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PHRM 865 > Intro to ID pt2 > Flashcards

Intro to ID pt2 Flashcards

1
Q

what color do gram-pos bacteria appear as

A

purple

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2
Q

what color do gram-neg bacteria appear as

A

red/pink

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3
Q

which one has thick cell wall

A

gram positive

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4
Q

what is the bacteria called when it does not stain using normal methods

A

atypical bacteria

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5
Q

what is it called when the bacteria is resistant to acids/ethanol based decolorization procedures

A

acid-fast bacilli (AFB)

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6
Q

2 most important morphologies for gram-positive bacteria

A

COCCI and Bacilli

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7
Q

Cocci: categorized into clusters and chains
A. Anaerobic
B. Aerobic

A

B

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8
Q

aerobic cocci:
strep A and strep B belong to this categorization:
A. clusters
B. pairs/chains

A

B

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9
Q

aerobic cocci:
coagulase tests are done in which categorization:
A. Clusters
B. Pairs/chains

A

A

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10
Q

Enterococcus faecium and Enterococcus faecalis fall under what categorization?
A. anaerobic bacilli
B. Aerobic bacilli
C. Aerobic cocci clusters
D. Aerobic cocci pairs/chains

A

D, these are also nonhemolytic

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11
Q

T or F: Most medically important pathogens are cocci rather than bacilli

A

true

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12
Q

T or F:
Staphylococcus form pairs or chains and Streptococci & Enterococci appear in clusters

A

false, other way around

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13
Q

what biochemistry testing do you use for staphylococci from streptococci

A

catalase test

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14
Q

what biochemistry test do you use for staphylococcus aureus from coagulase-negative staphylococcus (CoNS)

A

coagulase test

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15
Q

You receive a call from the microbiology lab informing you that patient JR has Gram- positive cocci growing in the blood. They don’t have a full identification but tell you the organism is catalase positive, coagulase positive. Which of the following organisms could be growing in JR’s blood?

A. Staphylococcus aureus
B. Staphylococcus epidermidis
C. Streptococcus pyogenes
D. Enterococcus faecalis

A

A, pretty much choose that if you see coagulase positive i think

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16
Q

what categorization does enterobacterales fall under?

A

gram-negative aerobic bacilli

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17
Q

how do you remember the enterobacteriales lactose-fermenters?

A

CEEK out lactose
Citrobacter
Enterobacter
E.Coli
Klebsiella
(THESE ARE OXIDASE-NEGATIVE)

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18
Q

do lactose-fermenters fall under anaerobic or aerobic bacilli

A

aerobic

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19
Q

T or F:
Non-lactose fermenters tend to be more drug resistant than their friends the lactose fermenters

A

true

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20
Q

try to think of things for slide 15

A

okay will do buddy

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21
Q

what is one common bacteria that falls under atypical (at least on slide 16 it does)

A

chlamydia

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22
Q

for gram-negative morphology, what is the predominant pathogen type?

A

bacilli

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23
Q

what kind of test helps distinguish between enteric vs. non-enteric lactose fermenters

A

oxidase, thats why some are oxidase positive and some are oxidase negative duh

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24
Q

what organisms are “slow growers” that require special supplemental media

A

fastidious organisms

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25
Q

You receive a call from the microbiology lab informing you that patient ZE has Gram negative rods growing in the blood. They don’t have a full identification but tell you the organism is a non-enteric non-lactose fermenter. Which of the following organisms could be growing in JR’s blood?

A. Pseudomonas aeruginosa
B. Citrobacter freundii
C. Morganella morganii
D. Aeromonas hydrophila

A

A, he said to know this for the exam

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26
Q

whats another way to say non-enteric lactose fermenter

A

oxidase-positive lactose-fermenter

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27
Q

what type of protein are transpeptidases, carboxypeptidases, and endopeptidases

A

penicillin-binding proteins (PBPs)

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28
Q

of the 3 PBPs, which one is most important and why?

A

transpeptidase, catalyzes the final cross linking in the peptidoglycan structure

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29
Q

where are penicillin-binding proteins located?

A

in bacteria

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30
Q

what significant thing binds to penicillin-binding proteins

A

Beta lactams!!!*

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31
Q

what are PBPs most essential for?

A

cell-wall synthesis

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32
Q

what are the hydrophilic channels that permit diffusion of essential nutrients and small hydrophilic compounds called

A

porins

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33
Q

what is the compartment between cell membrane and cell wall (or outer membrane if GN) called?

