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Acute Care I > Infectious Disease: Respiratory > Flashcards

Infectious Disease: Respiratory Flashcards

1
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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2
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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3
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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4
Q

Acute Bacterial Rhinosinusitis
Microbiology (common bacteria)?

A

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

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5
Q

Acute Bacterial Rhinosinusitis
Microbiology (common viruses)?

A

Rhinovirus
Influenza virus
Adenovirus

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6
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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7
Q

Acute Bacterial Rhinosinusitis
PCN Allergy

A

Levofloxacin
Doxycycline

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8
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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9
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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10
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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11
Q

CAP Pneumonia Criteria

A

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

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12
Q

Nosocomial Pneumonia Criteria: HAP

A

Occuring > 48 hrs after hospitalization

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13
Q

Nosocomial VAP Criteria: VAP

A

Occring > 48 hrs after intubation

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14
Q

CAP Pneumonia Probable Pathogens

A

Strep Pneumoniae
Mycoplasma pneumoniae
H. Influenzae
Chlamydophilia
Legionella spss.

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15
Q

Nosocomial Pneumonia Probable Pathogens

A

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

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16
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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17
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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18
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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19
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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20
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

21
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

22
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

23
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)

24
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

25
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

26
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

27
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

28
Q

High Risk for Mortality

A

Ventilator support d/t HAP
Septic Shock

29
Q

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

A

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

30
Q

When to switch IV to PO abx?

A

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

31
Q

Empyema Classifications:
Uncomplicated parapneumonic effusion

A

Exudative effusion
Resolves w/ resolution of pneumonia

32
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

33
Q

Empyema Classification:
Thoracic Empyema

A

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

34
Q

Empyema Diagnosis:
Pleural Fluid Analysis includes

A

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

35
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)

36
Q

Empyema Microbiology

A

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

37
Q

Empyema Treatment
Abx Treatment

A

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

38
Q

Empyema Treatment
Duration of Treatment

A

Very pt specific
Until clinical improvement
Depends upon other interventions

39
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

40
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

41
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

42
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

43
Q

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

A

Isoniazid and Rifapentine
Rifampin
INH + Rifampin
Isoniazid

44
Q

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

A

3mo
Once weekly
12

45
Q

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

A

4mo
Daily
120

46
Q

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

A

3mo
Daily
90

47
Q

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

A

9mo
Daily
270

48
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)

49
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)

Acute Care I (30 decks)

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