L38 Flashcards
Which strep is A hemolytic, optochin sensitive?
S.pneumoniae
What are strep pneumo’s virulence factors?
Capsule
Adhesion molecules - esp mouth
Few toxins
What resistance might you see with strep pneumo?
Some resistance to
- Penicillin (PBP2)
- Macrolides (ermB or mefA)
- TMP-SMX (in general, this wasn’t probably going to be your first choice for strep but you likely chose it for broad staph/strep/MRSA coverage)
MOPS for strep pneumo diseases
M = meningitis O = otitis media P = lower airway pneumonia/bronchitis S = sinusitis
M & P may progress to bacteremia
Where is strep pneumo colonized?
Nose
If you end up prescribing antibiotics, what do you give for otitis media?
Amoxicillin
If you end up prescribing antibiotics, what do you give for sinusitis?
Amoxicillin/clavulanate
Fluoroquinolones
Macrolides (increasing s.pneumo resistance)
What are your antibiotics of choice meningitis?
Ceftriaxone + vanco
What types of pathogens cause dense, multi-lobar pneumonia?
(Typical pathogens) S.pneumo S.aureus H.influ M.cattarhalis
What types of pathogens cause patchy, bilateral pneumonia?
Viruses Mycoplasma Chlamydia Legionella Fungi
How do you treat pneumonia outpatient?
BROAD b/c not sure if its typical/atypical
Young:
- Macrolide
- Doxy
Comorbities, predicted resistance to above:
- Fluroquinolone
Which fluroquinolone has bad activity against pneumonia?
Ciprofloxacin
How do you treat pneumonia inpatient?
- Cetriaxone (other beta lactam) + macroline (atypical coverage)
- Fluroquinolone
What are the 2 strep pneumo vaccines?
PCV 13 - kids & over 65
PPSV 23 - 65+
Which bacteria is G hemolytic, PYR positive?
Enterococcus
What are the 2 types of enterococcus you should know?
E. faecium
E. faecalis
Where do enterococci colonize?
GI
Skin/ST
What is the virulence factor you need to know for enterococcus?
AB RESISTANCE = VRE
Otherwise, a pretty weak bug!
What are the 2 leading causes of nosocomial infections?
- MRSA
2. VRE
How might VRE/enterococci infection present clinically?
Bacteremia
Endocarditis
UTI
Intra-ab/pelvic infection
Describe bacteremia due to enterococci.
Likely secondary to enterococci infection elsewhere (catheter)
Figure out if is the result of or cause of endocarditis (tells you origin)
Which patient population is susceptible to enterococci UTIs?
Hospital patients! Duh
When will you treat enterococci from a skin/ST culture?
Only if deep/sterile culture
Otherwise no b/c likely a contaminant from normal skin/ST colonization
Which drug do you use to treat E.faecalis? If causing endocarditis?
Ampicillin > vanco
Endocarditis:
- Ampicillin + gentamycin
Which drug do you use to E.faecium? If causing endocarditis?
VANCO **Resistant to ampicillin!!!** Endocarditis: - Vanco + gentamycin WATCH OUT FOR RENAL FAILURE
Drugs for VRE
Linezolid (static, PO/IV)
Dapto (cidal)
Tigecycline (bad serum [ ])
