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PHRM 865 > Intro to ID 1 > Flashcards

Intro to ID 1 Flashcards

1
Q

What is a commensal?

A
  • a microorganism that is a normal inhabitant of the human body
  • either microbe or host derives benefit
  • neither is harmed
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2
Q

What is a pathogen?

A
  • a microorganism capable of causing disease
  • includes commensals and noncommensals
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3
Q

What temperature indicates a fever?

A

38 C (100.4 F)

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4
Q

What is the main non-infectious cause of a fever?

A

Drug-induced

malignancies, blood transfusions, auto-immune disorders

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5
Q

What are the causes of false-negative fevers?

absence of a fever when a patient actually has an infection

A
  • antipyretics
  • corticosteroids

Overwhelming infections may cause patient to be hypothermic

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6
Q

What are the systemic signs of an infection?

A
  • hypotension (SBP <90)
  • tachycardia (>90 bpm)
  • tachypnea (>20 RPM)
  • fever (>38C or <36C)
  • increased/decreased WBC

At least two of the bottom 4 criteria are needed to meet SIRS

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7
Q

What are the systemic symptoms of an infection?

A
  • chills
  • rigors (cold sweats)
  • malaise
  • mental status changes
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8
Q

What local signs and symptoms indicate an infection?

A
  • symptoms referable to specific body system (flank pain)
  • pain and inflammation
  • inflammation in deep-seated infections

May be absent in neutropenic patients

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9
Q

What is the normal range for WBCs?

A

4,500 - 11,000 cells/mm^3

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10
Q

What are the non-infectious causes of elevated WBCs?

A
  • steroids
  • leukemia

stress, RA, pregnancy

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11
Q

What are the functions of mature neutrophils?

PMNs, polys, segs

A
  • most common WBC
  • fight infections
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12
Q

What are the functions of immature neutrophils?

bands

A
  • increased during infection = “left shift”
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13
Q

What are the functions of eosinophils?

0-8% of WBCs

A
  • involved in allergic reactions & immune response to parasites
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14
Q

What are basophils associated with?

0-3% of WBCs

A
  • associated with hypersensitivity reactions
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15
Q

What are lymphocytes associated with?

20-40% of WBCs

A
  • humoral (B-cell) & cell-mediated (T-cell) immunity
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16
Q

What are the functions of monocytes?

0-11% of WBCs

A
  • mature into macrophages
  • serve as scavengers for foreign substances
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17
Q

What is leukocytosis and what infections is it associated with?

A
  • increased neutrophils +/- bands
  • associated with bacterial infections
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18
Q

What is leukopenia?

A

abnormally low WBC that may be a sign of overwhelming infection

poor prognostic sign

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19
Q

What is lymphocytosis and what infections is it associated with?

A
  • increased in B-cells and T-cells
  • associated with viral, fungal, or tuberculosis infections
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20
Q

What is ANC?

Absolute Neutrophil Count

A
  • total number of circulating segs and bands

  • segs are mature neutrophils which have segmented nucleus
  • bands are immature neutrophils which lag that feature
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21
Q

What is neutropenia?

A
  • ANC <500 cells/mm^3
    or
  • ANC expected to decrease to <500 cells/mm^3 in the next 48 hours

ANC <100 cells/mm^3 is termed profound neutropenia

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22
Q

Why is ANC important?

A
  • risk of infection dramatically increases as ANC decreases
  • start to worry when ANC is <1000 cells/mm^3
  • ANC < 500 is associated with substantial risk of infection
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23
Q

What are the acute phase reactants that are evaluated when assessing for infection?

A
  • ESR (erythrocyte sedimentation rate)
  • CRP (C-reactive protein)
  • PCT (procalcitonin)
24
Q

How are ESR and CRP used in the diagnosis of infection?

erythrocyte sedimentation rate

A
  • elevated in the presence of an inflammatory process; however, it does NOT confirm infection
  • often elevated in presence of infection, so serial measurements can be useful to determine response to treatment
25
Q

What are the normal ESR ranges?

A
  • 0-15 mm/hr –> males
  • 0-20 mm/hr –> females
26
Q

What is the normal CRP range?

A

0-0.5 mg/dL

27
Q

What is the role of PCT (procalcitonin) in the diagnosis of infections?

A
  • magnitude of elevation provides useful diagnostic information
  • more specific for bacterial infections than the acute phase reactants
  • serial measurements every 1-2 days useful to assess response to therapy and when to d/c abx
28
Q

What do the different ranges of PCT indicate?

