L38

Question 1

Which strep is A hemolytic, optochin sensitive?

Answer 1

S.pneumoniae

Question 2

What are strep pneumo’s virulence factors?

Answer 2

Capsule
Adhesion molecules - esp mouth
Few toxins

Question 3

What resistance might you see with strep pneumo?

Answer 3

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)

Question 4

MOPS for strep pneumo diseases

Answer 4

M = meningitis
O = otitis media 
P = lower airway pneumonia/bronchitis
S = sinusitis 

M & P may progress to bacteremia

Question 5

Where is strep pneumo colonized?

Answer 5

Nose

Question 6

If you end up prescribing antibiotics, what do you give for otitis media?

Answer 6

Amoxicillin

Question 7

If you end up prescribing antibiotics, what do you give for sinusitis?

Answer 7

Amoxicillin/clavulanate
Fluoroquinolones
Macrolides (increasing s.pneumo resistance)

Question 8

What are your antibiotics of choice meningitis?

Answer 8

Ceftriaxone + vanco

Question 9

What types of pathogens cause dense, multi-lobar pneumonia?

Answer 9

(Typical pathogens)
S.pneumo
S.aureus
H.influ
M.cattarhalis

Question 10

What types of pathogens cause patchy, bilateral pneumonia?

Answer 10

Viruses
Mycoplasma
Chlamydia 
Legionella
Fungi

Question 11

How do you treat pneumonia outpatient?

Answer 11

BROAD b/c not sure if its typical/atypical
Young:
- Macrolide
- Doxy
Comorbities, predicted resistance to above:
- Fluroquinolone

Question 12

Which fluroquinolone has bad activity against pneumonia?

Answer 12

Ciprofloxacin

Question 13

How do you treat pneumonia inpatient?

Answer 13

1. Cetriaxone (other beta lactam) + macroline (atypical coverage)
2. Fluroquinolone

Question 14

What are the 2 strep pneumo vaccines?

Answer 14

PCV 13 - kids & over 65

PPSV 23 - 65+

Question 15

Which bacteria is G hemolytic, PYR positive?

Answer 15

Enterococcus

Question 16

What are the 2 types of enterococcus you should know?

Answer 16

E. faecium

E. faecalis

Question 17

Where do enterococci colonize?

Answer 17

GI

Skin/ST

Question 18

What is the virulence factor you need to know for enterococcus?

Answer 18

AB RESISTANCE = VRE

Otherwise, a pretty weak bug!

Question 19

What are the 2 leading causes of nosocomial infections?

Answer 19

1. MRSA

2. VRE

Question 20

How might VRE/enterococci infection present clinically?

Answer 20

Bacteremia
Endocarditis
UTI
Intra-ab/pelvic infection

Question 21

Describe bacteremia due to enterococci.

Answer 21

Likely secondary to enterococci infection elsewhere (catheter)
Figure out if is the result of or cause of endocarditis (tells you origin)

Question 22

Which patient population is susceptible to enterococci UTIs?

Answer 22

Hospital patients! Duh

Question 23

When will you treat enterococci from a skin/ST culture?

Answer 23

Only if deep/sterile culture

Otherwise no b/c likely a contaminant from normal skin/ST colonization

Question 24

Which drug do you use to treat E.faecalis? If causing endocarditis?

Answer 24

Ampicillin > vanco
Endocarditis:
- Ampicillin + gentamycin

Question 25

Which drug do you use to E.faecium? If causing endocarditis?

Answer 25

VANCO
**Resistant to ampicillin!!!**
Endocarditis:
- Vanco + gentamycin 
WATCH OUT FOR RENAL FAILURE

Question 26

Drugs for VRE

Answer 26

Linezolid (static, PO/IV)
Dapto (cidal)
Tigecycline (bad serum [ ])