Exam II Flashcards

Question

Enterobacter MOR

Answer 1

70-90% BSBL 20% AmpC Some make carbapenemase

Answer 2

70-90% BSBL 20% AmpC Some make carbapenemase

Answer 3

``` Restrictive outer membrane Unique PBPs 70-90% BSBL 20% AmpC Some make carbapenemase ```

Answer 4

Carbapenemase

Answer 5

Multiple MOR

Answer 6

Low affinity PBPs

Answer 7

70-90% BSBL

Answer 8

No beta lactamase

Answer 9

Beta lactamase | Spore former

Answer 10

No beta lactamases

Answer 11

``` 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) ```

Answer 12

``` No penicillin (absolute resistance) Ceftaroline (5th generation) No aztreonam No carbapenem Vancomycin, dapt, and tele No FQs ```

Answer 13

``` 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 ```

Answer 14

``` No penicillin (absolute resistance) Ceftaroline (5th generation) No aztreonam No carbapenem Vancomycin, dapto, and televancin No FQ ```

Answer 15

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)

Answer 16

``` 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) ```

Answer 17

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)

Answer 18

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)

Answer 19

``` 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 ```

Answer 20

``` 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 ```

Answer 21

Not susceptible to many beta lactams (can maybe use Pen G+ AG) No aztreonam Maybe carbapenems? All glycopeptides

Answer 22

Vancomycin is used for B. cereus | All other bacilli are susceptible to pens/ beta lactams

Answer 23

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)

Answer 24

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

Answer 25

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

Answer 26

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

Answer 27

``` 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 ```

Answer 28

``` 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 ```

Answer 29

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

Answer 30

``` 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 ```

Answer 31

``` 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 ```

Answer 32

``` AP or ESP (possibly use BLI, but probably unnecessary) 3rd-5th generation>2nd generation cephs Aztreonam All carbapenems All FQs ```

Answer 33

``` No penicillin is reliable No ceph is reliable Aztreonam All carbapenems All FQs ```

Answer 34

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

Answer 35

``` 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 ```

Answer 36

``` 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 ```

Answer 37

``` ESP+BLI if not Amp C 3rd-5th generation ceph if not ESBL Aztreonam if not above BSBL All carbapenems Cipro>Levo>Gati/moxi ```

Answer 38

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

Answer 39

No beta lactam works | Functionally resistant to FQs

Answer 40

``` No penicillin works No ceph works No aztreonam Meropenem works Functionally resistant to FQs ```

Answer 41

``` 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) ```

Answer 42

No beta lactam works

Answer 43

No beta lactam works

Answer 44

No beta lactam works

Answer 45

Patient will be on a 3-4 drug antibiotic regimen, which will be amoxicillin, clarithromycin, and lansoprazole

Answer 46

``` 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) ```

Answer 47

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)

Answer 48

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)

Answer 49

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

Answer 50

Any penicillin works All carbapenems No aztreonam No FQs, if forced use moxi (but don’t trust FQ alone)

Answer 51

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

Answer 52

No beta lactam works | Moxi/Gati>levo>cipro

Answer 53

No beta lactam works

Answer 54

No beta lactam works | Moxi/gati>levo>cipro (gati has lower MIC, cipro MIC slightly greater than cut off point so don’t pick

Answer 55

No beta lactam works