Infectious Disease II Flashcards
(100 cards)
1
Q
What are the most common skin bacteria that play a role in increased risk of infections during perioperative surgeries?
A
- Staphylococci & Streptococci
- Some Gram negative and anaerobics too
2
Q
What is the recommended antibiotics for someone getting an cardiac or vacular surgical procedure? What if the patient has a Beta-Lactam Allergy?
A
- Cefazolin or Cefuroxime
- Beta-Lactam Allergy: Clindamycin or Vanc
3
Q
What is the recommended antibiotics for someone getting an Orthopedic (Joint replacement, hip fracture repair…) surgical procedure? What if the patient has a Beta-Lactam Allergy?
A
- Cefazolin
- Beta-Lactam Allergy: Clindamycin or Vanc
4
Q
What is the recommended antibiotics for someone getting an Gastrointestinal (Appendectomy, Colorectal) surgical procedure? What if the patient has a Beta-Lactam Allergy?
A
- Cefazolin + Metronidazole, Cefotetan, Cefoxitin, or Unasyn
- Beta-Lactam Allergy: Clindamycin or Metronidazole + AGs or Quinolone
5
Q
What is meningitis?
A
- Inflammation of the meninges; membranes that cover the brain and spinal cords
6
Q
What are the classic symptoms of meningitis?
A
- Fever
- Headache
- Stiff Neck
- Altered Mental Status
7
Q
What is the way that meningitis is diagnosed?
A
- Lumbar Puncture and getting cerebrospunal fluid (looking for WBC, Proteins, Glucose…) - High CSF pressure could also show it too
- Also a grain stain to help with picking antibiotics
8
Q
What are the most common bacterial causes of meningitis?
A
- N. Meningitidis, Strep Pneumoniae, H. fluenzae
- Listeria Monocytogenes: higher risk in neotnates, Age > 50, Immunocompromised
- But its mostly viruses
9
Q
What is the antibiotic durations for each of the pathogens (N. Meningitidis, S. Pneumoniae, H. Fluenzae, Listeria Monocytogenes) when treating acute bacterial meningitis (community acquired)?
A
- 7 days: N. Meningitidis & H. Flu
- 10 - 14 days: S. Pneumo
- ~21 days: Listeria Monocytogenes
10
Q
What is the Empiric treamtnet for meningitis in Neonates (< 1 month)?
A
- Ampicilin (for Listeria Coverage) +
- Ceofteaxime, Ceftrazidime or Cepeime +/-
- Gentamicin
DO NOT use ceftriaxone in Neonates = Biliary Sludging and Kernicterus
11
Q
What is the Empiric treamtnet for meningitis in those aged 1 month to 50 years?
A
- Ceftriaxone +
- Vacnomycin
12
Q
What is the Empiric treamtnet for meningitis in those age > 50 or immunocompromised?
A
- Ampicillin (for Listeria Coverage) +
- Ceftriaxone +
- Vancomycin
13
Q
What are the signs and symptoms of Acute Otitis Media
Ear infections in kids
A
- Rapid Onset
- Bulging Eardrums
- Otorrhea (middle ear fluid)
- Ear Pain (Otalgia)
- Fever, Crying, Tugging/Pulling on ears
14
Q
What are some of the common pathogens that are seen within acute otitis media
A
- Mostly causes by viruses BUT
- S. Pneumoniae, H. Influenzae, M. Catarrhalis
15
Q
When is it best to consider observation in the treatment of Acute Otitis Media in kids?
A
- Try watching for 2 - 3 Days if symptoms are not severe (ear pain < 48H, No ear fluids, temp < 102.2 and age 6 -23 with ONE ear affected & age > 2 in ONE or BOTH ears
- symptoms worsen = antibiotics
16
Q
What is the antibiotic Treatment for someone that has acute otitis media?
Durations?
A
- High dose amoxicillin or Amoxicillin/Clavulante are 1st line
- With a Non-severe penicillin allergy: 2nd or 3rd gen cephalosporin is recommended (Cefdinir, Cefuroxime, Cefpodoxime, Ceftriaxone)
10 days for < 2yo
7 days for 2 - 5
5-7 days for >6
17
Q
What is acute bronchitis?
A
- Inflammation of the mucous membrane of the bronchi
- Key features: cough lasting 1-3 weeks, chest wall tenderness, wheezing…)
18
Q
What is important to know about acute bronchitis?
-
A
- Normally a virus but bacterial infections are rare (S. Pneumo, H. Flu, Atypycials)
- NO ANTIBIOTICS will help since its viral; give supportive care things
19
Q
what is pertussis and how does it differ form acute bronchitis?
A
- Just bronchitis caused by Bordetella Pertussis with coughs making that whooping sound
20
Q
What is the recommended treatment for someone with pertussis?
A
- Pertussiss is highly contagious can should be treated with Macrolides (azithormycin, Clarithormycin)
21
Q
What are the 3 cardinal symptoms of an COPD Exacerbation?
A
- Increased Dyspnea
- Increased Sputum Volume
- Increased Sputum Purulence
22
Q
What are some of hte bacterial pathogens that could trigger a COPD Exacerbation?
A
- H. Flu, M, Catarrhalis, S. Pneumo
23
Q
When should antibiotics be started for someone that is having a COPD Exacerbation? What are some of the preferred antibiotics?
A
- Antibiotics for 5-7 days if ONE of the following: all three cardinal symptoms, Increased purulence + 1 other symptoms, mechanic vent
- Amoxilillin/Clavulanate, Azithromycin, Doxycyline, Respiratory Quinoloine
24
Q
What are some of the common symptoms for comunity acquired pneumonia (CAP)?