A

periplasmic space

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34
Q

which of the following is vital for bacterial protein secretion, folding, quality control and acts as a reservoir for virulence factors?
A. Cytoplasmic membrane
B. Peptidoglycan layer (cell wall)
C. Outer membrane (GN)
D. Periplasmic space

A

D

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35
Q

what are the two mechanisms by which intrinsic resistance occurs?

A

absence of target site
bacterial cell impermeability (cant get through)

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36
Q

what is the definition of acquired resistance

A

initially susceptible but develop resistance due to a mechanism

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37
Q

what are the two mechanisms by which acquired resistance occurs (general ass answers)

A

mutation in bacterial DNA
acquisition of new DNA

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38
Q

cephalosporins vs. enterococci
A. intrinsic
B. Acquired

A

A

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39
Q

Stable derepression of AmpC
A. intrinsic
B. Acquired

A

B

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40
Q

Acquisition of KPC gene in GNRs
A. intrinsic
B. Acquired

A

B

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41
Q

B-lactams vs. mycoplasma
A. intrinsic
B. Acquired

A

A

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42
Q

plasmid, transposons, and conjugation all relate to which type of resistance?

A

acquired

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43
Q

transferable between organisms
A. Plasmid
B. Conjugation
C. Transposons

A

A

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44
Q

move from plasmid to chromosome or vice versa
A. Plasmid
B. Conjugation
C. Transposons

A

C

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45
Q

most common and referred to as “mating bridge”
A. Plasmid
B. Conjugation
C. Transposons

A

B

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46
Q

referred to as “jumping genes”
A. Plasmid
B. Conjugation
C. Transposons

A

C

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47
Q

what is the MOA of beta-lactamase?

A

hydrolyze beta-lactam ring by splitting amide bond -> inactivating drugs

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48
Q

what are the two classification systems of beta-lactamase?

A

ambler class
Bush-Jacoby-Medeiros

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49
Q

classified according to AA structure (A-D)
A. ambler class
B. Bush-Jacoby-Medeiros

A

A

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50
Q

classified according to functional characteristics
A. ambler class
B. Bush-Jacoby-Medeiros

A

B

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51
Q

serine beta-lactamases contain a _____ residue at active site

A

serine no shit

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52
Q

metallo beta-lactamases contain _____ residue at active site

A

zinc, easy to remember bc its a metal

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53
Q

uses acylation and deacylation in mechanism
A. serine beta-lactamase
B. zinc beta-lactamase

54
Q

skips intermediate step and just opens ring as part of its mechanism
A. serine beta-lactamase
B. zinc beta-lactamase

A

B, think metal can force through things and shit idk

55
Q

Ambler classification:
what do narrow-spectrum B-lactamases hydrolyze?

A

penicillin

56
Q

Ambler classification:
Narrow-spectrum B-lactamases are produced primarily by what bacteria?

A

enterobacterales

57
Q

Ambler classification:
what do Extended-spectrum B-lactamases hydrolyze?

A

narrow & extended spectrum B-lactam (3rd gen cephalosporins)

58
Q

Ambler classification:
bolded enzyme example for extended-spectrum B-lactamases (ESBL)

A

CTX-M-15 **

59
Q

Ambler classification:
bolded enzyme(s) example for serine carbapenemases **

A

KPC-1, KPC-2, KPC-3

60
Q

ambler classification:
what do serine carbapenemases hydrolyze?

A

carbapenems (WOAH)

61
Q

Ambler classification:
what do metallo-B-lactamases hydrolyze?

A

carbapenems

62
Q

T or F:
Serine carbapenems are more broad than metallo ones

A

false, other way around

63
Q

Ambler classification:
bolded enzyme(s) example for metallo-B-lactamases

64
Q

cephalosporinases didnt have any hydrolysis mechanisms listed, what was the one word characteristic used in that slot instead?

65
Q

Ambler classification:
bolded enzyme(s) example for cephalosporinases

66
Q

Ambler classification:
bolded enzyme(s) example for OXA-type

A

OXA-48 (no way)

67
Q

ambler classification:
what does OXA-type hydrolyze (3)

A

oxacillin, oxyimino B-lactams, and carbapenems

68
Q

which resistant-related enzyme is most prevalent in Escherichia coli, Klebsiella pneumoniae/oxytoca, and Proteus mirabilis? What ambler class is it?

A

CTX-M, ESBLs

69
Q

which of the following is not a beta-lactam agent?
A. Penicillin
B. Ciprofloxacin
C. Monobactams
D. Cephalosporins

A

B, thats a quinolone

70
Q

what is the treatment of choice when dealing with ESBL-based resistance?

