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Medd 422 > Infectious Disease and Antibiotics > Flashcards

Infectious Disease and Antibiotics Flashcards

1
Q

Beta-Lactams MOA

A

cell wall inhibitor

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2
Q

Beta-Lactams - 3 drug classes

A

Penicillins
Cephalosporins
Carbapenems

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3
Q

Penicillins (examples, spectrum, best clinical use)

A 
Penicillin G (IV)
Penicillin V or K (PO)
Benzathine Penicillin (IM)

Gram (+) aerobes/anaerobes, some gram (-)
Not for S. aureus, Bacteroides

Best for: Syphillis (benzathine penicillin), dental infections, Group A strep pharyngitis

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4
Q

Anti-staph penicillins (examples, spectrum, best clinical use)

A

Cloxacillin (IV/PO)
Methacillin

Methicillin-sensitive S. aureus (MSSA)

MSSA

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5
Q

Aminopenicillins

A

Amoxicillin (PO)
Ampicillin (IV)
Amoxicillin-clavulanate

Gram (+) and gram (-) aerobes/anaerobes
Amox/ampi = no S.aureus, bactericides, mycoplasmaplasma
Amoxi-clav = no pseudomonas, MRSA, mycoplasma

Amoxi, ampi = for URI, GBS prophylaxis, GI infection, rarely used empirically except for meningitis
Amoxi-clav = bite infections, aspiration pneumonia, GI/GU infections, COMPLICATED infections

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6
Q

Extended-spectrum penicillins

A

Piperacillin-tazobactam
Gram (+) and gram (-) aerobes/anaerobes
Empiric coverage for severe infections, pseudomonas

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7
Q

1st generation cephalosporins

A

Cephalexin (Keflex) PO
Cefazolin (Ancef) IV

Gram (+) and gram (-) aerobes (Proteus, E. Coli, Klebsiella)
No pseudomonas, MRSA, Enterococcus, Listeria, anaerobes

Skin infections, MSSA, PEcK, pre-op prophylaxis

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8
Q

2nd generation cephalosporins

A

Cefuroxime (PO and IV) - same as 1st gen but better H.influenza coverage; good for pneumonia, COPD
Cefoxitin (IV) - same as 1st gen but better Bacteroides coverage; good for GI/GU surgery prophylaxis

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9
Q

3rd generation cephalosporins

A

Ceftriaxone (IV) - better gram (-) aerobe coverage; good for meningitis, pyelonephritis, MSSA, group A strep, gram -ves
Ceftazidime - same as ceftriaxone but pseudomonas coverage

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10
Q

4th generation cephalosporins

A

Cefepime (IV) - same as ceftazidime; good for gram (-) and pseudomonas infections

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11
Q

Carbapenems

A

Ertapenem (IV) - gram (+) and gram (-) aerobes/anaerobes; no enterococcus, pseudomonas, MRSA; tx of ESBL infections needing outpt therapy

Meropenem (IV), imipenem (IV) - same as ertapenem but Pseudomonas and some Enterococcus coverage; empiric coverage for severe infections, Pseudomonas, ESBL; NO MRSA

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12
Q

Vancomycin MOA

A

GLYCOPEPTIDE

Disrupts cell wall by preventing peptidoglycan synthesis

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13
Q

Vancomycin

A

Gram (+) aerobes/anaerobes
For MRSA, Enterococcus, CoNS, C.diff colitis (PO)
NOT GOOD AGAINST STAPH AUREUS

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14
Q

Daptomycin MOA

A

CYCLIC LIPOPEPTIDE

Depolarizes cell membrane causing lysis

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15
Q

Daptomycin

A

Gram (+) aerobes

MRSA, VRE (Vancomycin-resistant enterococci)

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16
Q

Fluoquinolones MOA

A

DNA gyrase inhibitor

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17
Q

Fluoroquinolones

A

Ciprofloxacin - gram (-) aerobes, pseudomonas, MSSA, Mycobacteria tuberculosis, limited Strep; NOT FOR anaerobes, Enterococcus, MRSA
Levofloxacin - same as copra but better strep coverage and poor pseudomonas coverage
Moxifloxacin - same as levofloxacin but good anaerobic and some Enterococcus coverage (GI/GU infections)

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18
Q

Metronidazole MOA

A

Disrupts DNA by free radical production

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19
Q

Metronidazole

A

Anaerobes, protozoa (Giardia, Trichomonas, Entamoeba, Blastocystis)
C diff colitis, anaerobic infections, protozoa

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20
Q

Macrolides, lincomycin MOA

A

Inhibit protein synthesis by binding 50S ribosomal subunit and preventing translocation

