criteria w/ >/= 2 of the following:
Temp > 38C or < 36C
HR > 90 bpm
RR > 20 or PaCO2 < 32 mmHg
WBC count > 12K or < 4K

A

Severe

146
Q

Abx Therapy SSTIs Mild
No Complicating features, B-lactam allergy or intolerance
Usual Pathogens?
Potential Empiric Regimens?

A

GPCocci; GPChains

Cefazolin
Cephalexin
nafcillin
TMP/SMX
clinda
FQ
doxycycline

147
Q

Abx Therapy SSTIs Mild
Recent abx exposure w/ 90d
Usual Pathogens?
Potential Empiric Regimens?

A

GPC + GNR

Amox/Clav
Amp/sulb
TMP/SMX
FQ

148
Q

Abx Therapy SSTIs Mild
High Risk for MRSA
Usual Pathogens?
Potential Empiric Regimens?

A

MRSA

TMP/SMX
Linezolid
Doxycycline

149
Q

Abx Therapy SSTIs Moderate or Severe
No Complicating features
Usual Pathogens?
Potential Empiric Regimens?

A

GPC +/- GNR

Amox/Clav
Amp/Sulb
Cefotetan
Cefoxitin

150
Q

Abx Therapy SSTIs Moderate or Severe
Recent Abx exposure w/n 90d
Usual Pathogens?
Potential Empiric Regimens?

A

GPC +/- GNR

Piperacillin/tazobactam
Ceftriaxone
ertapenem

151
Q

Abx Therapy SSTIs Moderate or Severe
Macerated ulcer or warm climate or resulting from a puncture wound
Usual Pathogens?
Potential Empiric Regimens?

A

GNR, including Pseudomonas

Piperacillin/tazobactam
cefepime
nafcillin + ciprofloxacin
imipenem
meropenem
doripenem

152
Q

Abx Therapy SSTIs Moderate or Severe
Ischemic Limb/necrosis/gas forming
Usual Pathogens?
Potential Empiric Regimens?

A

GPC +/- GNR +/- anaerobes

Piperacillin/tazobactam
ertapenem
imipenem
meropenem
doripenem
cetriaxone + metronidazole

153
Q

Abx Therapy SSTIs Moderate or Severe
MRSA risk Factors
Usual Pathogens?
Potential Empiric Regimens?

A

MRSA + GNR

Acute Care I (25 decks)

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