Topic 19 Antimicrobials Flashcards
Deep sternal wound infections:
~Significantly worse long-term survival what is the cost to treat???
*Costs between $200 and $250k to treat
Major causes of device “failure” (like with VADS)
Infection/sepsis
along with thrombosis/hemorrhage
Biggest source of infection from the patient is the what?
patient’s skin
What is capitated payment ?
medicare only pays a certain amount for each type of procedure and if it goes over that it the hospital has to absorb it
Failure with assist devices means that what happens to the patient?
death
No amount of antibiotics can overcome the effects of what?
sterile technique
*MIC=stands for what?
“Minimum INHIBITORY Concentration”
the lowest concentration of antibiotic that inhibits bacterial growth
MBC= stands for what?
“Minimum BACTERIOCIDAL Concentration”
the lowest concentration of antibiotic that kills 99.9% of bacteria
They will use MIC and MBC on VAD patients with what?
infections
BacteriCidal antibiotic agent does what?
designed to kill bacteria
ex: penicillin
BacterioStatic antibiotic agent does what?
Stops the bacterias growth
If you mix a BacteriCidal and BacterioStatic Antibiotic what happens?
the static antibiotic prevents the bacteria from growing so it kinda works against the cidal. The combination is actually less effective
Major Pathogen Category: Gram Positive Bacteria
the bacteria takes up the blue dye for a positive result in the Gram stain test.
which type of bacteria has a thick Peptidoglycan layer? making it harder to be attacked
Gram Positive Bacteria
β-Lactam antibiotics - what type of antibiotics
are cidal antibiotics
β-Lactam antibiotics prevent the bacterial cell wall from doing what?
Prevent bacterial cell wall peptidoglycan cross-linking so newly produced bacterial cell walls are “weak” and the bacteria “fall apart” (think bacterial Marfan’s Disease)
“First Generation” Penicillins
are effective against what type of organisms?
gram-positive organisms (particularly Strep), gram negative cocci (what’s that?) and a few others, but resistance levels are high and growing
Penicillin-G
benzylpenicillin
“First Generation” Penicillins
benzylpenicillin
Penicillin-G
“First Generation” Penicillins
Staph grows in what shapes?
big colonies
strep grows in what shape?
long strips
Anti-staphylococcal Penicillins - 3 drugs
- Dicloxacillin (Dynapen)
- Nafcillin (Nallpe)
- Oxacillin
These antibiotics have a much narrower “spectrum” and are used specifically for Methicillin resistant Staphylococcus aureus
…AND SHOULD BE USED SPARINGLY
-Dicloxacillin
Dynapen
Anti-staphylococcal Penicillins
-Nafcillin
Nallpe
Anti-staphylococcal Penicillins
Dynapen
-Dicloxacillin
Anti-staphylococcal Penicillins
Nallpe
-Nafcillin
Anti-staphylococcal Penicillins
When is methicillin used clinically?
METHICILLIN IS NO LONGER USED CLINICALLY.
Amoxicillin: DRUG OF CHOICE for what?
for pre-cardiac surgery dental prophyllaxis !
Broad Spectrum Penicillin resistance
Resistance to broad -spectrum pens has increased dramatically (especially MRSA)
Broad Spectrum Penicillin Drugs (2)?
Ampicillin
Amoxicillin
Pseudomonas aeruginosa is notorious for causing what ?/
blue/green pus
Pseudomonas aeruginosa is what?
very pathogenic gram negative that readily develops resistance to antibiotics.
USE Antipseudomonal Penicillins
Antipseudomonal Penicillins Drugs (3)
Carbenicillin (Geocillin)
Piperacillin (Piperacil)
Ticarcillin (Ticar)
Carbenicillin
Geocillin
Antipseudomonal Penicillins
Piperacillin
Piperacil
Antipseudomonal Penicillins
Ticarcillin
Ticar
Antipseudomonal Penicillins
Geocillin
Carbenicillin
Antipseudomonal Penicillins
Piperacil
Piperacillin
Antipseudomonal Penicillins
Ticar
Ticarcillin
Antipseudomonal Penicillins
Clavulanic Acid does what
It is a suicide inhibitor of - bacterial β-lactamase - it attaches to and permanently deactivates the bacterial β-lactamase enzyme
Combine Clavulanic Acid with amoxicillin makes what ?
