Exam II Flashcards

1
Q

MSSA MOR

A

NSBL

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2
Q

MRSA MOR

A

NSBL

Modified PBPs

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3
Q

MSSE MOR

A

90% NSBL

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4
Q

MRSE MOR

A

NSBL

Modified PBPs

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5
Q

PSSP MOR

A

No beta lactamase

most susceptible

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6
Q

PRSP MOR

A

Modified PBPs

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7
Q

Streptococci (non- S. pneumoniae) MOR

A

Strep viridans more susceptible than others

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8
Q

Enterococcus faecalis/ faecium MOR

A

Modified PBPs

VRE has modified PTG

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9
Q

Listeria monocytogenes MOR

A

Modified PBPs

Ribosome is similar to traditional gram (+)

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10
Q

Corynebacterium MOR

A

Modified PBPs similar to enterococcals

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11
Q

Bacillus MOR

A

No beta lactamase

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12
Q

Acinetobacter MOR

A

Modified PBPs
Modified pores in OM
70-90% BSBL
Some carbapenemase

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13
Q

Moraxella catarrhalis MOR

A

20-50%, but up to 75% BSBL

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14
Q

Neisseria gonorrhea MOR

A

20-50% BSBL

Some have modified PBPs

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15
Q

Neisseria meningitides MOR

A

PRNM has modified PBPs

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16
Q

Haemophilus influenza MOR

A

20-50% BSBL

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17
Q

Pasteurella/Eikenella MOR

A

No beta lactamases

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18
Q

E. coli MOR

A

20-50% BSBL
Can make IRSBL (effective against all pens)
20% ESBL (nosocomial)

