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PHRM 865: Theraputics V > Lecture 30: Bacteremia > Flashcards

Lecture 30: Bacteremia Flashcards

1
Q

What is Staphylococcus Aureus Bacteremia [SAB]?

Treatment Failure?

A
  • Leading cause of bactermia
  • High mortality Rates [20-40%]
  • Treatment Failure is common [by death in 30ds, bacteremia > 10d, comes back in 60d]
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2
Q

What is the clinical approach for SAB?

What about Metastatic?

A
  • History and Phyiscal Exam [SOURCE? = any skin breaks or caths]
  • Metastatic Infections [bone ~ osteo; murmur/HF ~ endo; LUQ ~ splenic infarction…]
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3
Q

What are some of the Peripheral Manifestations for endocarditis?

A
  • 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
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4
Q

How often should you repeat blood cultures relateding to SAB or other blood infections?

A
  • Repeat blood cultures q48-72 hours [maybe 24 hours] to document clearence
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5
Q

What is the Diagnostic Evaluation in SAB?

A
  • Blood Cultures [ALWAYS TREAT; dont matter if 1/4 or 4/4]
  • Echocardiography [for ALL SABs]: TTE or TEE
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6
Q

What are some of the risk factors for Endocaditis and the need for TEE in SAB?

A
  • Persitant SAB
  • Unknown Duration
  • Cardiac Prosthetic
  • Valve Abnormality
  • Hemodialysis
  • IV drug use
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7
Q

What was it that the PREDICT study showed use about getting an ECHO or NOT?

A
  • Gave us scores to show when we should do ECHOs
  • > 3 strongly encourages ECHO
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8
Q

What is important to know about Imaging in SAB?

MRIs? CT?

A
  • Back pain = MRI
  • Ab pain = CT of Abdomen
  • Headache or Confusion = MRI
  • SOB = CT of Chest
  • Joint Pain = X-ray, CT, or MRI
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9
Q

What is the Urine Cultures are postitive for S. Aureus?

A
  • NOT common within UTIs
  • Can get into the bloodstream this way?
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10
Q

For a patient that has SAB, what are some of the things to note about Catheters and Prosthetic Device Management?

A
  • 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
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11
Q

What is teh Empiric Treatment for SAB?

Covering MSSA or MRSA?

A
  • Vancomycin or Daptomycin
  • Maybe Cafazolin or Nafcilin + Vancomycin [unsure if MSSA or MRSA]
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12
Q

What is the treatment of MSSA Bacteremia?

What to not do?

A
  • Cefazolin 2g IV q8h
  • Nefcilin 2g IV q4h [CSF activity]
  • Oxacillin 2g IV q4h

NO Vancomycin or anything with Rifampin

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13
Q

What is the Treatmetnt of MRSA Bacteremia?

A
  • Vancomycin
  • Daptomycin [more so in septic pulmoary emboli]
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14
Q

What is the Duration of treatment for SAB?

Uncompliated? Complicated? Complicated with Metastatic Infection?

A
  • Uncomplicated: 14d from first (-) blood culture
  • Complicated: 4w from first (-) blood culture
  • Complicated with Metastatic: 6-8w from first (-) blood culture
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15
Q

For uncomplicated SAB what are some of the things that need to be met?

A
  • Needs Endocarditis
  • NO Devices
  • Follow up cultures are negative
  • NO metastatic Infection
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16
Q

What is Bacteremia due to Streptococci?

A
  • 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
17
Q

What is the treatment for Streptococci Bactermia?

-

A
  • Pyogenes, Agalactiae = Penicillin IV to High dose Amox PO
  • Pneumoniae = Caftriazone or Penicillin
  • Durations 14d
18
Q

What is Bactermia due to Enterococci?

A
  • 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
19
Q

What is the Treatment for Enterococci Bactermia?

Faecalis? Faecium?

A
  • Faecalis: Ampicillin [or Daptomycin of allergic]
  • Faecuim: vanA or vanB (-) = Vancomyin & vanA or vanB (+) = Daptomycin or Linezolid
20
Q

What is the Treatment for Uncomplicated Gram-Nagative Bacteremia?

Durration? IV–>PO? Organism based?

A
  • 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

PHRM 865: Theraputics V (42 decks)

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