A

carbapenems

71
Q

in ESBL-based resistance, piperacillin/tazobactam is an option for ______ source only

72
Q

what enzyme is responsible for the most frequent cause of carbapenem-resistant enterobacterales (CRE)?

A

carbapenemase

73
Q

T or F:
CRE leads to resistance of the whole beta-lactam class

74
Q

look at the tx options on slide 34 again that looks wrong somehow

75
Q

T or F:
Metallo-B-lactamases confer resistance to all B-lactams

A

false, the exception is monobactams (aztreonam)

76
Q

Cefiderocol; aztreonam + ceftazidime/avibactam are the only treatment option for what ambler class type?

A

metallo-B-lactamases

77
Q

which ambler class and type is primarily found in acinetobacter baumannii and pseudomonas aeruginosa?

A

Class D, OXA-type

78
Q

2 tx options for OXA-type resistance

A

cefiderocol
sulbactam/durlobactam

79
Q

T or F:
carbapenem-resistant enterobacterales means that carbapenemases are present

A

false (slide 37)

80
Q

Efflux pumps and porin mutations
A. CP(carbapenem producing)-CRE
B. Non-CP-CRE

81
Q

AmpC and ESBLs
A. CP (carbapenem producing)-CRE
B. Non-CP-CRE

82
Q

JM is a 45 YOM admitted with fever, chills, urinary frequency and urgency. Blood cultures are collected and 12 hour after admission rapid diagnostic testing identifies E.coli, CTX-M (+) in 4/4 bottles.
What type of antibiotic resistance is present?
A. Non-CP CRE
B. ESBL
C. NDM
D. KPC

A

B, CTX-M = ESBL

83
Q

JM is a 45 YOM admitted with fever, chills, urinary frequency and urgency. Blood cultures are collected and 12 hour after admission rapid diagnostic testing identifies E.coli, CTX-M (+) in 4/4 bottles.
What is the recommended treatment option?
A. Meropenem
B. Meropenem/vaborbactam
C. Aztreonam + Ceftazidime/avibactam
D. Piperacillin/tazobactam

A

A, treatment of choice for ESBL is carbapenems, dont know what the combo one is though

84
Q

mechanisms of AmpC beta-lactamases:
- inducible via ____________ ________ AmpC genes
- Non-inducible chromosomal resistance via __________
- ________-mediated resistance

A
  • chromosomally encoded
  • mutations
  • plasmid
85
Q

what does “inducible via chromosomally encoded AmpC genes mean in english?

A

some bacteria produce AmpC enzymes when exposed to certain antibiotics, making them resistant

86
Q

T or F:
Non-inducible chromosomal resistance via mutations can happen without exposure to antibiotics

A

true actually

87
Q

what does plasmid-mediated resistance mean in english?

A

resistance genes can be carried on plasmids which are small DNA fragments that can transfer between bacteria which spreads resistance

88
Q

which of the following choices would inhibit AmpC?
A. avibactam
B. clavulanic acid
C. sulbactam
D. tazobactam

A

A, this is a “newer” B-lactamase inhibitor meaning that it is actually able to inhibit AmpC

89
Q

what is the easy way to remember common bacteria producing AmpC beta-lactamases

A

HECK-YES:
Hafnia alvei
Enterobacter cloacae
Citrobacter freundii
Klebsiella aerogenes
Yersinia enterocolitica

90
Q

if something is called an “AmpC inducer”, what does this mean?

A

it means it is a bacteria that produces AmpC when exposed to certain antibiotics

91
Q

if you were to add “ma’am” to the end of HECK YES, what bacteria would you be talking about?

A

Morganella morganii
Aeromonas hydrophila

92
Q

what in the fuck is slide 42 trying to say

93
Q

is Ceftriaxone a strong or weak AmpC inducer?

94
Q

what is the significance of ceftriaxone being a weak inducer?

A

it doesnt stimulate production of ampc as much as other options, making it less likely to cause resistance

95
Q

go look at slide 44

96
Q

JH is a 65 YOM admitted with pyelonephritis (infection in the kidney) and started on IV ceftriaxone. However, he soon develops a fever and becomes hypotensive. Blood cultures are taken and result for E. cloacae.
What could explain his sudden decompensation?
A. cloacae harbors an ESBL gene and this was induced with ceftriaxone treatment
B. cloacae harbors a KPC gene and this was induced with ceftriaxone treatment
C. cloacae harbors an AmpC gene and this was induced with ceftriaxone treatment
D. cloacae harbors a NDM gene and this was induced with ceftriaxone treatment

A

C, because ceftriaxone is a weak inducer of AmpC

97
Q

do carbapenems have a high or low susceptibility to AmpC hydrolysis?

