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Sepsis Flashcards

1
Q

what are the useful marker in Candedemia

A

Beta D glucan and whole blood PCR

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2
Q

How is the value of Candida score ?

A

Negative predictive value

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3
Q

Which candida species is growing resistance and Why ?

A

C glabarata and it is due to wide spread use of Fluconazole

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4
Q

what are common co morbidities with Candida?

A 
32%Ca -Solid organ>Haem>post Transplant
19%GI
13.8CVD
13.6DM
2% pancreatitis
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5
Q

What are common itrogenic RF for candedemia?

A

Abx Use 77%
Venous access 72.6%
Major Surgery 37%
TPN feedig 33%

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6
Q

what are techniquies used for detecting Candidemia

A

Germ tubes,MLDI -ToF,sequencing,Chromogenic agars

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7
Q

what does echinofungins(caspofungin) do?

A

Block cell wall synthesis by inhibiing BETA 1-3-D glucan

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8
Q

what is MOA for griseofungin?

A

Disrupt microtubule assembly

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9
Q

what does 5 fluorocytosine do?

A

Block nucleic acid synythesis

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10
Q

what Oxa boroles MOA?

A

block aminacyle transferase synthase

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11
Q

what Azoles MOA?

A

Inhibits C14 alpha demethylase-req for Ergosterol synthesis

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12
Q

what are 2 common use of Fluconazole?

A

1) In Sensitive Candida in non neutropenic pat

2) Also as prophylasix in SCT

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13
Q

Is itraconazole useful in Candida

A

no, it is broad spectrum and has low GI absorption

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14
Q

what is drug of choice in Resistant Candida ?

A

Voriconazole(Broader coverage and req theurapetic drug monitoring)

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15
Q

What is newest Drug in Azole family?

A

posaconalzole, used in highly resistant cases

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16
Q

what is polyene class?

A

Amphotericin-Bind to sterols in cell membrane to Increase Meb permeability

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17
Q

what are SE of Amphotericin B

A

Nephrotoxic

Infusion related reaction

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18
Q

what is Liposomal AmB?

A

Unilamellar liposome contain 1 molecule of AmB but 9 Mol of lipid
Liposome bind to Cell wall while AmB binds to Cell membrane

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19
Q

when does we need to adjust Caspofungin dose ?

A

in liver failure

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20
Q

what are interactions of Caspofungin?

A

CyclosporinA, Tacrolimus, Antiretroviral agent, CPR (Carbamazapine, phenytoin and rifampacin)

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21
Q

what are uses of Caspofungin

A

neutropenic and Resistant Candida pt

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22
Q

Which candida specie is not covered by Caspofungin?

A

C parapsilosis

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23
Q

which resistant Candida is emerging in hospital outbreaks?

