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ID > Test 3 > Flashcards

Test 3 Flashcards

1
Q

IE:Highly susceptible strep (MIC<0.12) Native valve treatment

A 
PCN G (12-18 M units/24 hr) OR ceftriaxone 2g/24 hr for 2-4 weeks
 \+/- 2 week course gentamicin
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2
Q

IE:Highly susceptible strep (MIC<0.12) prosthetic valve treatment

A

same as native valve except PCN G dose= 24 M units for 6 wks & mandatory 2 wk gentamicin

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3
Q

IE: Relatively resistant Strep (MIC 0.12-0.5) Native Valve

A

Same as highly susceptible native valve except PCN G dose= 24 M units/24 hr for 4 wks & mandatory 2 wk gentamicin

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4
Q

IE: Relatively resistant Strep (MIC 0.12-0.5) prosthetic valve

A

same as native valve except madatory 6-wk gentamicin

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5
Q

IE: Highly resistant strep (MIC>0.5)

A

Native valve: Ampicillin (12g/24hr) OR PCN (18-30 M units/24hr) + 4-6 wk course gent OR ceftriaxone
prosthetic valve: same but ≥6 wk course

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6
Q

IE: Enterococci (susceptible isolates)

A

Native valve: Ampicillin (12g/24hr) OR PCN (18-30 M units/24hr) + 4-6 wk course gent OR ceftriaxone
Prosthetic valve: same but ≥ 6wks

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7
Q

Enterococci (Beta-lactam resistant) Native & Prosthetic valve

A

Linezolid, quinupristin/dalfopristin, daptomycin (No PCN) ≥8 wk

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8
Q

MSSA Native Valve

A

Nafcillin (12g/24hr)
Alternate: cefazolin (C1)
6wks

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9
Q

MSSA Prosthetic valve

A

Nafcillin+ rifampin (900mg/24hr) + 2 wk gentamicin

≥6 wks

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10
Q

MRSA Native valve

A

Vancomycin
Alternate: daptomycin
6 wks

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11
Q

MRSA Prosthetic valve

A

Vancomycin + rifampin (900mg/24hr) + 2 wk gentamicin

≥6 wks

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12
Q

HACEK native & prosthetic

A

Ceftriaxone 2g/24hr or ampicillin/sulbactam 12g/day

alternate: ciprofloxacin

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13
Q

Culture negative native& prosthetic

A

dependent on risk factors

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14
Q

Always use what weigh for determining Vancomycin dosing?

A

Actual Body Weight

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15
Q

What determines frequency in vanc dosing?

A

renal function

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16
Q

indications for vanc loading dose

A 
endocarditis
febrile neutropenia
meningitis
osteomyelitis
pneumonia
sepsis/septic shock
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17
Q

vanc loading dose

A

25-30mg/kg IV once. max of 2000mg

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18
Q

initial vanc maintenance dose

A

15-20mg/kg/dose. max of 2g/dose

frequency 8-12H

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19
Q

infusion rate for vanc

A

1g/hour

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20
Q

Target trough for vanc used to determine what?

A

Efficacy; secondary reason is monitor toxicity

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21
Q

Vanc trough 15-20mg/L

A 
bacteremia
meningitis/CNS
pneumonia
severe SSTI/necrotizing facitis due to MRSA
endocarditis
osteomyelitis
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22
Q

vanc trough 10-15mg/L

A

Mild/moderate SSTI due to MRSA

UTI

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23
Q

MRSA agents

A

Vancomycin, daptomycin, linezolid, bactrim + rifampin, Clindamycin

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24
Q

Metronidazole covers

A

Anaerobes

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25
Q

Anti-pseudomonal agents

A

Imipenem, doripenem, meropenem, piperacillin/tazo, aztreonam, tobramycin, cipro, levo, oflaxacin, cefepime, ceftazidime)

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26
Q

Neisseria gonorrhea treatment

A

Ceftriaxone or cefotaxime

Adolescents/ adults with possible STD contact

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27
Q

If pt has neisseria pair with

A

Chlamydia treatment: once azithromycin or doxycycline for 7 days

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28
Q

Enterobacteriaceae aka

A

GNB

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29
Q

Nongonococcal duration of treatment

A

2-3 weeks (at least 2 weeks IV before PO)

MRSA (3-4 weeks)

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30
Q

Gonococcal treatment duration

A

7-10 days (ceftriaxone IV) on 4th day can be switched to oral therapy- amoxil/doxy/ tetra