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21
Q

Macrolides

A

Clarithromycin (PO) - S. pneumonia, H. influenza, Mycoplasma, Chlamydophila, Legionella, Moraxella, Mycobacterium avium ( MAC), H.pylori; good for URI, pneumonia, MAC, H.pylori

Azithromycin (PO/IV) - Gram+ and Gram - Atypical pneumonias, chlamydia, H. Pylori (+ clarithromycin), MAC, traveller’s diarrhea

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22
Q

Aminoglycosides MOA

A

Inhibit protein synthesis by binding to 30S ribosomal subunit and preventing translocation

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23
Q

Aminoglycosides

A

Gentamicin (IV) - gram (-) aerobes, MSSA; good for combo therapy for invasive gram (-), MSSA and enterococcus infections

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24
Q

Tetracycline MOA

A

Inhibit protein synthesis by binding to 30S ribosomal subunit and preventing translocation

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25
Q

Tetracycline

A

Doxycycline - gram (+) and (-) aerobes,

Atypical pneumonias, chlamydia, tick/lyme disease, community MRSA

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26
Q

Linezolid MOA

A

Inhibit protein synthesis by binding to 50S ribosomal subunit and preventing translocation

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27
Q

Linezolid

A

Gram (+) aerobes; good for MRSA, VRE

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28
Q

Trimethoprim-sulfamethozazole MOA

A

Disrupt folate synthesis by sequentially inhibiting enzymes needed for bacterial production of THF

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29
Q

Trimethoprim-sulfamethozazole

A

Gram (+) and gram (-) aerobes, protozoa; not for anaerobes, enterococcus, group A strep, pseudomonas; good for skin infections, MRSA, UTI, prophylaxis for immunocompromised

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30
Q

2 common Gram + cocci in chains

A

Streptococcus or enterococcus

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31
Q

Empiric tx for streptococcus

A

Ceftriaxone

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32
Q

Empiric tx for enterococcus

A

Ampicillin or linezolid

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33
Q

1 common gram + cocci in cluster

A

Staphylococcus

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34
Q

Empiric tx for staphylococcus

A

Vancomycin

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35
Q

2 common Gram + bacilli

A

Clostridium

Listeria

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36
Q

Common gram + bacilli that you do not need to be concerned about

A

Propionibacterium acnes
Bacillus
Corynebacterium
Coagulase negative staphylococci (CoNS)

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37
Q

Empiric tx for clostridium (anaerobic)

A

Metronidazole or Piperacillin-tazobactam

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38
Q

Empiric tx for listeria

A

Ampicillin

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39
Q

Bacteria that are never contaminants

A

Staph aureus
Gram - bacilli
Yeast

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40
Q

Common gram - cocci

A

Neisseria

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41
Q

Empiric tx of Neisseria

A

Ceftriaxone

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42
Q

Infection commonly caused by Neisseria

A

Meningitis

NB - look for purpura fulminans with neisseria meningitides

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43
Q

Common gram - coccobacilli

A

Haemophilus

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44
Q

Infection commonly caused by Haemophilus

A

URTI

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45
Q

Gram - bacilli

A 
Klebsiella
Enterobacter
E. Coli
Proteus 
Serratia 
Bacteroides 
Pseudomonas
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46
Q

Gram - coliform bacilli

A

Klebsiella
Enterobacter
E. Coli
Serratia

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47
Q

Empiric tx for gram - coliforms

A

Ceftriaxone, piperacillin-tazobactam, meropenem

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48
Q

Empiric tx for pseudomonas

A

Piperacillin-tazobactam or meropenem
Critically ill pts may need double coverage with amino glycoside or ciprofloxacin
ALWAYS HAVE PSEUDOMONAS COVERAGE IF SEVERE INFECTION (not needed for mild-moderate)

49
Q

Empiric tx for bacterioides (anaerobic)

A

Metronidazole or pipercerallin-tazobactam

50
Q

Organisms associated with infective endocarditis

A

S. aureus, Enterococcus, viridans group streptococci

51
Q

Common infections caused by Staphylococcus aureus

A

Soft tissue infections, endocarditis, catheter associated BSI, bone/joint infections, hospital acquired pneumonia, surgical site infections, prosthetic material infections

52
Q

Streptococcus pneumoni

A

Gram + cocci in pairs

53
Q

Common infections caused by streptococcus pneumoni

A

Otitis media, community acquired pneumonia, leading cause of bacterial meningitis

