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CMT > Gram Positive Infections > Flashcards

Gram Positive Infections Flashcards

1
Q

are Group B Streptococcal Infections gram positive or gram negative?

A

positive

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2
Q

Group B Streptococcal Infections

Where are these bacteria usually found?

A

normal vaginal flora

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3
Q

Group B Streptococcal Infections

why do we test pregnant women for this?

A
  1. to see if it’s present (normal vagina flora, but want to know potential for infection)
  2. don’t want to pass bacteria to baby during delivery
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4
Q

Group B Streptococcal Infections

what do we do if a pregnant women tests pos?

A

abx treatment for weeks prior to birth

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5
Q

Group B Streptococcal Infections

why do we treat pregnant women prophylactically?

A

can spread to baby during birth & the bacteria is much more serious in newborns.

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6
Q

Group B Streptococcal Infections

What infections can this lead to?

3 most common, 3 less common

A

Most Common: septic abortion, endometritis, peripartum infection
Less Common: cellulitis, bacteremia, endocarditis

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7
Q

Group B Streptococcal Infections

Treatment

A

Penicillin
Vancomycin

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8
Q

Group B Streptococcal Infections

Can lead to what in neonates?

3 not so great things

A
  • bacteremia
  • sepsis
  • meningitis
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9
Q

Strep Viridans

Are strep viridans hemolytic?

A

No- they are nonhemolytic

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10
Q

Strep Viridans

Where are strep viridans typically found?

A

normal oral flora

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11
Q

Strep Viridans

What do strep viridans most commonly cause?

A

native valve endocarditis

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12
Q

Group D streptococci

Group D streptococci

which bacteria is group D?

A

Streptococcus gallolyticus

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13
Q

Group D streptococci

what 2 things do people who become ill from this usually have?

A

GI cancer or cirrhosis

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14
Q

Group D streptococci

what is secondary to this infection?

A

endocarditis

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15
Q

Group A Streptococcal Infection Types

4 categories

A
  • Non-invasive Infections
  • Exotoxin Mediated Disease
  • Non-supportive Immune Related Sequalae
  • Invasive Infections
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16
Q

Group A Streptococcal Infection

Example of non-invasive infection

A

Bullous Impetigo

covered in Derm not ID

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17
Q

Group A Streptococcal Infection

Example of Exotoxin mediated disease

A

Scarlet Fever

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18
Q

Group A Streptococcal Infection

Example of Non-suppurative immune related sequalae

A

Rheumatic Fever

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19
Q

Group A Streptococcal Infection

Examples of Invasive Infections

4

A

Cellulitis (covered in Derm not ID)
Abscess
Bacteremia
Infective Endocarditis

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20
Q

Scarlet Fever

AKA

A

strep throat

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21
Q

Scarlet Fever

people with this have often recently been ______

A

exposed to someone with strep throat

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22
Q

Scarlet Fever

signs

5 things

A
  • Exudative pharyngitis
  • Bright red exanthem
  • Flushed face
  • Circumoral pallor
  • Tongue coated with enlarged red papillae
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23
Q

Scarlet Fever

sx

7 things

A
  • abrupt onset of fever
  • sore throat
  • headache
  • chills
  • nausea
  • myalgias
  • malaise
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24
Q

Scarlet Fever

what causes rash to develop?

A

group A beta-hemolytic streptococci toxin causes rash

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25
Q

Scarlet Fever

Physiology of rash occuring from toxin exposure

A
  • local production of inflammatory mediators and alteration in cutaneous cytokines
  • Dilation of blood vessels leads to characteristic scarlet color
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26
Q

Scarlet Fever

Evolution of “Strawberry Tongue”

A
  • Day 1/2: tongue heavily coated with white membrane through which you can see edematous red papillae protrude
  • Day 3/4/5: white membrane sloughs off, revealing shiny red tongue with prominent papillae
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27
Q

Scarlet Fever

Rash Characteristics

A
  • diffusely erythematous w/ find red papules (sandpaper consistency)
  • greatest in groin and axillae
  • blanches (touch it and it goes away, then returns when no touch)
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28
Q

Scarlet Fever

how could texture of rash be described?

PPP

A

sandpaper

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29
Q

Scarlet Fever

How long after onset of fever does rash occur?

