Infectious diseases Flashcards
What Is the negative predictive value of urinalysis?
94%
How long post kidney transplant should patients be screened and possibly treated for asymptomatic bacteriuria?
30-60 days
Which Urinary pathogen is intrinsically resistant to nitrofurantoin?
Proteus mirabilis
What are the criteria for CDI to be rated as non-severe?
WBC < 15,000 cells/microL AND SCr < 1.5 mg/dL
Microbiological pathogenesis of pneumonia: what does HAP-SP stand for?
Haemophilus influenzae, Atypicals (Legionella, mycoplasma, chlamydophila), Streptococcus pneumoniae, staph aureus, Pseudomonas aeruginosa
Which antibiotic cannot be used to treat pneumonia because it is deactivated by pulmonary surfactant?
Daptomycin
Which anti-MRSA agents can be used to treat pneumonia?
Vancomycin or linezolid
What is the clinical criteria for stability for systolic BP in pneumonia?
> 90 mm Hg
What is the heart rate for criteria for Clinical stability in pneumonia?
< 100 bpm
What is the body temperature threshold for clinical stability in pneumonia?
< 100.4 F
What level of MRSA prevalence does anti- MRSA coverage not need to be included for HAP treatment?
=< 20%
What is the threshold to consider white blood count to be elevated?
11,200 or 11,800, Depending on the lab
What percent bands would be considered elevated?
7-8%, depending on the lab
What body temperature in Fahrenheit is considered a fever?
100.4 F or greater
How do you calculate mortality risk from lactic acid?
Multiply by ten
What is CRE?
Carbapenem resistant enterobacterales
Which criteria/ tools are best for determining whether to initiate antibiotics?
Loeb criteria
Which tool/criteria are best for prospective surveillance?
NHSN criteria
What percent sensitivity of isolates should you have an agent for empiric therapy?
80% or more
What is the most common pathogen in older adults in UTI?
E. Coli
Which antibiotics penetrate prostate fluid?
Carbapenems and fluoroquinolones
How long after removal of a catheter is a UTI still considered a catheter associated UTI (CAUTI)?
Up to 48 hours
Which components of urinalysis could indicate a possible UTI?
1) Leukocyte esterases - medium or large
2) urinary nitrites- positive
3) pyuria - greater than 10
What is the only specific sign or symptom we have/objective measure for pyelonephritis diagnosis?
Costovertebral angle tenderness (CVA) (aggressive palpation of the border of the kidney)
31-60 days how do you decide whether to treat UTI Post kidney transplant ?
If you have two consecutive two consecutive urine samples, yielding more than 100,000 CFU of the same pathogen- may consider treatment for 5 days
What level of susceptibility to a fluoroquinolone do you need to have to be able to use it for pyelonephritis?
90% or more
When is the seven day treatment for pyelonephritis appropriate?
Resolution of symptoms occurs within the first 72 hours of antibiotics
For CAUTI, When would be a catheter needs to be changed if a catheter is still needed?
If it has been in place for more than 2 weeks 
What threat level does CDC consider Clostridioides difficile to be?
Urgent
Which antibiotic cannot be used to treat C. difficile in someone with severe macrolide allergy?
Fidaxomicin
What is the most Common pathogen for community acquired pneumonia ?
Viruses
what is the most common bacterial pathogen of community acquired pneumonia?
Streptococcus pneumoniae
When is Anaerobic coverage needed for pneumonia treatment?
Radiographic evidence of consolidation/empyema
When are blood cultures and sputum culture recommended for pneumonia?
Severe disease, or when suspecting MRSA or Pseudomonas
pneumonia is Severe when three minor criteria are present. What are the criteria Re:, respiratory rate, body, temperature, and blood pressure?
1) RR 30 breaths, per minute or more
2) core Temperature < 36 C (96.8 F)
3) hypotension requiring fluid resuscitation
Pneumonia is severe when 3 minor criteria are present. What lab results are minor criteria?
1) uremia (BUN >= 20 mg/dL)
2) leukopenia (WBC < 4,000 cells/microL)
3) thrombocytopenia (PLT < 100,000/microL)
Pneumonia is severe when 3 minor criteria are present. What are the minor criteria (miscellaneous)?
Confusion, multilobar infiltrates, Pa O2/Fi O2 =< 250
Which tool is the best mortality / prognosis predictor in pneumonia?
PSI/PORT (Pneumonia Severity Index/ Patient Outcomes Research Team)
PSI/PORT (Pneumonia Severity Index/ Patient Outcomes Research Team)= 130 points, What is the mortality rate?
9.3%
PSI/PORT (Pneumonia Severity Index/ Patient Outcomes Research Team)= 131 points, What is the mortality rate?
27%
Which Two groups of antimicrobial should be used to treat pneumonia without MRSA or Pseudomonas risk factors? (Except for outpatient without comorbidities)
Beta-lactam + macrolide
Which agent can be used to treat pneumonia in an outpatient without comorbidities? (2 choices)
Amoxicillin, doxycycline
What is the treatment duration required for pneumonia in a stable patient without MRSA or Pseudomonas?
5 days minimum
What are the 7 criteria for clinical stability ?
Temp < 100.4 F
HR < 100 bpm
RR < 24/min
SBP > 90 mmHg
Normal mental status
Ability to maintain oral intake
SpO2 > 90%
How many clinical instability criteria must be present before extending treatment for pneumonia to seven days?
2
Hospital acquired pneumonia: patient who is not high risk of mortality and has had no IV antibiotics in the previous 90 days with an MRSA prevalence under 20%. Which organism Must be covered?
Pseudomonas
HAP- pseudomonas regimens (4)
Pip-tax 4.5 gm q6h
Cefipime 2 g q8h (neurotoxicity risk)
Levofloxacin 750 mg q24h
Meropenem 1g q8h
HAP - MRSA coverage regimens (2)
Vancomycin 15 mg/kg q8-12h (AUC 400, or trough 15-20 mcg/mL)
Linezolid 600 mg q12h
HAP -When is double anti- Pseudomonal coverage needed? (3)
1) Septic shock w vent d/t pneumonia
2) Structural lung disease
3) No agent w susceptibility 90% or more
Which meningitis vaccine is contraindicated in a patient w prior severe allergy to tetanus toxoid?
MenQuadfi (MenACWY-TT)
Which Pneumonia vaccines are contraindicated in patients with severe reaction to diphtheria/Tdap?
PCV15, PCV20
Allergy to egg- other than hives (eg anaphylaxis) - can the patient receive flu vaccination?
Administer in any inpatient or outpatient setting by HCP who can recognize and manage severe allergic reaction
Patient XY received two shingrix doses four weeks apart. Does he need any more doses?
Yes -2
Which pneumococcal serotypes have highest risk of morbidity and mortality? (2)
22F, 33F
