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PHRM 865 > D Allen > Flashcards

D Allen Flashcards

(60 cards)

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1
Q

what is the leading cause of community acquired and hospital acquired bacteremia

A

staph aureus

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2
Q

mortality rates with MRSA

A

20-40% - highest

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3
Q

is treatment failure common in SAB

A

yes especially with MRSA

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4
Q

ID consults result in what

A

decreased mortality
fewer relapses
decreased readmission rates

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5
Q

when do we take blood cultures in SAB

A

repeat blood cultures q48-72 hours
2 sets

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6
Q

what is treatment day 0

A

start counting SAB treatment on first day of negative cultures

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7
Q

what is TEE and TTE

A

TTE - transthoracic echocardiography
TEE - transesophageal echocardiograph

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8
Q

TEE performed when

A

in SAB after TTE
more sensitive for identifying vegetation size/location

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9
Q

what if we see staph aureus in the urine

A

not a common organism, should take blood cultures for staph bc its probably coming from somewhere else

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10
Q

staph aureus in urine associated with what

A

increased mortality

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11
Q

what to do with catheters/devices in SAB

A

assume all are infected until infection ruled out
remove asap and if u cant then add rifampin

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12
Q

when can we replace catheters in SAB

A

blood cultures negative for 48-72 hours

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13
Q

empiric treatment of SAB

A

vancomycin 15-20 mg/kg IV q 8-12 h
daptomycin 6-10 mg/kg IV q24h
- add MSSA coverage only if critical condition

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14
Q

MRSA bacteremia treatment

A

vancomycin 15-20 mg/kg IV q8-12h
daptomycin 6-10 mg/kg IV q24h

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15
Q

can we add gentamicin or rifampin to MRSA SAB

A

no don’t add on

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16
Q

MSSA bacteremia treatment

A

nafcillin 2 g IV q4h
oxacillin 2 g IV q4h
cefazolin 2 g IV q8h

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17
Q

MRSA bacteremia treatment if severly ill high risk treatement failure and death

A

vancomycin/daptomycin + MSSA drug
for first 7 days then monotherapy

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18
Q

uncomplicated SAB defined as what

A

negative TEE,TTE
no devices or prosthesis
negative blood cultures
no evidence of metastatic

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19
Q

SAB duration

A

uncomp:14 days of IV therapy from first negative blood culture
complicated: 4 weeks
complicated w metastatic: 6-8 weeks

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20
Q

can we use PO for SAB

A

use IV for full duration of treatment

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21
Q

biggest risk factor for SAB relapse

A

implantable devicie

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22
Q

streptococci bacteremia pathogens and risk endocarditis

A

high risk: viridans
low risk: pyogenes, pneumo, agilactiae

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23
Q

treatment duration strep bacteremia

A

14 days IV to PO

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24
Q

treatment strep bacteremia

A

pyogenes/agalactiae: penicilliin q4h or CI then amoxicillin PO
pneumoniae: ceftriaxone or penicillin