Augmentin
Combine Clavulanic Acid with ticarcillin makes what ?
Timentin
Inflamed meninges are more permeable to what
penicillin
permitting rapid penetration of the drug into the CSF
Cephalosporins very commonly used in what part of open heart surgery ??
Very commonly used in open heart surgery and as part of the “prime”
Cephalosporins are what? and how are they classified?
β-lactams essentially just like penicillins
*Classified as 1st, 2nd, 3rd, & 4th generation based on their resistance to β-lactamases and their antimicrobial spectrums
Cefazolin
Kefzol
1st generation Cephalosporins
Kefzol
Cefazolin
1st generation Cephalosporins
1st generation Cephalosporins: main open-heart infection culprits are Staph. (mostly) and Strep. sp SOOO WHAT DOES THIS MEAN FOR US AND ITS USAGE
no advantage found using more expensive later-generation cephalosporins for ECC prophyllaxis!
Cefazolin (Kefzol) has a cross sensitivity with what?
1st generation Cephalosporin
Cross sensitivity with penicillins is high
2nd generation Cephalosporin advantages on pump?
Again, no proven advantage over 1st gens when used in the pump prime!
2nd generation Cephalosporin drugs (3)
Cefoxitin (Mefoxin)
Cefotetan (Cefotan)
Cefuroxime (Ceftin)
Cefoxitin
Mefoxin
2nd generation Cephalosporin
Cefotetan
Cefotan
2nd generation Cephalosporin
Cefuroxime
Ceftin
2nd generation Cephalosporin
Mefoxin
Cefoxitin
2nd generation Cephalosporin
Cefotan
Cefotetan
2nd generation Cephalosporin
Ceftin
Cefuroxime
2nd generation Cephalosporin
MRSE stands for ?
Methicillin Resistant Staph epidermidis
Use what antibiotic for Methicillin Resistant Staph epidermidis (MRSE) and enterococcal infections
Vancomycin
Vancomycin side affects
fever, chills, flushing and phlebitis
Aminoglycosides interfere with what synthesis of ribosomal subunits?
Interfere with bacterial protein synthesis by
binding to bacterial ribosomal 30S subunit
This action is CIDAL
order of resistance of Aminoglycosides Drugs (4)
Streptomycin (little used, lots of resistance)
Tobramycin (Nebcin)
Gentamicin
Amikacin (Amikin)= LEAST bacterial resistance
Tobramycin
Nebcin
Aminoglycosides
Amikacin
Amikin
Aminoglycosides
Aminoglycosides side affects “classic triad”
- Ototoxicity: Vestibular and or cochlear
(bc they are toxic to middle ear) - Neuromuscular paralysis: PARTICULARLY with myasthenia gravis patients.
- Nephrotoxocity ranging from mild to total renal failure
Amikin
Amikacin
Aminoglycosides
Nebcin
Tobramycin
Aminoglycosides
Aminoglycosides do what when used with pens, cephs and vancomycin for resistant bacteria?
Exhibit a synergistic effect when used with pens, cephs, and vancomycin (why?) for resistant bacteria.
Aminoglycosides are used with what for resistant bacteria?
Exhibit a synergistic effect when used with pens, cephs, and vancomycin
Aminoglycosides are given how?
parenterally or used topically
Aminoglycosides Exhibit concentration-dependent killing: - what is this?
Exhibit concentration-dependent killing:
-Increasing concentrations of aminoglycosides kill increasing proportions of bacteria at increasing rates
Aminoglycosides cross what??
All aminoglycosides cross the blood/placenta barrier and concentrate in fetal tissue!
Neomycin: used how?
used only topically (too nephrotoxic)
Streptomycin: produced? resistance?
first produced. LOTS of microbial resistance has developed
Gentamicin and Tobramycin: resistance?
mid-level microbial resistance
Amikacin: resistance ?
least microbial resistance (also most expensive!)