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19
Q

Salmonella MOR

A

20% BSBL

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20
Q

Shigella MOR

A

20% BSBL

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21
Q

Proteus mirabilis MOR

A

BSBL

Least likely to make beta lactamase

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22
Q

Proteus vulgaris MOR

A

BSBL

Modified PBPs

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23
Q

Klebsiella MOR

A

70-90% BSBL
20% ESBL
Some make carbapenemase

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24
Q

Citrobacter, morganella, and providencia MOR

A

70-90% BSBL

20% AmpC

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25
Enterobacter MOR
70-90% BSBL 20% AmpC Some make carbapenemase
26
Serratia MOR
70-90% BSBL 20% AmpC Some make carbapenemase
27
Pseudomonas aeruginosa MOR
``` Restrictive outer membrane Unique PBPs 70-90% BSBL 20% AmpC Some make carbapenemase ```
28
Stenotrophomonas maltophilia MOR
Carbapenemase
29
Burkholderia cepacia MOR
Multiple MOR
30
Legionella pneumophilia MOR
Low affinity PBPs
31
Bacteroides fragilis MOR
70-90% BSBL
32
Clostridium MOR
No beta lactamase
33
Clostridium difficile MOR
Beta lactamase | Spore former
34
Peptostreptococcus and Propionibacterum MOR
No beta lactamases
35
MSSA Drugs
``` ASP (resists NSBLs and BSBLs) Pen+BLI 1st>2nd>3rd/4th>5th generation cephs Cephamycin not great for staph No aztreonam All carbapenems (Dori most effective) Vancomycin only use if patient has beta lactam allergy Dapto and tela 2.5, 3, or 4 generation FQs may work, but other drugs are better and resistance develops quickly during therapy (MOR on plasmid that bug carries causing end treatment resistance) ```
36
MRSA Drugs
``` No penicillin (absolute resistance) Ceftaroline (5th generation) No aztreonam No carbapenem Vancomycin, dapt, and tele No FQs ```
37
MSSE Drugs
``` ASP Pen+BLI 1st>2nd>3rd-5th generation cephs No aztreonam All carbapenems Vanco if beta lactam allergy Dapto and televancin but don’t use 2.5, 3, and 4th generation FQs work but do not use them ```
38
MRSE Drugs
``` No penicillin (absolute resistance) Ceftaroline (5th generation) No aztreonam No carbapenem Vancomycin, dapto, and televancin No FQ ```
39
PSSP Drugs
Any penicillin (Pen G would be most appropriate) 1st>2nd>3rd/4th>5th generation cephs (must have a non-acid AKI group) No aztreonam No carbapenems Vancomycin if beta lactam allergy Dapto and televancin work but don’t use 2.5 and up FQs work, (resistant to early gen FQs because they don’t bind PAR)
40
PRSP Drugs
``` Pens ineffective at normal dose Cephs need to have non-acid AKI group 2nd generation: cefpodoxime and cefuroxime 3rd-5th gens: ceftriaxone, cefepime, and ceftaroline No aztreonam All carbapenems (Dori> Imi> the rest) Vanco, dapto, and televancin 2.5 and up FQs (respiratory FQs) ```
41
Other Streptococci Drugs
All pens effective (Pen G most appropriate) 1st>2nd>3rd-5th generation cephs as long as non-acidic AKI group No aztreonam All carbapenems Vanco (especially for viridans) Dapto and televancin 2.5 and up FQs (except cipro)
42
Enterococcus faecalis Drugs
Amino penicillins work the best> Pen G+ AG ASP will not work (PB doesn’t bind) Piperacillin works but is not great (PIP>TICAR, ticar not effective) No cephs are effective because they do not bind the PBPs No aztreonam All carbapenems except ertapenem Vanco is AOC in serious infections Dapto? Telavancin No FQs (but more susceptible than faecium)
43
Enterococcus faecium Drugs
``` Less susceptible than faecalis AP> Pen G+ AG ASPs won’t work Piperacillin works but not great (AP only drug that is really effective) No cephs because they do not bind the PBPs No aztreonam No carbapenems All glycopeptides No FQs ```
44
Listeria monocytogenes Drugs
``` AP> Pen G+ AG Pen V does not work ASPs do not work ESPs work slightly No cephs work because they do not bind the PBPs No aztreonam No carbapenems Vanco IV for gram + meningitis Dapto and televancin ```
45
Corynebacterium Drugs
Not susceptible to many beta lactams (can maybe use Pen G+ AG) No aztreonam Maybe carbapenems? All glycopeptides
46
Bacillus Drugs
Vancomycin is used for B. cereus | All other bacilli are susceptible to pens/ beta lactams
47
Acinetobacter Drugs
AP/ESP+BLI may be effective, but you would never use it alone 3rd and 4th generation cephs may be effective, but are not reliable Do not use Ceftaroline!!! No aztreonam All carbapenems can kill 75% of these except ertapenem Susceptible to FQs (always want to recommend multiple drugs for this bug such as carbapenem+ FQ)
48
Moraxella catarrhalis Drugs
Do not use NP or ASP AP+BLI or ESP+BLI 2nd-5th generation cephs. When possible use a 2nd generation with an AKI group Cefamycins will work, but you want to save them for more complicated infections Aztreonam works All carbapenems All FQs
49
Neisseria gonorrhea Drugs
ASPs will not work NP+BLI may work, but probably has a really high MIC90, so therefore is not used AP+BLI or ESP+BLI will work 2nd-5th generation cephs will all work. Ceftriaxone (3rd) is the antibiotic of choice because it has a long half life 3rd>2nd in general, but can use either Others listed: cefuroxime, cefpodoxime, cefixime Aztreonam works All carbapenems FQ resistance, so do not use
