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CDM 3 Exam 2 > Lecture 1 - Bloodstream Infections & Infective Endocarditis > Flashcards

Lecture 1 - Bloodstream Infections & Infective Endocarditis Flashcards

1
Q

Most common Community Acquired Pathogen for infection

A

E.coli
S.aureus
Streptococcus

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2
Q

Most common Healthcare associated Pathogen for infection

A

Staphylococcus
Other gram neg

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3
Q

How to diagnose Blood stream infection

A

Blood cultures

Draw 2 sets of cultures -> 12hrs/5 days it turns positive -> after positive do stain/subculture & rapid diagnostics -> 18-24hr after subculture ID organism and start susceptibility test 0> 6-24hrs ID organism and susceptibility results

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4
Q

Gram + cocci clusters vs pairs/chains

A

Clusters = staph
Chain/pairs = strep/Enterococci

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5
Q

Primary infection

A

Direct introduction into bloodstream
Idiopathic, source unclear

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6
Q

Secondary infection

A

Translocation form other source of infection
Continual seeding from non-infected area

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7
Q

Empirc management of suspected sepsis

A

obtain >2 blood cultures
initial brand antimicrobial therapy, guided by suspected source

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8
Q

If no clear source of infection, empiric therapy is..

A

Broad gram + (MRSA) & Borad GNR & Anaerobes/Atypiclals/ Candida/Toxins maybe

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9
Q

Med specific monitoring Vanco

A

renal toxicity

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10
Q

Med specific monitoring Dapto

A

creatinine kinase

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11
Q

Med specific monitoring Linezolid

A

thrombocytopenia

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12
Q

2 reasons for treatment failure

A

inadequate coverage or source control

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13
Q

2 Gram + cocci in clusters

A

Staph aureus
Coagulase negative staph

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14
Q

Risk factors for S.aureus bacteremia

A

> 70yrs old
HD requirements, PICC lines, Urinary catheter
Foreign material
Immunosuppression

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15
Q

MRSA specific risk factors

A

Hospital / HC exposure
Recent IV ABX exposure
Injectable drug use

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16
Q

3 main agents for MRSA bacteria

A

Vanco = AUC/MIC 400-600
Dapto = 8mg/kg ABW
Linezolid = 600mg Q12h

Vancomycin tends to be used first, but none is better

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17
Q

MSSA Bacteria treatment

A

cefazolin 2g Q8H or oxacillin/nafcillin 2g Q4h

both better than vanco

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18
Q

Gram positive cocci in cluster, MRSA Txm =

A

Vanco
Dapto
Linezolid

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19
Q

Gram positive cocci in clusters, MSSA Txm =

A

Cefazolin
Nafcillin
Oxacillin

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20
Q

Gram positive cocci in pair/chain, Streptococci

A

PCN-S = penicillin G IV
PCN-R = ceftriaxone

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21
Q

Gram positive cocci in pair/chain, Enterococci

A

E.faecalis = ampicilin
E.faecium = variable

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22
Q

S. aureus txm duration

A

uncomplicated = 14 +/- 2 days
complicated 24-42 +/- 2 days, > 4wk most pts

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23
Q

Basic different between complicated and uncomplicated

A

pts who respond to therapy quickly and don’t have any other concerning site for infection = uncomplicated

other = complicated

most S.aureus is complicated

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24
Q

Coag Neg Staph txm Duration

A

Simple = 0-3 +/- 1 day
uncomplicated = 5 +/- 1 day
Complicated = 7-28 +/- 2 day

25
Q

Pseudomonas Aeruginoas Risk Factors

A

Modifiable: immunosuppression, housing insecurity, IDU
non-modifiable: hospitalization, recent IV ABX use < 90 days, history of PsA

26
Q

Empiric GNR Bacteremia Txm w/o ESBL history

A

Cefepime 2g Q8H
Ceftazidime 2g Q8H
Pip/Tazo 4.5g IV Q6h

27
Q

Empiric GNR Bacteremia Txm w/ ESBL history

A

Meropenem 1g Q8H

28
Q

Pts eligible for Oral Therapy ABX Gram -

A

Enterobacterales BSI
Afebrile & Hemodynamically stable for > 48hrs
Isolate susceptible to agents with reliable serum conc
Able to take oral meds

29
Q

Pts eligible for 7 day treatment Gram -

A

enterobacterales BSI
Afebrile & Hemodynamically stable for >48hrs
Adequate source control

30
Q

Unclear eligibility for 7 day therapy Gram -

A

PsA BSI
pts with immunocompromising condition/meds
Men with UTI

31
Q

Short term catheter, uncomplicated CoNs

A

remove line and treat with systemic agents for 5-7 days
or
retain line and treat w/ lock therapy and systemic agents for 10-14 days

32
Q

Short term catheter, complicated or any other organism

A

remove line and treat w/ systemic agents for > 7 days

33
Q

Long term catheter, complicated, S.aureus, or Candida spp.

