EXAM 4 Staph Aureus Bacteremia (SAB)

Question 1

What is the diagnosis for staph aureus bacteremia?

Answer 1

blood cultures

echocardiography

urine culture

Question 2

Blood culture for diagnosis SAB

Answer 2

gold standard

clinically significant regardless of # of positive bottles

Repeat (2 sets) every 48-72 hrs until negative

establishes day 0 of antibiotics as 1st negative test

Question 3

enchocardiography

Answer 3

all patients

transthoraticic echocardiography (TTE) 1st

transesophageal echocardiography (TEE) 2nd –> preferred for MRSA

Question 4

catheter/ prosthetic device management

Answer 4

Prosthetic devices: remove prosthetic device, if cannot add riframpin + long-term suppressive therapy

Catheters:
short-term: remove ASAP
long-term: remove unless major CI and replace when (-) blood culture

Question 5

empiric treatment for SAB

Answer 5

cover MSSA + MRSA: when gram stain show clusters:
Vancomycin or Daptomycin IV

high risk (severe sepsis, endocarditis, hemodynamic unstable, prior hx):
Vancomycin + nafcillin/oxacillin/cefazolin

Question 6

targeted treatment SAB - MRSA

Answer 6

Vancomycin IV
Daptomycin IV –> right-sided endocarditis

Question 7

targeted treatment SAB - refractory/ persistent MRSA

Answer 7

Vancomycin/Daptomycin + Ceftaroline

Question 8

targeted treatment SAB - MSSA

Answer 8

Nafcillin IV
Oxacillin IV
Cefazolin IV

Question 9

SAB treatment duration

Answer 9

uncomplicated: 14 days
complicated: 4 weeks
complicated + metastatic infection: 6-8 weeks

but must meet all criteria:
* Exclusion of endocarditis (negative TTE, TEE)
* No indwelling or implantable devices/prostheses
* Follow-up blood cultures at 2-4 days were negative
* Clinically improvement in 48-72 hours
* No evidence of metastatic infection

Question 10

SAB Prognosis

Answer 10

Presence of prosthetic material or devices increase risk of relapse

Question 11

Steptococci Bacteremia treatment (HANDOC)

Answer 11

treatment:
group A+B strep: penicillin IV –> amoxicillin PO

s. pneumoniae: ceftriaxone or penicillin

duration 14 days

Question 12

enterococci bacteremia treatment (DENOVA)

Answer 12

E. faecalis:
ampicillin, if resistance or allergy –> vanc/dapto

E. faecium:
VanA/B negative –> vancomycin
VanA/B positive (VRE) –> daptomycin or linezolid

duration 7 days

Question 13

uncomplicated gram negative bacteremia treatment

Answer 13

pseudmonas:
zosyn, cefepime, levofloxacin, meropenem, bactrim

duration 7 days
total days, not from day 0