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25
treatment bacteremia enterococci
e faecalis: ampicillin 2 g q4h or 12 g CI - if amp resist or penicllin allergy: vanc or dapto e faecium: vancomycin - if van a/b positive: daptomyciin 10 mg/kg, linezolid
26
treatment uncomplicated gram neg duration
7 days total don;t have to repeat blood cultures
27
can we use PO in bacteremia treatment
not staph but for gram negatives yes
28
PO treatment bacteremia uncomplicated gram neg
TMP/SMZ, FQ beta lactam
29
highest risk factors for endocarditis include
presence of prosthetic valve history of endocarditis
30
most common organisms in endocarditis
staph aureus - people who inject drugs viridans strep - underlying cardiac abnormalities enterococci - abnormal heart valves HACEK fungi - after CV surgery or prolonged IV/antibiotic therapy
31
most common symptom of endocarditisi
fever
32
most important lab test for endocarditis
blood cultures get 3 sets from diferent sites then 2 sets q 2-3 days
33
what duke criteria do we need for endocarditis diagnosis
2 major 1 major + 3 minor 5 minor
34
major Duke criteria
positive blood cultrues from 2+ sets positive lab test imaging surgical inspection
35
minor criteria DUKE
previos history of IE prosthetic valve previous valve repair congenital heart disease regurgitation or stenosis cardiac implant device obstructive cardiomyopathy inject drug use
36
endocarditis treatment viridans strep native penicllin suseptible MIC <0.12
penicillin G 12-18 mil OR ceftriaxone x 4 weeks penicillin G 12-18 mil+/- gentamicin x 2 weeks ceftriaxone +/- gentamicin x 2 weeks vancomycin x 4 weeks
37
endocarditis treatment viridans strep native penicillin relatively resistant MIC 0.12-0.5
penicillin G 24 mil x 4 weeks + gentamicin x 2 weeks ceftriaxone x 4 weeks + gentamicin x 2 weeks vancomycin x 4 weeks
38
endocarditis treatment viridans strep prosthetic penicillin suseptible MIC <0.12
penicillin G 24 mil x 6 weeks +/- gentamicin x 2 weeks ceftriaxone x 6 weeks +/- gentamicin x 2 weeks vancomycin x 6 weeks
39
alternative to penicillin G in strep treatment
ampicillin
40
endocarditis treatment viridans strep prosthetic penicillin relatively resistant (MIC > 0.12)
penicillin G x 6 weeks + gentamicin x 6 weeks ceftriaxone x 6 weeks + gentamicin x 6 weeks vancomycin x 6 weeks if beta lactam allergy
41
endcarditis treatment staph aureus native oxacillin suseptible (mssa)
nafcillin/oxacillin x 6 weeks OR cefazolin x 6 weeks if PCN rash (if uncomplicated right sided can do 2 weeks)
42
endocarditis treatment staph aureus native oxacillin resistant
vancomycin x 6 weeks daptomycin 8mg/kg + x 6 weeks
43
daptomycin dosing in endocarditis with MRSA
8 mg/kg +
44
endocarditis treatment staph aureus prosthetic oxacillin susceptible
nafcillin/oxacillin x 6 weeks + rifampin x 6 weeks + gentamicin x 2 weeks
45
endocarditis treatment staph aureus prosthetic oxacillin resistant
vancomycin x 6 weeks + rifampin x 6 weeks + gentamicin x 2 weeks
46
endocarditis treatment enterococci prosthetic or native penicillin and gentamicin susceptible
ampicillin + gentamicin x 4-6 weeks penicillin + gentamicin x 6 weeks ampicillin + ceftriaxone x 6 weeks use if CrCl < 50
47
endocarditis treatment enterococci prosthetic or native penicillin susceptible, aminoglycoside resistant
ampicillin + ceftriaxone x 6 weeks
48
endocarditis treatment enterococci prosthetic or native penicillin susceptible gentamicin resistant, streptomycin suseptible
ampicillin + streptomycin x 46 weeks penicllin + streptomycin x 4-6 weeks
49
endocarditis tratment enterococci prosthetic or native penicillin allergy or resistance
vancomycin + gentamycin x 6 weeks
50
endocarditis treatment enterococci prosthetic or native if you cant use anything else
daptomycin x 6 weeks linezolid x 6 weeks
51
HACEK organisms endocarditis treatments
ceftriaxone ampicillin / sulbactam ciprofloxacin 4 weeks native 6 weeks prosthetic
52
if pseudomonas or e coli what to do in endocarditis
surgery and long term antibiotics
53
fungal endocarditis treatment
fluconaole > 6 weeks
54
what does it mean if we have culture negative endocarditis
likley gave the drugs before we got a culture
55
treatment of culture negative endocarditis native
vancomycin + cefepime if acute onset (days) vancomycin + amp/sulbactam if subactute (weeks) 4-6 weeks
56
treatment of culture negative endocarditis prosthetic < 1 year
vancomycin x 6 weeks gentamycin x 2 weeks rifampin x 6 weeks cefepime x 6 weeks
57
treatment of culture negative endocarditis prosthetic > 1 year
vancomycin x 6 weeks ceftriaxone x 6 weeks
58
treatment of culture negative endocarditis suspected bartonella
ceftriaxone x 6 weeks gentamicin x 2 weeks +/- doxycycline x 6 weeks
59
treatmentof culture negative endocarditis documented bartonella (positive culture)
doxycycline x 6 weeks gentamicin x 2 weeks
60
monitoring for endocarditis
fever blood cultures and susceptibilities every 24-48 h

PHRM 865 (33 decks)

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