A

remove line and treat w/ systemic agents for > 7 days

34
Q

Long term catheter, uncomplicated w/ other organism

A

remove line and treat w/ systemic agents for > 7 days
or
line salvage w/ lock therapy and systemic agent for > 7 days

35
Q

Lock therapy

A

uses high conc but low volume of antimicrobial in line itself
sits in line for 24-48hrs
needs to be given W/ systemic therapy for treatment

36
Q

Candidemia initial therapy

A

Echinocandin = Caspofungin or micofungin

alternative if not critically ill or low risk of resistance = fluconazole

37
Q

Candidemia Definitive therapy

A

based on susceptibilities

different species have different breakpoints

38
Q

Candidemia Txm duration

A

uncomplicated = 2 weeks
complicated = based on site of infection

39
Q

Right side IE more common in…

A

IDU due to impure ingredient that damage right side of heart

40
Q

Left side IE more common in…

A

non-IDU due to turbulent flow the damage left side of heart

41
Q

General risk factors for Endocarditis

A

Hear structure abnormalities
Comorbidities - CKD, DM, HD
Prior infection - prior endocarditis, skin-soft tissue infection w/ DM
Patient factors - IDU, indwelling catheter, HD, devices, poor oral hygiene

42
Q

Endocarditis immunologic reactions

A

Osler nodes = painful papules pads of toes/fingers
Roth spot = retinal infarct w/ surrounding hemorrhage

43
Q

Endocarditis Thromboembolic complication

A

Janeway lesions = painless lesion on palms
Finger clubbing = long standing disease
Splinter hemorrhage = occurs in nail bed
Petechiae = painless lesions typically on trunk
Septic emboli = stroke or PE

44
Q

Most common way to ID endocarditis

A

Blood cultures + Imaging
> 3 blood cultures

TTE (more specificity) 1st and then can do TEE (higher sensitivity)

45
Q

Definitie Endocarditis using modified Duke Criteria

A

2 major, 1 major + > 3 minor and/or 5 minor criteria

46
Q

Possible Endocarditis using modified Duke Criteria

A

1 major + 1 minor or 3 minor

47
Q

Empiric therapy, Native valve Txm

A

Vanco + ceftriaxone

48
Q

Empiric therapy, Prosthetic valve w/ <1 year of placement txm

A

Vanco + cefepime + rifampin + gentamicin

49
Q

Empiric therapy, Prsthetic valve > 1 year of placement txm

A

Vanco + ceftriaxone

50
Q

what group is S.bovis?

A

Viridians group strep

51
Q

Pts ineligible for short 2 week treatment for VGS in Native valve PCN-S

A

known cardiac or extra-cardiac abscess
History of renal dysfunction/AKI, CrCl < 20
Impaired eight cranial nerve
Non-traditional sp (ie Gemella)

52
Q

Gentamicin duration in therapy for VGS in Native value PCN-R?

A

add on only for 2 weeks, but course is for 4weeks

53
Q

Typical Txm duration for native vs Prosthetic valve

A

4 weeks vs 6 weeks

54
Q

Most common causes of IE

A

S.auerus and Coagulase Negative Staph

55
Q

Why are rifampin and Gentamicin add ons for prosthetic valve?

A

to help penetrate biofilms potentially

56
Q

Prophylaxis indications Endocarditis

A

dental procedures w/ perforation of oral mucosa or manipulation of gingival tissue

incision or biopsy of mucosa

57
Q

Pts who are at high risk of adverse endocarditis outcomes

A

Prosthetic valve or prostheses from valve repair
history of infective endocarditis
Cardiac tranplan w/ valvulopathy
congenital HD, unreparired or repaired with retained foreign material

58
Q

Common prophylaxis txm endocarditis

A

Amoxicillin PO
Cefazolin IV
Clindamycin if B-lactam allergy

CDM 3 Exam 2 (11 decks)

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