A

12-48 hrs

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30
Q

Scarlet Fever

How does rash change over course of illness?

A
  • 12 to 48 hrs: onset, appears on neck
  • travels to trunk/extremities
  • 2 to 5 days: fades leaving desquamation, peeling occurs
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31
Q

Scarlet Fever

Timeline

A

Untreated: fever peaks by 2nd day, afebrile by days 5-7
Treated: fever abates 12-24 hrs after abx initiation

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32
Q

Scarlet Fever

Dx

A
  • primarily a clinical diagnosis
  • test: rapid strep test or throat culture
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33
Q

Scarlet Fever

when to do culture vs rapid test?

A

if rapid test was negative but you still suspect strep, send off for culture.

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34
Q

Strep Throat

do not treat until you have ?

A

positive test result

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35
Q

Scarlet Fever

Treatment

3 options, give med, route, dosage, and duration

A

Treat strep pharyngitis
* Pen VK 500mg PO 2-3x daily for 10 days
* Amoxicillin (tastes better) 500 mg PO 2x daily for 10 days
* PCN G benzathine 1.2 million units IM x 1 (expensive, not readily available)

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36
Q

Scarlet Fever

when to use PCN shot vs amox series?

A

worried about non-compliance, kids refuse meds, recurrent infections (indicating non-complicance)

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37
Q

Acute Rheumatic Fever

Define

A

autoimmune inflammatory process that develops after beta-hemolytic streptococcal pharyngitis

perivascular granulomatous rxn with valvulitis

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38
Q

Acute Rheumatic Fever

Epidemiology

A
  • Most common in developing countries
  • 250,000 deaths worldwide/year
  • Peak incidence between ages 5-15
  • Predisposition to recurrence
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39
Q

Acute Rheumatic Fever

Complication

A

Rheumatic heart disease

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40
Q

Acute Rheumatic Fever

Molecularly mimics which other disease?

A

Scarlet Fever
* immune response aimed at strep antigens
* recognizes human tissue especially on endothelial cells on heart valves

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41
Q

Acute Rheumatic Fever

Clinical Presentation

sx onset after what?, % of people with groups of presentations

A
  • Typically sx onset is 2-3 wks after strep throat infection
  • Variable presentation
  • Carditis 50-70%
  • Arthritis 35-66%
  • Chorea 10-30%
  • SubQ nodules 0-10%
  • Erythema marginatum < 6%
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42
Q

Acute Rheumatic Fever

what presentation are we most worried about?

it’s the most common

A

cardiac complications

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43
Q

Acute Rheumatic Fever

Diagnosing

5 things

A
  • Troat culture
  • ASO titer
  • ESR
  • CRP
  • Echo

no specific diagnostic tests

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44
Q

Acute Rheumatic Fever

what does the Jones criteria help a provider determine?

A

when/whether to treat for strep

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45
Q

Acute Rheumatic Fever

Treatment

med, dosage, duration, freq

A

Treat group A strep infection
* Pen VK 500mg PO 2-3x daily for 10 days
* Amoxicillin (tastes better) 500 mg PO 2x daily for 10 days
* PCN G benzathine 1.2 million units IM x 1 (expensive, not readily available)

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46
Q

Acute Rheumatic Fever

Symptomatic Tx

1 med, 1 action

A

Salicylates (ex: Aspirin)
Bed rest for carditis

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47
Q

Acute Rheumatic Fever

Continuous abx prophylaxis for years

what med/dosage/freq

A

PCN G benzathine 1.2 mil units IM every 3-4 wks

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48
Q

Acute Rheumatic Fever

Education to provide

A

risk of infective endocarditis- sx watch
emphasize oral hygiene

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49
Q

Acute Rheumatic Fever

what percentage of people with rheumatic heart disease have a history of rheumatic fever?