A

.C auris
.Mortality 30-60%
.mainly Blood borne
.Contact tracing req

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24
Q

C auris is resitant to which antifungals

A

AmB and Echinocandins

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25
HOw long Candida Auris can last in enviroment ?
atleast 14 days
26
What is mechanism of MRSA ?
SCC mec carries Mec A gene which encodes aPBP2 a protein it has poor affinity to all Beta Lactam ABX including Carbepenams .
27
Can we use Vanc in MSSA
No, Vanc is poor choice in comparison to Anti staph penicillin for MSSA
28
what inclusion are seen in CMV
Owl eye inclusions
29
what is Marabvir ?
antiviral that targets UL97, compettaive kinase inhibitor.
30
when do we do Prophylactic antiviral therapy
After SOT(Solid organ transplant)
31
when do we do Premptibe antiviral therapy
After HSCT (Due to BM toxicity)
32
What is Letemovir?
suggested as Prophylaxis for CMV and act by interupting packaging of viral DNA by binding to CMV terminase Complex
33
WHATis predictor of mortalitry in Encephalitis?
Level of conciousness is best predictor of mortality and mortality is 10%
34
WHATis predictor of mortalitry in Encephalitis?
Level of conciousness is best predictor of mortality and mortality is 10% Nsurocognitive impirment 20%
35
what are most common causes of Viral encephalitis?
HSV,VZV,Enetro virus
36
what are ani Hu and Ma associated with?
Anti Hu small cell Lung Cancer | Anti Ma-testicular Ca
37
what antibodies ADEM has ?
Anti MOG
38
which Abx can not cross BBB?
1)Aminoglycosides 2)1st Gen Ceph 3) Erythromycin, $)Tetracyclines and 5)Clindamycins
39
is CT required before LP in Meningitis Pt ?
Generally not , unless clinical signs of High ICP --> NPV 97%.
40
What are normal values for CSF
Opening pressure >20 CSF/bld Glucose Ratio<0.5% Protein >1 gm/l GM stain and culture -->Positive 60% only
41
What are WCCC for Bacterial Meningitis?
>1000 But 10% Strep <100 Listeria can be lymphocytic Viral Meningitis can have neutrophilia in first 48 hrs
42
Is S penumonae antigen better than Gm stain for meningitis?
yes >95 sensivity >85 % specifity
43
what are advantage of dexa in penumococcal meningitis?
.Reduced mortality .Reduced hearing loss and neurological sequlea .Redued inflammation
44
what is the rationale of addition of Vancomycin to Ceftriaxone for Penumococcal cover?
IT is done if MIC of ceftriaxone is more than 4 MIC to | cover resistance penumococcal strains?
45
what is appropriate treatment of N meningitidis and Pneumococcus in Australia
Ceftriaxone at minimum
46
what is PEP FOR house hold and HCW who has exposure to N mningitis Pt
Avoid resp droplet untill after 24 hr abx Rifampacin 600 mg BD 4 days Cipro 500 mg once Ceftriaxone 250 mg IM once
47
what are Common OPSI infections?
S. penumonia H influenze N meningitidis Serious infection Capnocytopahga Canmorsus (From Dog) Shigella id Sickle_Hyposplenia Gm -ve Ecoli and P aurignosa
48
who is at risk of OPSI?
Kid s<4 and> 50 Spleen removed for hematologcal reason than Trauma Life long risk but more n first 3 years post splenentomy
49
what are advantages of having conjugated vaccines?
More immunogenic More T cell mediated,Mucosal and herd mmunity Long lasting
50
what vacination should Asplenia pt get?
``` 1 PCV before PPV X3 PPV ateast 5 yesars apart 4MenCVX 2doses than 5 yearly HIB once n life time Yearly Influenza vaccne PCV now protein subunit or conjugate (Capsular Polysaccride obsolete) ```
51
what are important point regarding fever history taking?
``` Travel Co morbidities Immunocompromised state 24 % will have fever 4% had critical illness an d 97 % had fever ```
52
what is Choce of Abx against ESBL producng bacteria?
Carbepenams esp Mero and Imipenam | * Ertapenam can be used OP setting if non resistant bacteria and NON SEVERE sepsis
53
Can Fosfamycin and Nitrofurantoin can be used against ESBL
YES, if Carbapenam cant be used then we can used Fosfamycin and Nitrifur
54
what are the Rx option for Enetrobacteracae sepsis?
If nil MDR organism FIRTSLINE:Ceftriaxone /or Cefotaxime Ecoli and KPneumonia resistant to cephalosporin but suseptibe to tazo : Use MEROPENAM instead of Taz as high mortality with Taz
55
what are MDR enterobacteracae?
Has 1. Amp C beta lactemase 2. ESBL 3. Carbapenamases
56
what are Rx option for MDR eneterobacteracae?
1. Amp C beta lactemase: treated with Cefpime 2. ESBL: treated with meropen 3. Carbapenamases :difficult to treat
57
What is the difference between activity of Meropenam and Imipenam?
Imipenam has acivity against E faecalis that meropenam lacks. ALTERNATIVELY MEROPENAM has good CNS penetration and lower incidence of seizures.
58
How Ertapenam Coverage is inferior to other members of its class ?
It does not cover P aurignosa, E faecalis and Acinobacters
59
Which organisms are not covered by Carbepenam ?
5 organisms 1. MRSA 2. VRE 3. E Faecum 4. Stenotropomonas Maltophilia 5. Atypical Mycoplasma and Clamydia
60
what organisms are covered by Linazolid?
``` VRE MRSA MR coaglase -ve staph Mycoplasma and Chlamydia Penicillin resistant strains of Strep pneumonia ```
61
what is the name of Oraganism that Vanc could cover bUT carbepenam can not ?
E Faecum
62
what is the Super drug for P aurgnosa ?
Colistin can cover non only MDR Paurignosa but many Gram -ve Including Acinobacter Baumannii
63
what is the spectrum of Tigacycline?
``` MRSA VRE Aerobic Gm-ve but no Paurignosa Anaerobic Rapidly growing Mycobacteriam ```

infecteous disease (8 decks)

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