A
  • <0.05 mcg/L –> normal
  • <0.25 mcg/L –> low risk of infection
  • > 0.5 mcg/L –> antibiotics should be continued
29
Q

Differentiate between colonization and infection:

A
  • colonization is when a potentially pathogenic organism is present at the body site but is not invading host tissue or eliciting a host immune response
  • infection is when a pathogenic organism is present at the body site and is damaging host tissue and eliciting host responses and symptoms consistent with an infection
30
Q

Define MIC:

minimum inhibitory concentration

A

Minimum inhibitory concentration is the lowest antimicrobial concentration that prevents visible growth

31
Q

What is a breakpoint?

A

A breakpoint is an MIC or zone diameter value used to categorize an organism as susceptible, susceptible-dose dependent, intermediate, resistant, or non-susceptible

32
Q

Define Susceptible (S):

A
  • Isolates with an MIC at or below or a zone diameter at or below the (S) breakpoint are inhibited by the usually achievable concentrations of antimicrobial agent when normal dosing regimens are used
  • (S) indicates it will likely result in clinical efficacy
33
Q

Define susceptible-dose dependent (S-DD):

A

S-DD implies susceptibility is dependent on the dosing regimen used

34
Q

Define Intermediate: I

A

Isolates with MICs approach achievable blood or tissue concentrations and response rates may be lower than for susceptible isolates

35
Q

Define resistant (R):

A
  • isolates not inhibited by usually achievable concentrations of agent with normal dosage schedules
  • clinical efficacy has not been reliably demonstrated
36
Q

Define non-susceptible (NS):

A
  • used for isolates for which only susceptible breakpoint is designed
  • if MIC is above or zone diameter is below the susceptible breakpoint, isolate is categorized as NS
37
Q

Which test is the gold standard when identifying a pathogen?

A

MIC testing (broth dilution)

38
Q

What is the drawback of using disk diffusion (Kirby-Bauer) for susceptibility testing?

A

CANNOT derive a MIC from the zone of inhibition

Only results are susceptible, intermediate, or resistant

39
Q

What are key things to remember when evaluating the results of susceptibility tests?

A
  • Look for drugs that say S or S-DD
  • MICs are unique to bug-drug combos and therefore they CANNOT be compared between abx
40
Q

What is the benefit to automated testing systems?

A

saves space

41
Q

Which rapid diagnostics test for bloodstream infections gives a susceptibility profile?

A

PhenoTest BC Kit

42
Q

What is empiric therapy?

A
  • starting abx before identification and susceptibility results are known

  • the abx selected should cover most common pathogens
  • usually very broad coverage and may require 2-3 different abx
43
Q

What is directed (targeted) therapy?

A
  • abx therapy selected after organism identification and/or susceptibility is known
44
Q

What is the difference between empiric and targeted therapy?

A
  • empiric is just the first abx we pick before we know anything
  • targeted is picked based upon test results
45
Q

What is de-escalation?

A
  • process of empiric –> directed
  • selecting an abx with the narrowest spectrum of activity

Can be stepwise or all at once

46
Q

What is spectrum of activity?

A

what anti-microbial does the drug cover

47
Q

What is an antibiogram?

A
  • annual summary of institution-specific anti-infective susceptibility
  • used to pick empiric options
48
Q

What is the rule of thumb when picking an empiric therapy off an antibiogram?

A

Pick a therapy with at least 80% of susceptibility

49
Q

Which genetic variations are important to consider during antibiotic selection?

A
  • G6PD deficiency
  • HLA-B*5701 allele
50
Q

How is antibiotic therapeutic response monitored?

A
  • culture and sensitivity reports
  • WBC, temp, physical complaints
  • therapeutic drug monitoring (serum concentration)
51
Q

What are the factors to consider in antibiotic selection?

A
  • Indication
  • Source
  • Pathogens
  • Spectrum of Activity
  • Resistance patterns
  • PK/PD parameters
  • Monitoring parameters
  • Duration of therapy

Infections scare people so really practice memorizing drugs

52
Q

Define antimicrobial resistance:

AR

A

AR occurs when germs develop the ability to defeat the drugs designed to kill them

germs - bacteria, fungi, viruses, or parasites

53
Q

What is the purpose of antimicrobial stewardship?

AMS

A
  • optimize clinical outcomes while minimizing unintended consequences
  • reduce healthcare cost without adversely impacting quality of care
54
Q

What are the core elements for an AMS program?

A
  • Leadership commitment
  • Accountability –> PharmD or MD
  • Pharmacy expertise
  • Action
  • Tracking
  • Reporting
  • Education
55
Q

What are examples of AMS strategies?

A
  • antibiotic de-escalation
  • requiring approval from ID Steward prior to use of certain abx
  • antibiotic timeout
  • creation of optimized order sets for different disease states

PHRM 865 (12 decks)

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