Intro to ID pt1 Flashcards by Cole O'Connor

hallmark of infection

fever

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non-infectious causes (false-positives) (4 but one main one)

DRUG-INDUCED FEVERS
malignancies
blood transfusions
auto-immune disorders

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1 class/3 drugs that can mask poor therapeutic response -> meaning use is discouraged during tx

antipyretics
acetaminophen, NSAIDs, aspirin

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number for fever in C and F

> 38C or 100.4F

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5 systemic signs for establishing presence of infection

BP
HR
RR
Fever
Inc/dec WBC count

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for the systemic vital signs (minus BP) how many criteria out of 4 are needed for systemic inflammatory response syndrome (SIRS)

at least 2

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systemic symptoms (not vital signs) for presence of infection (4)

chills
rigors
malaise
mental status changes

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example of sx referable to specific body system

flank pain in pyelonephritis

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some non-infectious things that can cause elevated WBC (5)

steroids, leukemia, stress, rheumatoid arthritis, pregnancy

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associated with bacterial infections:
A. Leukocytosis
B. Lymphocytosis

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increased neutrophils+bands:
A. Leukocytosis
B. Lymphocytosis

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presence of bands indicates (inc/dec) bone marrow response to infection

increased

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leukocytosis may be elevated to 2 non-infectious diseases (kinda) or drugs. what diseases and what drugs

leukemia, stress
steroids

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Proliferate into plasma cells to produce antibodies & memory B-cells
A. B-lymphocytes
B. T-lypmocytes

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CD4
A. T-helper
B. T-suppressor

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CD8
A. T-helper
B. T-suppressor

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bind to and directly kill tumor cells
A. T-helper
B. T-suppressor

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help with antibody production and secrete lymphokines
A. T-helper
B. T-suppressor

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help with regulation of humoral and cell-mediated immunity
A. T-helper
B. T-suppressor

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risk of infection dramatically (increases/decreases) as ANC decreases

increases

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ANC <___ associated with substantial risk of infection

<500
(start to worry when ANC is <1000)

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Neutropenia:
- ANC < ___
- ANC expected to _______ to <500 cells in next 48 hours
- ANC < ___ is termed profound neutropenia

500, decrease, 100

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T or F:
ESR (erythrocyte sedimentation rate) & CRP (C-reactive protein) are elevated in the presence of an inflammatory process and confirm infection

False, they do NOT confirm infection

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Normal ESR

0-15 mm/hr (males)
0-20 mm/hr (females)

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normal CRP

0-0.5 mg/dL

if you see acute phase reactant what should you think of

Procalcitonin (PCT)

wtf is procalcitonin

precursor to calcitonin, this is also more specific for bacterial infections than ESR and CRP

normal procalcitonin (PCT)

< 0.05 mcg/L

PCT increases _-__ hours after stimulation then declines over 24-__ hours

3-12, 72

mature neutrophils description (2)

most common WBC fight infections

Immature neutrophil (bands) description

elevated during infection (we call it the left shift)

eosinophil description

involved in allergic reactions and immune response to parasites

basophil description

associated with hypersensitivity reactions

lymphocyte description

B-cell and T-Cell immunity

monocytes description (2)

mature into macrophages serve as scavengers for foreign substances

types of cultures collected: bone biopsy A. Osteomyelitis B. Meningitis C. Endocarditis

types of cultures collected: CSF A. Osteomyelitis B. Meningitis C. Endocarditis

types of cultures collected: Blood cultures, heart valve tissues A. Osteomyelitis B. Meningitis C. Endocarditis

what does 1 set of blood cultures typically contain

1 aerobic and 1 anaerobic bottle

minimum inhibitory concentration (MIC) definition

lowest antimicrobial concentration that prevents visible growth

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

breakpoint

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, resulting in likely clinical efficacy

Susceptible (S)

Implies susceptibility is dependent on the dosing regimen used

Susceptible-dose dependent (S-DD)

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

Intermediate (I)

Isolates not inhibited by usually achievable concentrations of agent with normal dosage schedules; clinical efficacy has not been reliably demonstrated

Resistant (R)

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 ____

Non-susceptible (NS) -> he said something about picking the option that has the "s" in it on the exam *

what is the "gold standard" method for identifying a pathogen?

broth dilution

what does "semi-quantitative" mean in the context of broth dilution

no ability to determine exact inhibitory concentration

alternate option for identifying a pathogen that isnt broth dilution

disk diffusion assay

there are 3 results for disk diffusion assay, what are they?

susceptible, intermediate, resistant

T or F: you can derive an MIC from the zone of inhibition

false, you cannot (although i have no idea what this means)

there is another susceptibility test, what is it called and whats special about it?

Gradient strip tests (also called epsilometer or e-test) it is more precise than "standard" methods

T or F: When given the option to choose a drug, you want to pick the ones that say intermediate

false, you want susceptible

what is empiric therapy? (4)

- typically first regimen we pick - initiation of drugs before we know identification and susceptibility results - drugs that should cover MOST COMMON pathogens - broad ass coverage

what is directed (targeted) therapy (1)

therapy selected after organism identification and/or susceptibility is known

what is de-escalation? (2)

- selecting a drug with the narrowest spectrum of activity - can be stepwise or all at once

what is spectrum of activity? (1)

what anti-microbials does the drug cover (easy as shit)

primary goal of antimicrobial stewardship

optimize clinical outcomes while minimizing unintended consequences

unintended consequences of AMS (3)

- toxicity - selection of pathogenic organism such as C.Diff - emergence of resistant pathogens

secondary goal of AMS

reduce healthcare cost without impacting quality of care

Which of the following is an example of an antimicrobial stewardship strategy? a) Switch to broad spectrum antimicrobials to better treat infections b) Require ID pharmacist approval before ordering broad spectrum antibiotic c) Continuing empiric antibiotics for 96 hours prior to reassessment d) Developing polices aimed at increasing antimicrobial resistance

B lmao