Lecture 30: Bacteremia Flashcards
What is Staphylococcus Aureus Bacteremia [SAB]?
Treatment Failure?
- Leading cause of bactermia
- High mortality Rates [20-40%]
- Treatment Failure is common [by death in 30ds, bacteremia > 10d, comes back in 60d]
What is the clinical approach for SAB?
What about Metastatic?
- History and Phyiscal Exam [SOURCE? = any skin breaks or caths]
- Metastatic Infections [bone ~ osteo; murmur/HF ~ endo; LUQ ~ splenic infarction…]
What are some of the Peripheral Manifestations for endocarditis?
- Osler Nodes: pads of fingers and toes
- Janways Lesions: palms/soles of hands/fett
- Spliter Hemorrhage: under nail beds
- Petechiae:
- Roth Stops: lesions in eye
How often should you repeat blood cultures relateding to SAB or other blood infections?
- Repeat blood cultures q48-72 hours [maybe 24 hours] to document clearence
What is the Diagnostic Evaluation in SAB?
- Blood Cultures [ALWAYS TREAT; dont matter if 1/4 or 4/4]
- Echocardiography [for ALL SABs]: TTE or TEE
What are some of the risk factors for Endocaditis and the need for TEE in SAB?
- Persitant SAB
- Unknown Duration
- Cardiac Prosthetic
- Valve Abnormality
- Hemodialysis
- IV drug use
What was it that the PREDICT study showed use about getting an ECHO or NOT?
- Gave us scores to show when we should do ECHOs
- > 3 strongly encourages ECHO
What is important to know about Imaging in SAB?
MRIs? CT?
- Back pain = MRI
- Ab pain = CT of Abdomen
- Headache or Confusion = MRI
- SOB = CT of Chest
- Joint Pain = X-ray, CT, or MRI
What is the Urine Cultures are postitive for S. Aureus?
- NOT common within UTIs
- Can get into the bloodstream this way?
For a patient that has SAB, what are some of the things to note about Catheters and Prosthetic Device Management?
- S. Aureus colonizes to them easily
- ALL IV caths and prothetics are considered in SAB [Remove or Add Rifampin]
- Caths: Short Term = REMOVE; Long Term = REMOVE unless contraindications
What is teh Empiric Treatment for SAB?
Covering MSSA or MRSA?
- Vancomycin or Daptomycin
- Maybe Cafazolin or Nafcilin + Vancomycin [unsure if MSSA or MRSA]
What is the treatment of MSSA Bacteremia?
What to not do?
- Cefazolin 2g IV q8h
- Nefcilin 2g IV q4h [CSF activity]
- Oxacillin 2g IV q4h
NO Vancomycin or anything with Rifampin
What is the Treatmetnt of MRSA Bacteremia?
- Vancomycin
- Daptomycin [more so in septic pulmoary emboli]
What is the Duration of treatment for SAB?
Uncompliated? Complicated? Complicated with Metastatic Infection?
- Uncomplicated: 14d from first (-) blood culture
- Complicated: 4w from first (-) blood culture
- Complicated with Metastatic: 6-8w from first (-) blood culture
For uncomplicated SAB what are some of the things that need to be met?
- Needs Endocarditis
- NO Devices
- Follow up cultures are negative
- NO metastatic Infection
What is Bacteremia due to Streptococci?
- Highest Risk with Viridans, Strep Gallolytiucs
- HANDOC: Heart Murmur, Aetiology, Number of (+) Blood Culture >2, Duration fo Symptoms > 7d, Only 1 speices in Blood Cultures, Community acquired
What is the treatment for Streptococci Bactermia?
-
- Pyogenes, Agalactiae = Penicillin IV to High dose Amox PO
- Pneumoniae = Caftriazone or Penicillin
- Durations 14d
What is Bactermia due to Enterococci?
- Faecalis [increased Ampicillin sus] & Faecium [Vancomycin resistance]
- DENOVA for endocarditis risk: Duration >7d, Embolization, Number of positive cultures, Origin of Infection unknown, Valve disease, Auscultation of murmur
What is the Treatment for Enterococci Bactermia?
Faecalis? Faecium?
- Faecalis: Ampicillin [or Daptomycin of allergic]
- Faecuim: vanA or vanB (-) = Vancomyin & vanA or vanB (+) = Daptomycin or Linezolid
What is the Treatment for Uncomplicated Gram-Nagative Bacteremia?
Durration? IV–>PO? Organism based?
- Duration: 7 days [Total days; NOT the first day of negative blood]
- IV to PO when clinically improved [PO: Bactrim, FQ, or B-lactam]
- CTX-M: Mero; KPC: Avibactam/Caftazidime, Vaborbactam/Meropenem, Imipenem/cilstatin/Relebactam; Metallos: Atreonam + Caftazidime/Avibactam