A

60%

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50
Q

Acute Rheumatic Fever

Describe chronic rheumatic heart disease

A
  • rigid and deformed valve cusps
  • fusion of the commissures
  • shortening and fusion of the chordae tendinae
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51
Q

Acute Rheumatic Fever

What can Rheumatic Fever lead to in the long term?

more specific than rheumatic heart disease

A

valvular stenosis and/or regurgitation

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52
Q

Infective Endocarditis

Describe endocarditis

A

inflammatory process of the valvular or endocardial surface of the heart

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53
Q

Infective Endocarditis

Clinical Findings

5 (1 sx, 1 condition, 1 test result, 2 signs)

A
  • Fever
  • Pre-existing organic heart lesion
  • pos blood cultures
  • Evidence of vegetation on ECG
  • Evidence of systemic emboli
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54
Q

Infective Endocarditis

Microbiology

3 bacteria, 1 other

A
  • Staphylococcus
  • Strep viridans
  • Enterococcus
  • Fungal
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55
Q

Infective Endocarditis

Which gender is IE more common in?

A

males

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56
Q

Infective Endocarditis

Which bacteria is most common for IE in IV drug users?

A

S. aureus
> 60% of cases

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57
Q

Infective Endocarditis

Which valves are typically impacted in the general population?

A

left sided valves (mitral/bicuspid & aortic)

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58
Q

Infective Endocarditis

Which valves for IV drug users?

A

Right sided valves, especially tricuspid

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59
Q

Infective Endocarditis

The rate of ____ is higher for IE in IV drug users

A

recurrence

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60
Q

Infective Endocarditis

Cardiac Predispositions

6 things

A
  1. valvular heart disease
  2. congenital heart disease
  3. prosthetic valve
  4. history of IE
  5. pacemakers
  6. hypertrophic cardiomyopathy
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61
Q

Infective Endocarditis

Most Common Clinical Findings

2 (1 sx, 1 sign)

A

Fever (90%)
New/changed murmur (85%)

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62
Q

Infective Endocarditis

Additional Clinical Findings

11 sx

A

chills/night sweats
anorexia, wt loss
arthralgias, myalgias
malaise
dyspnea, cough, pleuritic pain
splenomegaly

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63
Q

Infective Endocarditis

Uncommon findings

but pathognomonic!

A

janeway lesions
osler nodes
roth spots

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64
Q

Infective Endocarditis

Janeway lesions

A

nontender erythematous macules on the palms and soles

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65
Q

Infective Endocarditis

Osler nodes

A

tender subQ violaceous nodules mostly on the pads of the fingers and toes, which may also occur on the thenar and hypothenar eminences

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66
Q

Infective Endocarditis

Roth spots

A

exudative, edematous hemorrhagic lesions of the retina with pale centers

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67
Q

Infective Endocarditis

Components of a Diagnosis

A

Blood cultures
ECG
CXR
Chest CT

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68
Q

Infective Endocarditis

use cation with what diagnostic procedure?

A

cardiac catheterization

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69
Q

Infective Endocarditis

What would an echo show?

A

which valves are impacted

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70
Q

Infective Endocarditis

What would the CXR show?

A

cardiac abnormalities

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71
Q

Infective Endocarditis

What would a chest CT show?

A

may show emboli

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72
Q

Infective Endocarditis

What criteria help determine if someone has IE?

A

Duke Criteria

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73
Q

Infective Endocarditis

Duke Criteria thresholds for dx

A
  1. 2+ major criteria
  2. 1 major & 3+ minor
  3. 5+ minor
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74
Q

Infective Endocarditis

Major Criteria

Duke’s (3)

A
  1. positive blood cultures
  2. evidence of endocardial involvement
  3. new or worsening regurgitation murmur
75
Q

Infective Endocarditis

Minor criteria

Duke’s (6)

A
  1. predisposition
  2. Fever > 100.4
  3. Vascular phenomena
  4. Immunologic phenomena
  5. Microbiologic evidence
  6. Echo findings not congruent w/ major criteria
76
Q

Infective Endocarditis

What would qualify a blood culture to meet major criteria?

Duke’s (3)

A
  1. typical microbe in 2 cultures
  2. persistently pos cultures
  3. single pos culture for Coxiella burnetii
77
Q

Infective Endocarditis

What would qualify as evidence of endocardial involvement to meet major criteria?

Duke’s (3)

A
  1. definite vegetation
  2. myocardial abscess
  3. new partial dehiscence of prosthetic valve
78
Q

Infective Endocarditis

What is included as vascular phenomena meeting minor criteria?

Duke’s (6)

A
  1. major arterial emboli
  2. septic pulm infarcts
  3. mycotic aneurysm
  4. intracranial hemorrhage
  5. conjunctival hemorrhage
  6. janeway lesions
79
Q

Infective Endocarditis

What are immunologic phenomena that meet minor criteria?