50
Neisseria meningitides Drugs
NP or AP are pretty effective All penicillins work, but Pen G is drug of choice Caution with high Pen G doses and seizures 3rd>2nd gen Cefuroxime is the drug of choice Aztreonam works All carbapenems (do not use imipenem because it can cause seizures) Gram Negative Bacilli No FQs because they can cause seizures
51
Haemophilus influenza drugs
``` NP and ASP don’t work AP+BLI or ESP+BLI 2nd-5th gen cephs work, but use 2nd gen when possible but do not use 2nd gen in meningitis Aztreonam All carbapenems All FQs ```
52
Pasteurella/Eikenella drugs
``` All penicillins except ASPs Pasteurella= NP Eikenella= AP Prefer to use amox/clav to cover staph as well Penicillins work better than cephalosporins, but all cephs are active (5th>2nd>rest) Aztreonam All carbapenems All FQs ```
53
E. coli drugs
AP+BLI or ESP+BLI Clavulanate is the only BLI that inhibits ESBLs NP and ASPs will not work 2nd-5th gen cephs can work, but 3rd-5th are best (2nd are not likely to be effective) Aztreonam All carbapenems (mero and dori are the best) All FQ's, although seeing more resistance
54
Salmonella drugs
``` AP alone likely effective (ampicillin alone is the antibiotic of choice) AP+BLI or ESP+BLI NP and ASP will not work 2nd through 5th work but 3rd>2nd All FQs ```
55
Shigella drugs
``` AP alone likely effective AP+BLI or ESP+BLI NP and ASP will not work 2nd through 5th work but 3rd>2nd Aztreonam All carbopenems All FQs ```
56
Proteus mirabilis drugs
``` AP or ESP (possibly use BLI, but probably unnecessary) 3rd-5th generation>2nd generation cephs Aztreonam All carbapenems All FQs ```
57
Proteus vulgaris drugs
``` No penicillin is reliable No ceph is reliable Aztreonam All carbapenems All FQs ```
58
Klebsiella drugs
ESP+BLI if not ESBL AP+BLI if not BSBL possibly 3rd-5th generation ceph if not ESBL Aztreonam if not ESBL, AmpC or carbapenemase producing All carbapenems unless producing carbapenemase All FQs
59
Citobacter, morganella, and providencia drugs
``` ESP+BLI if it’s not Amp C 3rd-5th generation ceph if not ESBL Aztreonam if not aove BSBL All carbapenems All FQs aren’t great for providencia retigeri, although they all work well against providencia stuartii FQs work nest for citrobacter Cipro best for Morganella ```
60
Enterobacter drugs
``` ESP+BLI if it is not Amp C 3rd-5th generation ceph if not ESBL: cefepime, ceftazadine Aztreonam if not above BSBL All carbapenems All FQs ```
61
Serratia drugs
``` ESP+BLI if not Amp C 3rd-5th generation ceph if not ESBL Aztreonam if not above BSBL All carbapenems Cipro>Levo>Gati/moxi ```
62
Pseudomonas aeruginosa drugs
Only use ESP+BLI Only tazo covers Amp C Cefoperazone, ceftazadin, cefepime, ceftaroline (add tazobactam for AmpC) Aztreonam- inhalation product for CF patients All carbapenems except ertapenem (mero has highest PBO affinity) Cipro is FQ with the best activity for this bug however all FQs could work but have more resistance
63
Stenotrophomonas drugs
No beta lactam works | Functionally resistant to FQs
64
Burkholderia drugs
``` No penicillin works No ceph works No aztreonam Meropenem works Functionally resistant to FQs ```
65
Legionella drugs
``` Penicillins are not reliable No cephs work due to modified PBPs No aztreonam No carbapenems Moxi/Gati>Levo>Cipro (use later gen FQs for respiratory infections) ```
66
Brucella drugs
No beta lactam works
67
Francisella drugs
No beta lactam works
68
Yersinia pestis
No beta lactam works
69
Helicobacter pylori drugs
Patient will be on a 3-4 drug antibiotic regimen, which will be amoxicillin, clarithromycin, and lansoprazole
70
B. fragilis drugs
``` AP+BLI or ESP+BLI 2nd gen cephamycins only (-OCH3 group) All carbapenems No aztreonam No FQs, if forced use moxi (but don’t trust FQ alone) ```
71
Fuso/prevotella drugs
Any penicillin will work except for the anti-staph. Any ceph will work although 1st gen is least likely All carbapenems No aztreonam No FQs, if forced use moxi (but don’t trust FQ alone)
72
Clostridium drugs
Any penicillin (ASPs least effective to not effective at all) Any ceph will work although 1st gen and cefamycins are the best All carbapenems No aztreonam No FQs, if forced use moxi (but don’t trust FQ alone)
73
Clostridium defficile drugs
No penicillin works Ampicillin is known to cause this infection No cephs work (3rd gen can cause CDAD) No carbapenems No aztreonam Oral vanco No dapto and tela because can’t be given orally
74
Peptostrep and propionibacterium drugs
Any penicillin works All carbapenems No aztreonam No FQs, if forced use moxi (but don’t trust FQ alone)
75
Treponema and Borrelia (spirochetes) drugs
Any penicillin works, but use Pen G, because it is the most appropriate Can give IM dose of benzanthine salt (slow absorption, very susceptible) No aztreonam
76
Chlamydia/Rickettsia drugs
No beta lactam works | Moxi/Gati>levo>cipro
77
Mycoplasma drugs
No beta lactam works
78
Mycobacteria drugs
No beta lactam works | Moxi/gati>levo>cipro (gati has lower MIC, cipro MIC slightly greater than cut off point so don’t pick
79
Fungi/parasites drugs
No beta lactam works