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31
Q

Gonococcal

A

Gram -

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32
Q

Acute diarrhea

A

Less than 14 days

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33
Q

Persistent diarrhea

A

More than 14 days

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34
Q

Chronic diarrhea

A

Greater than 4 weeks

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35
Q

Watery diarrhea

A

Watery
Less than 10 times per day
Toxins
Reduced absorption

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36
Q

Inflammatory diarrhea

A

Bloody
Mucosal invasion
More than 10 times per day

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37
Q

Stool culture detects

A

Campylobacter, salmonella, shigella

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38
Q

Toxin test detects

A

E.coli O157:H7

C.diff toxins A and B

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39
Q

Antibiotics can be indicated in confirmed GI infections due to

A

shigella, campylobacter, yersinia

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40
Q

Antibiotics likely to cause c. Diff

A

Clindamycin, ampicillin, cephalosporins, FQs

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41
Q

organs in the peritoneal cavity

A

stomach, small bowel, large bowel, liver, gallbladder & spleen

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42
Q

organs in the retroperitoneal space

A

duodenum, pancreas, kidneys & adrenal glands

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43
Q

complicated intra-abdominal infection

A

when it has extended from the organ of origin into the peritoneal cavity

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44
Q

uncomplicated intra-abdominal infection

A

infection is only in the organ

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45
Q

primary abd. infection

A

CAPD and SBP
integrity of the GIT has NOT been compromised
typically monomicrobial

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46
Q

secondary abd. infection

A

infection in the peritoneal cavity that results from perforation of a hollow viscus
usually polyicrobial
CA or HA
always complicated

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47
Q

Tertiary abd. infection

A

secondary infections that fail to respond to therapy

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48
Q

routes of entry of bacterial into abdominal cavity

A

primary CAPD- catheter
primary SBP- blood stream & impaired host defenses–can’t find source of the disease (spontaneous)
secondary- perforation, appendicitis, disease, cancer, trauma, etc

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49
Q

peritoneal cavity is considered

A

a sterile site

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50
Q

CAPD symptoms

A

milder, may have cloudy effluent

51
Q

SBP symtoms

A

may have altered mental status

52
Q

primary peritonitis diagnosis

A 
nonspecific symptoms
peritoneal fluid analysis (paracentesis)
- bacterial culture
- WBC, differential
-- CAPD >100 WBCs w/ >50% PMNs
--SBP >250 PMNs
53
Q

secondary diagnosis

A

clinical + radiograph (CT scan)

54
Q

most common secondary peritonitis cause

A

appendicitis

55
Q

source control

A

draining infected foci, absecesses & fluid collections or surgical repair of organ.

56
Q

antibiotics alone are not sufficient to resolve infection in

A

secondary infections.

57
Q

secondary SBP prophylaxis

A

FQs or bactrim

58
Q

primary CAPD treatment

A

gram + coverage (cefazolin or vanc) + G- (AG, ceftazidime, cefepime, carbapenem, cipro, levo)

59
Q

primary SBP treatment

A

tax//triax. FQ

60
Q

Prophylaxis

A

administered prior to contamination of previously sterile tissues of fluids

61
Q

presumptive

A

looks like an infection but we haven’t proved it yet

62
Q

indications for antibiotic prophylaxis

A

foreign body implantation
infection unlikely but severe consequences if occurs
surgeries with high infection rates

63
Q

ID of the perfect antibiotic

A

active against likely pathogen
achieves adequate antimicrobial conc.
shortest effective duration

64
Q

prophylaxis: re-dose every:

A

2 half-lives

65
Q

administer ABX ____ before incision

A

1 hour prior or 2 hours if using vanc or FQs

66
Q

Aztreonam re-dosing interval

A

4 hours

67
Q

cefazolin re-dosing interval

A

4 hours

68
Q

cefoxitin re-dosing interval

A

2 hours

69
Q

clindamycin re-dosing interval

A

6 hours

70
Q

recommended to stop prophylaxis ABX within

A

24 hours post surgery

exception 48 hours post cardiothoracic surgeries

71
Q

IE prophylaxis ABX should be administered

A

30-60 minutes prior to procedure

72
Q

Major limitations of MIC

A

static measure

ignores the patient

73
Q

drug-bug

A

microbiology

74
Q

drug-patient

A

pharmacokinetics

75
Q

drug-bug + drug-patient

A

pharmacodynamics

76
Q

Post antibiotic effect (PAE)

A

continuous suppression of organism after the [drug] drops below MIC

77
Q

possible mechanisms of PAE

A

continued persistence of the drug at the bacteria’s drug-binding site after [] below MIC

78
Q

AGs PD

A

Cmax/MIC

concentration dependent

79
Q

Beta-lactams PD

A

% time>MIC
target: 40-50% time over MIC
time dependent
extended infusion

80
Q

vancomycin PD

A

%time > MIC- troughs are associated with efficacy
AUC/MIC >400
time dependent

81
Q

FQs PD

A

AUC/MIC
concentration dependent
G- AUC/MIC>125
G+ AUC/MIC >33.7

82
Q

Systemic inflammatory response syndrome (SIRS)

A

need 2/4:
HR >90bpm
RR>20breaths/min or PaCO2 38C/100.4F
WBC > 12,000, <4,000 or 10% bands

83
Q

Sepsis

A

SIRS + infection

84
Q

severe sepsis

A

sepsis + organ dysfunction, hypoperfusion or hypotension(40 decrease w/out another cause or MAP <70)