Duke’s (4)

A
  1. glomerulonephritis
  2. Osler’s nodes
  3. Roth spots
  4. rheumatoid factor
80
Q

Infective Endocarditis

Classifications of Endocarditis

A
  1. acute
  2. subacute
81
Q

Infective Endocarditis

Incubation Period of acute IE

A

< 6 week incubation, can be very rapid course

82
Q

Infective Endocarditis

Presentation and findings of acute IE

A
  1. toxic presentation (high fevers, CP, SOB, fatigue)
  2. rapid progression, fatal if untreated
83
Q

Infective Endocarditis

most common bacteria for acute IE

A

s. aureus

84
Q

Infective Endocarditis

Incubation Period of subacute IE

A

> 6 wk incubation, can be several months

85
Q

Infective Endocarditis

Presentation of subacute IE

A
  1. less dramatic presentation (low grade fever, sweats, wt loss)
  2. gradual progression
86
Q

Infective Endocarditis

Most common pathogens for subacute IE

A

less virulent organisms
s. viridians, enterococcus

87
Q

Infective Endocarditis

are native or prosthetic valve pts at higher risk for IE?

A

Prosthetic valve pts more susceptible to developing IE

88
Q

Infective Endocarditis

Treatment for infection only

A

abx

89
Q

Infective Endocarditis

tx with valve destruction

A

surgery

90
Q

Infective Endocarditis

prevention

A

prophylaxis abx, hygiene

91
Q

Infective Endocarditis

Abx Therapy- consult who?

A

ID

92
Q

Infective Endocarditis

Abx Therapy- duration

A

4-6 wks

93
Q

Infective Endocarditis

Abx therapy- when to begin?

A

immediately while awaiting culture results

94
Q

Infective Endocarditis

Abx therapy- bacteria to cover prior to receiving culture/sensitivity results?

A

MRSA, staph, strep, entero

95
Q

Infective Endocarditis

Abx therapy- what to initially prescribe?

A

Vancomycin and Ceftriaxone

96
Q

Infective Endocarditis

Abx therapy- when to change meds?

A

only if necessary, once culture results are back!

97
Q

Infective Endocarditis

Abx therapy- rechecking blood

A

recheck blood cultures after abx started, q 48 hrs until negative

98
Q

Infective Endocarditis

Abx for Streplococcus

only give med names, 4 meds

A

PCN G IV
Ceftriaxone IV
Vancomycin
PCN or Ceftriaxone + Gentamicin

99
Q

Infective Endocarditis

Dosage/Frequency/Duration for PCN G IV when treating for Streptococcus

A

12-18 mil units, divided doses
Q24 hrs
4 wks

100
Q

Infective Endocarditis

Dosage/duration/freq for Ceftriaxone IV when treating for Streptococcus

A

2g
Q24 hrs
4 wks

101
Q

Infective Endocarditis

Dosage/duration/freq for Vancomycin when treating for Streptococcus

A

15 mg/kg
Q12 hrs
4 wks

102
Q

Infective Endocarditis

Dosage/duration/freq for PCN or Ceft. + Gentamicin when treating for Streptococcus

A

PCN and Ceft are same as previous

Genta: 3 mg/kg, single or divided doses; Q24 hrs, 2 wks

103
Q

Infective Endocarditis

PCN considerations for streptococcus

A
  • renal pts require dose adjustment
  • use ceftriaxone if pt has non-severe PCN allergy
  • use vancomycin if pt has severe PCN allergy
104
Q

Infective Endocarditis

Meds to use for PCN resistant Streptococcus

A
  1. Vancymycin
  2. PCN G IV + Gentamicin
105
Q

Infective Endocarditis

Dosage/duration/freq of Vancomycin in PCN resistant Streptococcus

A

30 mg/kg
Q24 hrs
4-6 wks

106
Q

Infective Endocarditis

Dosage/duration/freq of PCN G IV + Genatmicin in PCN resistant Streptococcus

A

PCN
* 18-30 mil. units, divided
* Q24 hrs
* 4-6 wks

Genta
* 3 mg/kg
* Q24 hrs
* 4-6 wks

107
Q

Infective Endocarditis

Abx for Enterococcus

2 options

A
  1. PCN G or Ampicillin or Vancomycin
  2. Above + Gentamicin
108
Q

Infective Endocarditis

Which abx is inadequate as monotreatment for Enterococcus?

