blood infections 2 Flashcards
what are the risk factors for pseudomonas
- admission to an ICU
- recent pseudomonas infection
- recent hospitalization
- dialysis
- nursing home
- recent IV antibiotics
- recent chemotherapy
how is pseudomonas treated in a BSI
double coverage with 2 drugs with 2 different mechanisms of action.
what are 4 drug classes with the same type of MOA that should not be used together to treat pseudomonal infections
- antipseudomonal PCNs (Zosyn, ticar/clav)
- cephalosporins
- monobactams
- carbapenems
what class of drugs works for pseudomonas by inhibiting protein synthesis
aminoglycosides
what class of drugs works for pseudomonas by targeting DNA and replication
fluoroquinolones
what should be done to treat ESBL (gram -) blood infections
carbapenems: imipenem/ cilastatin meropenem doripenem ertapenem
what should be used to treat someone with both an ESBL and pseudomonas infection
- an carbapenem (imipenem, meropenem, doripenem)
+ aminoglycoside OR fluoroquinolone
what carbapenem should not be used for pseudomonas
ertapenem; does not work for pseudomonas
how long should a gram negative BSI be treated
7-14 days after 1st negative blood culture
what are two most common fungal BSI’s
C. albicans
C. glabrata (fluconazole resistant)
what is the treatment duration for fungal BSIs
14 days after the 1st negative culture
what is the standard approach if a CLABSI is suspected (Central Line Associated BSI)
- pull central line and culture tip
- obtain blood cultures
- establish a peripheral IV
- follow either short term or long term algorithms
what is considered short term central line placement
less than 14 days
what are the complicated cases of CLABSI
- thrombophlebitis
- endocarditis
- osteomyelitis
if there is a complicated case of CLABSI, what must always be done
remove catheter