A

low, this makes them a good treatment option

98
Q

JH is a 65 YOM admitted with pyelonephritis (infection in the kidney) and started on IV ceftriaxone. However, he soon develops a fever and becomes hypotensive. Blood cultures are taken and result for E. cloacae. Ceftriaxone caused resistance through inducing ampC.

What antibiotic change do you recommend?
Switch to
A. Piperacillin/tazobactam
B. Switch to Cefepime
C. Switch to Ceftazidime
D. Switch to Aztreonam

99
Q

what is the most common method of aminoglycoside resistance?

A

enzymatic inactivation

100
Q

what are the 3 mechanisms involved in enzymatic inactivation for aminoglycosides?

A

acetylation
nucleotidylation
phosphorylation

101
Q

what is the mechanism of vancomycin resistance in enterococci species?

A

altered target sites

102
Q

vancomycin MOA

A

a glycopeptide antibiotic that inhibits bacterial cell wall synthesis by binding to D-Ala-D-Ala terminal of peptidoglycan precursors

103
Q

T or F:
Vanco spec of activity is limited to gram-negative bacteria only

A

false, GP only

104
Q

most common resistance mech for vanco

A

VanA or VanB mediated resistance by altering any formation of D-Ala whatever

105
Q

two treatment options for VRE

A

daptomycin
linezolid

106
Q

T or F:
Alterations in PBPs (penicillin binding proteins) leads to B-lactam resistance

107
Q

where do we most commonly see alterations in PBPs?

A

methicillin-resistant Staphylococcus aureus (MRSA)**

108
Q

MRSA related resistance is due to expression of what very important gene?

109
Q

so if you see mecA what two things do you think about and vice versa

A

MRSA
Staph aureus

110
Q

do porin channels help antibiotics into bacteria or pump them out?

A

helps perfuse into bacteria

111
Q

Important resistance mechanism for P. aeruginosa against carbapenems
A. efflux pumps
B. Porin channels

112
Q

Important resistance mechanism for S. pneumoniae against macrolide antiobiotics
A. efflux pumps
B. Porin channels

113
Q

Important resistance mechanism for Enterobacterales and carbapenem-resistant P. aeruginosa
A. efflux pumps
B. Porin channels

114
Q

What is the mechanism of Staphylococcus aureus resistance to beta-lactams?

A. mecA gene
B. VanA gene
C. ermB gene
D. KPC gene

A

A, always associate with mecA

115
Q

Based on ADME
A. PK
B. PD

116
Q

PK/PD terminology:
conc dependent

A

max conc at binding site

117
Q

PK/PD terminology:
time dependent

A

optimize duration of exposure at binding site

118
Q

PK/PD terminology:
Bactericidal

A

kills organism

119
Q

PK/PD terminology:
Bacteriostatic

A

inhibit bacterial replication WITHOUT killing organism

120
Q

PK/PD terminology:
AUC

A

overall drug exposure over a certain time

121
Q

T or F:
Time that free drug conc remains above MIC correlates with clinical and microbiological outcomes (fT>MIC)

A

true, basically just saying that the longer the drug is above MIC and the has a high concentration correlates with how well the drug kills bacteria

122
Q

Penicillin
A. fT>MIC 50%
B. fT>MIC 60-70%
C. fT>MIC 40%

123
Q

Cephalosporin
A. fT>MIC 50%
B. fT>MIC 60-70%
C. fT>MIC 40%

124
Q

Carbapenem
A. fT>MIC 50%
B. fT>MIC 60-70%
C. fT>MIC 40%

125
Q

4 ways to maximize fT>MIC

A
  • inc dose, same interval
  • same dose shorter interval
  • cont. infusion
  • prolonged infusions
126
Q

Goal AUC0-24/MIC for vanco

127
Q

prolonged or elevated AUC0-24/MIC for vanco has a risk for what and at what range?

A

nephrotox
600-700

128
Q

fluoroquinolones
A. time dependent
B. conc dependent

129
Q

aminoglycosides
A. time dependent
B. conc dependent

130
Q

B-lactams (penicillin, cephalosporin, carbapenem, monobactam)
A. time dependent
B. conc dependent

131
Q

Which of the following describes the PK/PD parameters of meropenem?

A. Time-dependent antibiotic; fT>MIC 40% of the dosing interval
B. Concentration dependent antibiotic; fAUC/MIC
C. Time-dependent antibiotic; fT>MIC 80% of the dosing interval
D. Concentration dependent antibiotic; Cmax/MIC

A

A (40% for carbapenems)

132
Q

vancomycin
A. time dependent
B. conc dependent

PHRM 865 (16 decks)

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