A

PCN

109
Q

Infective Endocarditis

What do you add for tx because PCN is inadequate for Enterococcus spp?

A

aminoglycoside (streptomycin or gentamicin)

110
Q

Infective Endocarditis

Dosage/duration/freq of PCN G when used for enterococcus

note: don’t use as monotreatment!

A

18-30 mil units
Q24 hrs
4-6 wks

111
Q

Infective Endocarditis

Dosage/duration/freq of Ampicillin for Enterococcus

A

2 g
Q4 hrs
4-6 wks

112
Q

Infective Endocarditis

Dosage/duration/freq of vancomycin when used for Enterococcus

A

15 mg/kg
Q12 hrs
4-6 wks

113
Q

Infective Endocarditis

Dosage/duration/freq for Gentamicin when used for Enterococcus

A

1 mg/kg
Q8 hrs
4-6 wks

114
Q

Infective Endocarditis

Define MSSA

A

Methicillin-susceptible S. aureus

115
Q

Infective Endocarditis

Define MRSA

A

Methicillin-resistant S. aureus

116
Q

Infective Endocarditis

Abx for MSSA with Native Valve IE

4

A
  1. Nafcillin/Oxacillin
  2. Cefazolin
  3. Vancomycin
117
Q

Infective Endocarditis

Dosage/duration/freq for Nafcillin or Oxacillin when used for MSSA

Native Valve IE

A

5-2 g
Q4 hrs (12g/24 hrs)
6 wks

118
Q

Infective Endocarditis

Dosage/duration/freq for Cefazolin when used for MSSA

Native Valve IE

A

2g
Q8 hrs
6 wks

119
Q

Infective Endocarditis

Dosage/duration/freq for Vanco when used for MSSA

Native Valve IE

A

15 mg/kg
Q12 hrs
6 wks

120
Q

Infective Endocarditis

Abx for MRSA in Native Valve IE

2

A
  1. vancomycin
  2. daptomycin
121
Q

Infective Endocarditis

Dosage/duration/freq of Vancomycin for MRSA

Native Valve IE

A

15 mg/kg
Q12 hrs
6 wks

122
Q

Infective Endocarditis

Dosage/duration/freq for Daptomycin with MRSA

Native Valve IE

A

> / = 8 mg/kg
Q24 hrs
6 wks

123
Q

Infective Endocarditis

If the pt has prosthetic valve IE how do you modify abx therapies?

A

Triple therapy

124
Q

Infective Endocarditis

Which abx are added to achieve triple therapy with both MSSA and MRSA in prosthetic valve IE?

A

Rifampin
Gentamicin

125
Q

Infective Endocarditis

Abx therapy for MSSA in Prosthetic Valve IE

A
  1. Nafcillin/Oxacillin, Ceftriaxone, or Vacno
  2. Rifampin
  3. Gentamicin
126
Q

Infective Endocarditis

Dosage/duration/freq of Rifampin for MSSA or MRSA in Prosthetic Valve IE

A

300 mg PO
Q8 hrs
6 wks

127
Q

Infective Endocarditis

Dosage/duration/freq of Gentamicin for MSSA or MRSA in Prosthetic Valve IE

A

1 mg/kg
Q8 hrs
2 wks

128
Q

Infective Endocarditis

Do the doses/durations/freqs of Nafcillin/Oxacillin, Ceftriaxone, or Vancomycin differ from Native Valve IE to Prosthetic Valve IE?

A

No

129
Q

Infective Endocarditis

Does the dose/duration/freq of Vanco differ from Native Valve IE to Prosthetic Valve IE?

A

No

130
Q

Infective Endocarditis

HACEK bacteria

these are gram neg

A

Haemophilus spp.
Aggregatibacter actinomycetemcomitans
Cardiobacterium hominis
Eikenella corrodens
Kingella kingae

131
Q

Infective Endocarditis

Abx options for HACEK IE

6 total

A
  1. Ceftriaxone
  2. Ampicillin
  3. Cipro
  4. Bactrim/Quinolong/Aztreonam
132
Q

Infective Endocarditis

Early surgical indications

7

A
  1. acute heart failure due to valve destruction
  2. unresponsive to abx
  3. septal abcess
  4. sinus of valsalva involved
  5. recurrent IE with the same organism
  6. embolism despite tx
  7. large mobile vegetation
133
Q

Infective Endocarditis

What would be a late surgery? do we prefer late surgery?

after what?

