Infectious Disease Flashcards
What is CURB:65 scoring?
Confusion Urea greater or equal to 20 mg/dL Respiratory rate greater than 30 Systolic bp less than 90, diastolic bp less than 60 Age equal to or greater than 65
What score on curb 65 constitutes an inpatient setting?
What score on the curb 65 constitutes ICU?
Two or higher
Four or higher
What are the three types of nocosomial pneumonia, and what are the differences?
Hospital acquired pneumonia, ventilator associated pneumonia, healthcare associated pneumonia.
Hospital acquired happens two days after admission without intubation.
Ventilator is more than 48 to 72 hours after endotracheal intubation.
Healthcare associated happens after discharge from the hospital stay for two or more days with in 90 days of the infection, or resided in nursing home or long-term care facility, Or who received a recent IV antibiotics, chemotherapy, or wound care with in the past 30 days of the current infection, or who attended a hospital or hemodialysis clinic.
What are some risk factors for nocosomial pneumonia? Name at least five.
Intubation and mechanical ventilation, supine patient position, enteral feeding, oral pharyngeal colonization, stress leading prophylaxis, blood transfusion, Hyperglycemia, immunosuppression/corticosteroids, surgical procedures: thoracic, abdominal, immobilization, nasogastric tubes, previous antibiotic therapy, admission to the ICU, elderly, underlying chronic disease.
What are the most common bugs in the community acquired pneumonia?
Mycoplasma pneumoniae, streptococcus pneumoniae, haemophilus influenzae, chlamydia pneumoniae, Legionella pneumophila
What are common pneumonia bugs in alcoholics, nursing home, COPD, post influenza, exposure to water, poor oral hygiene, and HIV infection?
Alcoholics: strep pneumoniae, Oral anaerobes, gram-negative bacilli
Nursing home: strep pneumoniae, H influenzae, gram-negative bacilli, S aureus
COPD: S pneumoniae, H influenzae, M catarrhalis
Post influenza: H influenzae, S aureus, S pneumoniae
Exposure to water: Legionella
Poor oral hygiene: oral anaerobes
HIV infection: pneumocystis jirovechi, S pneumoniae, M pneumoniae, Mycobacterium
What common bugs are in hospital acquired pneumonia?
S aureus, pseudomonas aeruginosa, enterobacter
Less common: K pneumonia, Candida spp, acinobacter, Serratia marcescens, E. coli, S pneumonia
Which hospital acquired pneumonia bugs tend to be transmitted by healthcare workers hands?
Pseudomonas, S aureus
Which hospital acquired pneumonia bugs are transmitted by respiratory equipment?
Pseudomonas, Enterobacteriaceae
1) In pneumonia, what is empiric treatment of non-hospitalized patients, without comorbidities, previously healthy and no antibiotics in the past three months?
A) A macrolide: specifically clarithromycin or Azithromycin if H. influenzae is suspected
OR
B) Doxycycline
In community acquired pneumonia or, what is in. Treatment of a non-hospitalized patient with comorbidities or recent antibiotic therapy in the past three months?
A)Respiratory Fluoroqinolone (mixing, gemi, levo 750)
OR
B) Macrolide (or Doxycycline) with high-dose amoxicillin, or Augmentin 2 g b.i.d., or a cephalosporin (Ceftriaxone, cefuroxime, or cefpodoxime)
In community acquired pneumonia, what is empiric treatment of hospitalized patients with moderately severe pneumonia?
A) respiratory fluoroquinolone (moxifloxacin, Gemifloxacillin (oral), or levofloxacin 750 mg)
OR
B) ampicillin, ceftriaxone, or cefotaxime (ertapenem in select patients), Plus a macrolide (or doxycycline)
And community acquired pneumonia and what is empiric treatment of hospitalized patients with severe pneumonia requiring ICU treatment (may need to add antibiotics to cover pseudomonas or MRSA)
A) ampicillin/sulbactam OR
B) Ceftriaxone OR
C) Cefotaxime
PLUS
A respiratory fluoroquinolone or azithromycin
How long should a person with community acquired pneumonia be treated for?
At least five days with 2 to 3 days afebrile and no more than one sign of clinical instability (S I RS): (elevatedtemperature, heart rate, respiratory rate, decreased systolic blood pressure, or arterial oxygen saturation)
If hospital acquired pneumonia is less than five days and the patient has no risk factors for multi drug-resistant organisms, how do you empirically treat?
A)Third generation cephalosporin (ceftriaxone), B)Fluroquinolone (levofloxacin, moxifloxacin, ciprofloxacin)
C)ampicillin/sulbactam
D) ertapenem
If hospital acquired pneumonia starts after five days or longer, Or patient has risk factors for multi drug-resistant organisms (Pseudomonas, Klebsiella(ES BL), acinobacter, MRSA, legionella)?
A)Ceftazidime, or cefepime OR
B) Imipenem, meropenem, or doripenem OR
C)pip/tazo OR
PLUS aminoglycoside or fluoroquinolone (Cipro, Levo)
(Vanco or linezolid only MRSA risk factors (History of M RSA a infection, recent hospitalization or antibiotic use, presence of invasive healthcare devices) or high incidence locally greater than 10 to 15%.
What is the treatment duration for hospital acquired pneumonia?
Seven or eight days. 14 days for pseudomonas or acinobacter
In pneumonia, what are five risk factors for multi drug resistant organisms?
Antibiotics in past 90 days
Hospitalization of five days or more
High resistance and community or hospital unit
Risk factors for healthcare associated pneumonia
Immunosuppressive disease or therapy
What are differences between cold and influenza?
Colds are gradual onset, hacking cough, stuffy nose, sneezing, sore throat
Flu is sudden, high temperature for 3 to 4 days, headache, myalgia, exhaustion, Dry cough
Which patients have a higher risk of influenza complications
Patients younger than two or 65 and older, patients with chronic disease, immunosuppressed patients, pregnant women, patients younger than 19 on long-term aspirin, Native Americans,residents of nursing homes
When mistreatment for the flu occur?
Within 48 hours
What are the brand and generic name of adamantane flu drugs?
How do they work?
amantadine (Symmetrel), rimantadine (Flumedine)
The inhibit viral and coding and release of viral nucleic acid by inhibiting m2 protein.
Only works for flu A virus and not recommended for treatment due to high resistance.
What are examples of neuraminidase inhibitors and what do they do?
Who shouldn’t use them, what is regular and renal dosing?
When should they be given if someone has high risk the flu?
oseltamivir (Tamiflu), zanamivir (Relenza)
The inhibits neuraminidase. Side effects include nausea vomiting for Tamiflu, andbronchospasm or cough in relenza. Do not use Relenza in asthma or COPD patients.
Tamiflu is 75 mg orally b.i.d. for five days. Renal dosing is 75 mg a day (CrCl
What is the difference between PPSV23 and PCV13?
Strep Pneumoniae Vaccine:
PCV13 contains a carrier protein, and is not for children. PCV 13 is for patients with CSF leaks and cochlear implants. Give this one first, wait 8 weeks and then the other.
PPSV 23 is for those over 65 OR those between 2-64 with certain diseases OR those between 2–64 living in nursing homes.
Only revaccinate PPSV 23 patients who received the vaccine more than five years ago when they were under 65. Also 2-64yo patients who are immunocompromised (they should also get PCV 13), or patients with asplenia (they should also get PCV 13)
