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Therapeutics > Blood Stream and CNS infections > Flashcards

Blood Stream and CNS infections Flashcards

1. difficult to accesses infected tissue compartment pre-mortem 2. pretreatment with antimicrobials 3. organisms burden blelow limit of qualification 4. unable to be cultured with standard techniques

1
Q

which organisms are usually involved in catheter related blood stream infections? CRBSI

A
  1. staphylococcus aureus
  2. staphylococcus epidermidis
  3. viridans streptococcus
  4. PEK
  5. Pseudomonas aerigonosa
  6. Candida
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2
Q

what is the empiric treatment for CRBSI?

A

Vancomycin +/- [cefepime or ceftazidime or pip/tazo] +/- antifungal

The vancomycing is for S.A, S. epi, viridans strept. The cefepime/ceftazidime/piptazo are for PEK and pseudomonas a.. The anti fungal would be for candida

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3
Q

which organisms are usually involved in bacterial meningitis (central nervous infection)

A

Community acquired:

  1. streptococcus pneumoniae
  2. neisseria menigiditis
  3. H. influenza
  4. Listeria (immunocompromised)
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4
Q

what is the empiric treatment for bacterial meningitis

A

Vancomycin + ceftriaxone +/- ampicillin

Vancomycin is for the streptococcus pneumoniae. The cefriaxone is for neisseria meningditis and H. Influenza and s. pneum. The ampicilling would be for the listeria.

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5
Q

what is bacteremia?

A

bacteria in the blood

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6
Q

what is fungemia?

A

fungi in the blood

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7
Q

what is viremia?

A

viruses in the blood

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8
Q

what is septicemia?

A

microorganisms in the blood plus signs/symptoms of sepsis syndrome:
tachycardia
hypotension
elevated WBC etc

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9
Q

what are the complications of CRBSI?

A
  1. organism enters blood stream and it leads to SIRS or sepsis syndrome
  2. metastasis: seeding of other organs like heart valves, cps, liver, kidney, blood vessels, eye
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10
Q

what are the signs and symptoms of CRBSI?

A 
local: 
redness
tenderness
warmth
pain at catheter site
Systemic:
 fever
chills
increased WBC
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11
Q

how do they diagnose CRBSI?

A

they perform blood cultures by taking samples of blood through the catheter and via peripheral venipuncture (another area on the opposite side of where catheter is). If both samples are positive for bacteria. determine if catheter is the source.

  1. do a differential time to positivity: if the catheter culture turns + greater than 2 hours before the peripheral line (then catheter is the source)
  2. Do a quantitative culture count: if the catheter culture CFU is greater than 3 fold greater than peripheral (then catheter is the source)
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12
Q

what conditions make the invading organism to be more like likely PEK, pseudomonas, enteroccocus or candida in CRBSI?

A
  1. hospitalization >5 days
  2. they had antibiotics within 7 days
  3. high risk/high severity patient: immunocompromised and SIRS/sepsis
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13
Q

how long should therapy be for uncomplicated CRBSI infections? what about for complicated infections?

A

s. epidermis: 5-7 days
s. aureus and PEK and Pseudomonas: 14 days
Candida: 14 days

Complicated infections: 4-6 weeks

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14
Q

what does it mean to have complicated CRBSI?

A

it means that you have another complication such as septic throbophlebitis, endocardidts, osteomyelitis, or persistently positive blood culture on therapy

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15
Q

what are the signs and symptoms of bacterial meningitis?

A 
Fever
headahce
altered mental status (AMS)
Stiff neck
photophobia
nausea/vomiting
seizure
brudzinki's sign
kerinig's sign
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16
Q

for bacterial meningitis, what is the onset time?

A

12-24 hours

17
Q

for viral meningitis, what is the onset time/

A

1-5 days

18
Q

for fungal meningitis, wat is the onset time?

A

days to weeks

19
Q

for mycobacterial meningitis ,what is the onset time?

A

days to weeks

20
Q

what is the Empiric treatment of bacterial meningitis for a person <1month old?

A

cefotaxime + ampicillin

21
Q

what is the Empiric treatment of bacterial meningitis for a person 1-23 months old?

A

[cefotaxime or ceftriaxone] + vancomycin
also add:
dexamethasone 0.15mg/kg q6h with or before first dose of antibiotics. Continue for x2-4 days unless: cultures are negative for H.influenzae or strep pneumo. Make sure there are no contraindications to dexamethasone

22
Q

what is the Empiric treatment of bacterial meningitis for a person 2-50 years old?

A

[cefotaxime or ceftriaxone] + vancomycin
also add:
dexamethasone 0.15mg/kg q6h with or before first dose of antibiotics. Continue for x2-4 days unless: cultures are negative for H.influenzae or strep pneumo. Make sure there are no contraindications to dexamethasone

23
Q

what is the Empiric treatment of bacterial meningitis for a person >50 years old or immunocompromised?

A

[cefotaxime or ceftriaxone] + vancomycin + ampicillin
also add:
dexamethasone 0.15mg/kg q6h with or before first dose of antibiotics. Continue for x2-4 days unless: cultures are negative for H.influenzae or strep pneumo. Make sure there are no contraindications to dexamethasone

24
Q

who should get a vaccine for S. pneumoniae?

A 
children 2-15 mos
Age >65
Chronic disease
immunocompromised
Asplenia: absence of spleen function
25
Q

who should get a vaccine for H. influenza

A

children 2-15mos

asplenia

26
Q

who should get a vaccine for n. meningiditis?

A 
children 11-12years
college freshmen in dorms
military recruits
travelers to endemic areas
asplenia
27
Q

who should get bacterial meningitis prophylaxis?

A

close contact with people who had documented n. meningidits: roommates, family, health care workers with exposure to oral secretions.

Exposure must be 7 days before symptoms and 24 hours after antibiotic treatment

28
Q

what are the regimens for N. meningiditis prophylaxis ?

A

rifampin 600mg po bid x 2 days
ceftriaxone 125mg iv x 1
ciprofloxacin 500mg po x 1

29
Q

what are the most likely pathogens in Bacterial meningitis in patients <1mo?

A

Group B strep
E and K
listeria

30
Q

what are the most likely pathogens in Bacterial meningitis in patients 1-23mos?

A 
Group B strep
strept pneumoniae
E
N. meningiditis
H. influenza
31
Q

what are the most likely pathogens in Bacterial meningitis in patients 2-50years old?

A

S. pneumoniae

N. Meningiditis

32
Q

what are the most likely pathogens in Bacterial meningitis in patients >50yo?

A

Strept pneumoniae
N. mengiditis
Gram N bacilli
listeria

33
Q

what are the most likely pathogens in bacterial meningitis in post surgical patients?

A

Staphylococcus
Gram N rods
pseudomonas

Therapeutics (23 decks)

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