A

abx course completed
prefer this is pt is stable enough

134
Q

Infective Endocarditis

Surgical considerations of repair vs replacement of valve?

A
  1. extent of damage
  2. active infection
  3. compliance w/ anti-coags
135
Q

Infective Endocarditis

What things should be continued post op?

which meds? how long?

A
  1. abx 1-2 wks post-op
  2. anti-fungal 6 wks post-op
136
Q

Infective Endocarditis

Risk stratification for surgery

7 things

A
  1. age
  2. EF < 40%
  3. pre-op shock
  4. CKD on dialysis
  5. Paravalvular abscess
  6. Dysrhythmia
  7. S. aureus infection
137
Q

Infective Endocarditis

Prognosis

survival rate, surgery rate, recurrance rate

A
  1. almost always fatal if untreated
  2. ~70% survival w/ tx
  3. 60% require surgery
  4. 20-31% have recurrance
138
Q

Infective Endocarditis

Bacterial IE mortality

in hospital vs 6-month

A
  1. 18-23%
  2. 22-27%
139
Q

Infective Endocarditis

Fungal IE mortality

in hospital vs 1 yr

A
  1. 36%
  2. 59%
140
Q

Infective Endocarditis

Overall Complications

BIG PICTURE (4)

A
  1. valve damage/destruction
  2. abscess
  3. peripheral embolization
  4. therapy-related complications
141
Q

Infective Endocarditis

What would valve damage/destruction complication lead to?

A

heart failure

142
Q

Infective Endocarditis

what would an abscess complication lead to?

A

conduction disturbance

143
Q

Infective Endocarditis

What can peripheral embolization lead to?

6 things

A
  1. in myocardium, MI
  2. in lungs, PE
  3. in brain/spinal cord, stroke/paralysis
  4. in eyes, blindness
  5. in extremities, limb ischemia
  6. in spleen/kidney, infarct
144
Q

Infective Endocarditis

Prevention

A
  1. Basic considerations of risk factors
  2. Basic considerations of risk of bacteremia from procedures
  3. Basic considerations of risk of adverse outcomes from abx
  4. Targeting most likely orgnaisms
145
Q

Infective Endocarditis

When is prophylaxis indicated?

5 things

A
  1. hx of IE
  2. cardiac valve disease in transplanted heart
  3. unrepaired cyanotic CHD or incompleted repaired
  4. CHD repair using prosthetic material
  5. prosthetic heart valve
146
Q

Infective Endocarditis

When is prophylaxis not indicated?

7 things

A
  1. hx of rheumatic fever or kawasaki disease w/out valvular dysfuntion
  2. acquired valvular dysfunction
  3. bixuspid aortic valve
  4. simple atrial septal defect
  5. mitral valve prolapse w/ regurgitation
  6. hypertropic cardiomyopathy
  7. valve repair w/out prosthetic materia
147
Q

Infective Endocarditis

High risk procedures that can lead to IE

3

A
  1. dental work (gingival)
  2. resp tract incisions
  3. surgery for infected skin
148
Q

Infective Endocarditis

Prophylaxis meds/doses for high risk pts undergoing high risk procedures

4

A
  1. Amoxicillin- 2g PO
  2. Cephalexin- 2g PO
  3. Clindamycin- 600mg PO
  4. Azithromycin- 500mg PO
149
Q

Infective Endocarditis

When to dose prophylatic meds to high risk pts

A

60 min prior to procedure

150
Q

Infective Endocarditis

Low risk procedures leading to IE

A
  1. GI/GU
  2. c-section
151
Q

Staphylococcus Aureus

Most common infections associated w/ S. aureus

A
  1. skin/soft tissue
  2. osteomyelitis (60%)
  3. bacteremia
  4. endocarditis
  5. TSS
152
Q

Staphylococcus Aureus

what % of population are carriers?

A

25%

153
Q

Staphylococcus Aureus

Rates of ____ are high?