54
Q

Empiric therapy for bacterial meningitis

A

Ceftriaxone + vancomycin + dexamethasone

55
Q

Group A Strep

A

Streptococcus pyrogens

56
Q

Common infections caused by streptococcus pyogene

A

STREP PHARYNGITIS AND CELLULITIS

pneumonia, empyema, necrotizing fasciitis, toxic shock

57
Q

Non-infectious complications caused by streptococcus pyogene

A

rheumatic fever

glomerulonephritis

58
Q

Viridans group streptococci

A

Gram + cocci in chains

59
Q

Common infections caused by Viridans group streptococci

A

Abscess (brain, lung, pleura, liver, abdo), aspiration pneumonia (common in oral flora), can cause endocarditis (repeat blood cultures after 48h to ensure cleared)

60
Q

Empiric therapy for viridans group streptococci

A

Ceftriaxone

61
Q

2 common types of enterococcus

A

E. faecalis: more common in community infections

E. faecium: more common in hospital-onset infections

62
Q

Common infections caused by enterococcus

A

UTI, hepatobiliary infections, endocarditis (repeat blood culture in 48h)

63
Q

Empirix tx for E. faecalis

A

Ampicillin

64
Q

Empiric tx for E. faecium

A

Linezolid

65
Q

Common infections caused by coliforms/enterobacteriaciae

A

UTI, hepatobiliary infection, intra-abdominal infection, health-care associated infections

66
Q

Empiric tx for community acquired coliform infection in non-septic pt

A

Ceftriaxone

67
Q

Empiric tx for community acquired coliform infection in septic pt

A

Piperacillin-tazobactam or meropenem

68
Q

Common infections caused by candida

A

Oral thrush, vaginal candidiasis, cutaneous
Serious infections usually healthcare associated
Endocarditis seeding to eyes (endopthlamitis)

69
Q

Empiric tx for candida

A

Fluconazole if not critically ill, no prev anti fungal tx and not neutropenic
Micafungin for everyone else

70
Q

Main resistance pathways of beta lactams

A

Enzymatic destruction (beta lactamases), altered target (PBP mutation), decreased uptake (porin channel alterations)

71
Q

Beta lactamases MOA

A

Hydrolysis of betalactam ring

72
Q

Beta lactamases examples

A

ESBL, AMPC, KPC, Penicillinase

73
Q

ESBL examples

A

E.coli and other Enterobacteriaceae (ie. Klebsiella, Proteus)

74
Q

AmpC examples

A

E. coli and other enterobacteriaceae

75
Q

Penicillinase examples

A

Staph aureus

76
Q

KPC (K. Pneumonia carbapenemase) examples

A

E. coli and other enterobacteriaceae

77
Q

Beta-lactam resistance: PBP mutating bacteria

A

MRSA

78
Q

Beta-lactam resistance: OPR-D porin channel altering bacteria

A

P. aeruginosa (resistance to imipenem)

79
Q

Main resistance pathway to glycopeptides (vancomycin)

A 
Altered target (cell wall precursor mutation: d-ala-d-ala 
--> d-ala-d-lac = decreases vanco binding)
80
Q

Examples of vancomycin resistant bugs

A 
VRSA = Vanco resistant staph aureus 
VRE = Vanco resistant enterococcus
81
Q

Main resistance pathways to aminoglycosides (gentamicin)

A

Enzymatic modification (AG changes –> decrease ribosome binding), altered target (mutational changes on ribosomal binding site), decreased uptake (porin channel alterations)

82
Q

Examples of AG modifying enzymes

A

Gram + and - resistance to AGs

83
Q

AG resistance: example of ribs binding site mutating bacteria

A

Enterococcal resistance to streptomycin

84
Q

AG resistance: porin channel altering bacteria

A

Gram - resistance to AGs

85
Q

Main resistance pathways to quinolones (ciprofloxacin, levofloxacin)

A

Decreased uptake (porin channel alteration), increased efflux, altered target (mutational changes in DNA gyrase subunit)

86
Q

Quinolone resistance: examples of porin channel altering bacteria

A

Gram - resistance to quinolones

87
Q

Quinolone resistance: examples of efflux altering bacteria

A

Gram - resistance to quinolones (ie. multi drug efflux pump in P. aeruginosa), staphylococcal

88
Q

Quinolone resistance: examples of DNA gyrase mutating bacteria

A

Gram + and - resistance to quinolones

89
Q

Main resistance pathways to macrolides (erythromycin, azithromycin, clarithromycin)

A

Increased efflux, altered target (ribosomal alteration decreasing macrolide binding)