85
Q

septic shock

A

severe sepsis + hypotension despite fluid resuscitation

patients may not be hypotensive if they are already on vasopressor agents

86
Q

factors associated with increased mortality rates in sepsis

A

shock, rapid fatal underlying disease (neoplasm, HIV), age >70, G- OR yeast infection, inappropriate ABX therapy, leucopenia, severe thrombocytopenia, bleeding, multiple organ failure

87
Q

diagnosis of sespsis

A

minimum of 2 blood cultures
at least on percutaneous blood culture
one blood culture from each vascule access device

88
Q

procalcitonin

A

marker for severe infection

89
Q

sepsis ABX therapy

A

begin within 1 hour of recognition of severe sepsis/septic shock

90
Q

duration of therapy for sepsis

A

7-10 days

91
Q

longer duration of therapy for sepsis

A

slow clinical response, undrainable foci of infection
bacteremia with staph aureus
some fungal & viral infections
immunologic deficiencies, inc. neutropenia

92
Q

infection prevent for sepsis

A

selective oral decontamination (nonabsorbably ABX combo)

oral chlorhexidine gluconate (oropharyngeal decontamination)

93
Q

first priority in managing patients with severe sepsis or septic shock

A

initial reuscitation (w/in the first 6 hours)

94
Q

Goals of initial resuscitation of sepsis-induced hypoperfusion

A

central venous pressure (CVP) 8-12mmHg
MAP >65mmHG
urine output >0.5mL/kg/hr
central venous O2 sat >70 OR mixed venous >65%

95
Q

who gets fluid resuscitation?

A

patients with hypotension of serum lactate >4mmol/L

96
Q

Fluid resuscitation therapy for sepsis:

A

crystalloids (1L over 30 minutes): initial fluid choice
–normal saline or lactated ringers
colloinds (300-500 mL over 30 minutes)
– albumin (Hetastarch, not recommended)

97
Q

who gets cardiovascular support in pts with sepsis?

A

patients who do not respond to fluid resuscitation

98
Q

what do patients get for cardiovascular support in sepsis?

A

vasopressors
1st line- norepinephrin
1st alt.- epinephrine
other alt.- vasopressive, dopamine, phenylephrine

99
Q

when to consider steroid use in sepsis?

A

poor response to fluids & vasopressors
only for septic shock
hydrocortisone 200mg/day

100
Q

when to give blood products in sepsis?

A

RBCs- when Hgb50X10^9 only for invasive procedures

erythropoietin- not for sepsis-related anemia

101
Q

supportive therapies in sepsis?

A

glucose control (goal 140-180) check Q1-2H
DVT prophylaxix- heparin
stress ulcer prophylaxis- H2 antagonist or PPI
nutrient support
mechanical ventilation
hemodialysis

102
Q

G+ associated with septic shock

A

staph aureus, strep pneumo, CONS & enterococcus sp.

103
Q

G- associated with septic shock; high mortality

A

pseudomonas, enterobacteriaceae: E.coli, klebsiella, serratia, enterobacter, proteus

104
Q

fungi; high mortality

A

candida

105
Q

sepsis can cause

A

coagulation, vasodilation, capillary leak

106
Q

timing of trough evaluation

A

evaluate at steady state ~PRIOR to 4th dose

some do it prior to 3rd dose, but not at SS then.

107
Q

gentamicin & tobramycin traditional dosing

A

1-2.5mg/kg/dose

108
Q

amikacin traditional dosing

A

5-7.5mg/kg/dose

109
Q

traditional AG frequency

A

> 60mL/min: Q8H
40-59: Q12H
20-39: Q24H
usually use IBW for calculation

110
Q

for AGs peaks determine

A

efficacy

opp. vanc

111
Q

for AGs troughs determine

A

toxicity- nephrotoxicity

112
Q

high AG peaks are associated with

A

ototoxicity

113
Q

life threatening infection of pneumonia AG peak

A

Gent/tobra: 8-10

amikacin:25-35

114
Q

serious infection AG peak

A

gent/tobra:6-8

amikacin: 20-25

115
Q

UTI AG peak

A

gent/tobra: 4-6

amikacin: 15-20

116
Q

Endocarditis (synergy) AG peak

A

gent/tobra: 3-4

no amikacin

117
Q

toxicity troughs for AGs

A

gent/tobra: 0.5-2 (target 1)

amikacin: <8 (target 4)

118
Q

rationale for extended interval dosing

A

[] dependent killing
post-antibiotic effect
prevents adaptive resistance
less tissue accumulation

119
Q

exclusion criteria for extended interval dosing

A

impaired renal function (20% body

120
Q

extended interval dosing of AGs

A

Gent/tobra:5-7mg/kg/dose

121
Q

extended interval frequency for AGs

A

> 60ml/min Q24H
40-59: Q36H
30-39:Q48H

122
Q

evaluate random level of AG at

A

10 hours (+/-4 hours) after 1st dose

123
Q

moxifloxacin does not cover

A

pseudomonas

levo & cipro do

ID (9 decks)

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