A

MRSA

154
Q

Staphylococcus Aureus

Treatment of non-MRSA infections

A
  1. incision & drainage
  2. Cephalexin, 500mg PO, QID
155
Q

Staphylococcus Aureus

Treatment of MRSA infections

A
  1. incision & drainage
  2. Clindamycin, 300mg PO, TID
    or
  3. Vanco, 1gm IV, Q12 hrs
156
Q

Staphylococcus Aureus Toxins

What infections can S. aureus lead to?

3 things

A
  1. Scalded skin syndrome
  2. TSS
  3. Enterotoxin food poisoning
157
Q

Staphylococcus Aureus Toxins

which population is scalded skin syndrome typically seen in?

A

children

158
Q

Staphylococcus Aureus Toxins

describe TSS

A

quick onset febrile illness w/ diffuse macular erythematous rash and nonpurulent conjunctivitis

159
Q

Staphylococcus Aureus Toxins

fatality rate of TSS

A

15%

160
Q

Coagulase Negative Staphylococcus

most common species?

3

A
  1. epidermidis
  2. haemolyticus
  3. hominis
161
Q

Coagulase Negative Staphylococcus

are commonly resistant to ____, so they are treated with _____

A
  1. beta-lactams
  2. vancomycin
162
Q

Coagulase Negative Staphylococcus

most common type of infection?

A

wound infections in those with intravascular and prosthetic devices

163
Q

Coagulase Negative Staphylococcus

Can cause which complications?

A

osteomyelitis
endocarditis

164
Q

Coagulase Negative Staphylococcus

part of which flora normally?

A

skin flora

165
Q

Enterococcus

typical species causing infection

A
  1. faecalis
  2. faecium
166
Q

Enterococcus

typical infections

A
  1. wound infections
  2. UTIs
  3. bacteremia
  4. IE
167
Q

Enterococcus

Treatment options

A
  1. PCN
  2. Vanco
  3. Linezolid
168
Q

Enterococcus

when to use vanco rather than PCN?

A
  1. PCN allergy
  2. PCN resistance
169
Q

Enterococcus

dosage/freq of PCN/ampicillin

A

A: 2g, Q4 hrs
PCN: 3-4 mil units, Q4 hrs

170
Q

Enterococcus

Vancomycin dosage/freq

A

15 mg/kg IV, Q12 hrs

171
Q

Enterococcus

what to use in vanco resistance?

A

Linezolid
600mg Q12 hrs

172
Q

Enterococcus

what to do with VRE?

A
  1. culture sensitivity
  2. inpatient contact isolation
  3. ID consult
173
Q

Enterococcus

risks of linezolid

A
  1. bone marrow suppression
  2. thrombocyotpenia
174
Q

Pneumococcus

most common cause of?

A

community acquired bacterial pneumonia

175
Q

Pneumococcus

what makes a patient high risk?

5 things

A
  1. old age
  2. multilobar disease
  3. hypoxemia
  4. bacteremia
  5. extrapulm complications
176
Q

Pneumococcus

Dx

A
  1. sputum culture
  2. rapid urine antigen test for s. pneumoniae
177
Q

Pneumococcus

sens/spec of rapid urine antigen test

A
  1. sens: 70-80%
  2. spec: 95%
178
Q

Pneumococcus

complications

4

A
  1. parapneumonic effusions
  2. pericarditis
  3. endocarditis
  4. meningitis
179
Q

Pneumococcus

Outpatient tx

first line & in PCN allergy

A
  1. Amoxicillin, 750mg PO, Q24
  2. Azithromycin, 500mg day 1, followed by 250mg daily for 4 days
180
Q

Pneumococcus

inpatient tx

first line & PCN allergy

A
  1. PCN G, 2 mil units IV, Q4 hrs
  2. Vanco, 1g IV, Q12 hrs
181
Q

Bacillus

most common species causing infection

A

B. cereus

182
Q

Bacillus

which pts are most likely to become ill with this?

3 populations

A
  1. immunocomp
  2. IVDU
  3. indwelling/implanted catheters
183
Q

Bacillus

most common infections

A
  1. food posioning
  2. bacteremia
  3. endocarditis
  4. ocular infections
184
Q

Bacillus

most commonly resistant to what? so we use what?

A
  1. PCN and cephalosporins
  2. Vanco

CMT (72 decks)

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