90
Q

Macrolide resistance: examples of increased efflux bacteria

A

Various staphylococcus and streptococcus

91
Q

Macrolide resistance: examples of ribosomal altering bacteria

A

Various staphylococcus and streptococcus

92
Q

Alternative Abx for ESBL

A

Carbapenem, Aminoglycoside (gentamicin - NB renal dysfunction), Ciprofloxacin, Pip-tazo, TMP-SMX

93
Q

Alternative Abx for VRE

A

Daptomycin, Linezolid

94
Q

Classic empiric antibiotic combo for severe infection and very little idea of culprit organism

A

Piperacillin-Tazobactam + Vancomycin

95
Q

Top 3 causes of community acquired blood stream infection

A
  1. E. Coli
  2. Staph aureus
  3. Strep pneumo
96
Q

Top 3 causes of hospital acquired blood stream infection

A
  1. Coagulase negative staphylococci
  2. Staph aureus
  3. Enterococcus / candida
97
Q

Coagulase negative staph IE tx

A

Vancomycin (resistant to B-lactams, treat like MRSA)

98
Q

Staph lugdunensis IE tx

A

Cloxacillin (treat like MSSA)

99
Q

Staph aureus IE tx

A

SUSCEPTIBLE
1. Cloxacillin
2. Cefazolin
Prosthetic: Cloxacillin + Rifampin + 2 weeks of gentamicin

RESISTANT
1. Vancomycin
2. Daptomycin
Prosthetic: Vancomycin + Rifampin + 2 weeks of gentamicin

All for 6 weeks (unless susceptible right-sided IE in IDU = 2-4 wks)

100
Q

Viridans group strep and S. bovis IE tx

A

Susceptible: 4 wks Penicillin G OR ceftriaxone OR 2 wks of penicillin G or ceftriaxone AND Gentamicin
Prosthetic valve: 6 wks of Penicillin G OR ceftriaxone +/- Gentamicin for 2 weeks

Resistant: Penicillin G + 2 wks of Gentamicin or Ceftriaxone alone
Prosthetic valve: Penicillin or Ceftriaxone AND gentamicin for 6wks

101
Q

Enterococcus faecalis IE common cause

A

Nosocomial infection

102
Q

Coagulase negative staph IE common cause

A

Prosthetic valve

103
Q

Viridans group strep IE common cause

A

Non-IVDU, poor dentition

104
Q

Streptococcus bovis IE common cause

A

Colonic lesion

105
Q

Enterococcus facaelis/facecium IE tx

A

Ceftriaxone + Ampicillin

Alt: Penicillin G or Ampicillin + Gentamicin but b/c of nephrotoxicity, avoid gentamicin

106
Q

Top common causes of native-valve non-IDU IE

A
  1. Staph aureus
  2. Viridans Group Strep
  3. Enterococcus
107
Q

Empiric regimen for native-valve non-IDU IE

A

Penicillin G + Cloxacillin OR Ampicillin + Gentamicin

108
Q

Empiric regimen for native-valve IDU IE

A

Most common cause = Staph aureus

Vancomycin until you know MRSA vs MSSA

109
Q

Top common causes of prosthetic valve IE

A
  1. Staph aureus and CoNS
  2. Viridans Group Strep
  3. Enterococcus
110
Q

Empiric regimen for prosthetic valve IE

A

Vancomycin + Gentamicin + Rifampin

111
Q

HACEK organisms

A 
Often give -ve result in IE testing b/c fastidious growth
Haemophilus sp
Aggregatibacter sp
Cardiobacterium hominis 
Eikenella corrodens
Kingella sp
112
Q

Tx for HACEK organism IE

A

Ceftriaxone for 4-6wks

113
Q

True culture negative IE likely culprits

A

Coxiella –> Doxycycline + hydroxychloroquine x 18mo

Bartonella –> Ceftriaxone + Gentamicin + Doxycycline x 6wks

114
Q

Candida IE tx

A

Micafungin IV for >6wks
Surgery
If no surgery, lifelong fluconazole suppression

115
Q

Directed tx against Neisseria meningitides

A

Penicillin G for ~7-14d

116
Q

MRSA tx options

A

Oral: TMP-SMX, doxycycline, clindamycin

Parenteral (severe): Vancomycin, daptomycin, linezolid

117
Q

4 different types of penicillins

A
  1. Penicillin
  2. Aminopenicillins
  3. Cloxacillin
  4. Piperacillin
118
Q

Types of 30s ribosomal subunit inhibitors

A
  1. Aminoglycosides

2. Tetracycline

119
Q

Lincosamide

A

Clindamycin: Gram (+) aerobes/anaerobes; no enterococcus; MRSA, skin and dental infections (anaerobe coverage ABOVE the diaphragm), for its with penicillin allergies
A/W C.diff

Medd 422 (4 decks)

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