A
- SOB, Fever, Cough with Purulent Sputum, Rales (Crackling noises in lungs), tachypenia
25
What is the **gold standard diagnostic test** to help indicate if someone has **Pneumonia** or not?
- Chest x-ray showing **Infiltrate, opacities, or consolidation**
26
What is **community acquired pneumonia**?
- Pneumonia that is contracted **outside** of a healthcare facility and can be **bacterial, viral, or fungal (rare)** - "walking pneumonia"
27
What are some of the **most common bacterial pathogens** for **CAP**?
- S. Pneumo
- H. Flu
- M. Pneumo
28
What is the **outpatient CAP treatment** for someone that is **healthy (no comorbidities)**?
## Footnote
What are the comorbities?
- Amoxicillin high dose (1 gram TID) **OR**
- Doxycycline **OR**
- Macrolides (azithormycin or clarithromycin) if local Pneumo resistance is < 25%
| 5 - 7 days
## Footnote
Comorbities: Chronic Heart, Lung, Liver or Renal Disease; Diabetes; Alcohol Use Disorder
29
What is the **outpatient CAP treatment** for someone that is **High Risk (with comorbidities)?
## Footnote
What are the comorbidities
- Beta Lactam + Macrolide or Doxycyline (**Amoxicillin/Clavulanate or Cephalosporine** [Cefpodoxime, Cefuroxime] **+ Macrolide or Doxycyline**)
- Respiratory Quinolone Mono (**Moxifloxacin or Levofloxacin**) [NOT Cipro; bc it is NOT a Repiratory Quinolone]
| 5 - 7 days
## Footnote
Comorbities: Chronic Heart, Lung, Liver or Renal Disease; Diabetes; Alcohol Use Disorder
30
What is the **Inpatient CAP treatment options** for someone that is **non-severe [admission to a general medicine unit]**?
- Beta-Lactam + Macrolide or Doxycyline (Preferred **Ceftriaxone**, Ceftaroline, or **Unasyn**)
- Respiratory Quinolone Monotherapy (**Moxi or Levo**)
31
What is the **Inpatient CAP treatment options** for someone that is **severe [admission to the ICU]**?
- Beta Lactam + Macrolide
- Beta Lactam + Respiratory Quinolone (**DO NOT** use quinolone as Mono here)
32
What are some **Inpatient CAP treatment options** for someone that has **risk factors for Pseudomonas and/or MRSA**?
- MRSA: **+ Vancomycin or LInezolid**-
- Pseudo: **Zosyn, Cefepime, Merrem** (any Pseduo coverage drug)
33
What is the **difference** between **Hospital Acquried Pneumonia (HAP)** and **Ventilator Associated Pneumonia (VAP)**?
- HAP: Onset **> 48 hours** after **admission**
- VAP: Onset **> 48 hours** after starting **Vent**
34
What are the **common pathogens** that are associated with **HAP & VAP**?
- **Nosocomial Pathogens** (MRSA, MDR Gram Negative Rods, P. Aeruginosa, Acinetobacterm Enteobacterm E. Coli, Klebsiella)
## Footnote
Nosocomial are those bugs found only within healthcare building
35
What is **tuberculosis**?
- Caused by **Mycobacterium Tuberculosis**; is is a Lung infection that can spread to other organs and has two phases **Latent & Active**
36
What is the **difference** between **latent & active** TB?
- Latent: immune system has contained the infection and there are **no symptoms**
- Active: easily transmitted via **areosolized droplets** and is **highly contagious** causing; **coughing up blood, fevers, night sweats, weight loss**
## Footnote
**Hospitalization** required the patient to be in a **negative pressure room** with the staff wearing **repurator masks** upon entering the room
37
What is the way that **Latent Tuberculosis** can be **Diagnosed**?
## Footnote
What you had to do for rotations
- Tuberculin Skin Test (TST): inject **intradermally** to check for a **raised area** after **48-72 hours**
38
What are the **Latent TB Treatment Options**?
- **INH + Rifapentine** once weekly for **12 weeks** (DO NOT use this with **pregnant patients**)
- **INH + Rifapentine** daily for **3 months**
- **Rifampin 600** mg daily for **4 months**
- **INH 300** mg daily for **6 or 9 months** (**good** in those with **HIV**)
39
What is the way that we **diagnosed Active TB**?
- Acid-fast bacilli with a AFB Smear
40
What are the **2 phases** of **Active TB Treatment**?
- Intensive: **4 drugs for 2 months** (**"RIPE"**: Rifampin, Isoniazid, Pyrazinamide, Ethambutol)
- Continuation: **2 drugs for 4 months** (Isoniazid & Rifampine)
41
What are the **side effects** for **Rifampin** used in **active TB**?
- **Increased LFTs, Hemolytic Anemia** (detected with + Coombs test), **Flu like symptoms**
- **orange-red discoloration** of body fluids
42
What are the **additional notes** for **Rifampin** used in **active TB**?
- MANY **DRUG-DRUG** INTERACTIONS; Rifabutin has fewer tho and can replace Rifampin if needed
43
What are the **boxed warnings** for **Isoniazid** used in **active TB**?
- Severe (and fatal) **Hepatitis**
44
What are the **warnings** for **Isoniazid** used in **active TB**?
- **Peripheral Neuropathy** - giving **vitamin B6** (Pyridoxine) is recommended
45
What are the **side effects** for **Isoniazid** used in **active TB**?
- **Increased LFTs, DILE, Hemolytic Anemia** (Detected with + Coombs test)
46
What are the **contraindications** for **Pyrazinamide** used in **active TB**?
- Those with **acute gout**
47
What are the **side effects** for **Pyrazinamide** used in **active TB**?
- Increased LFTs, Hyperuricemia/Gout
48
What are the **side effects** for **Ethambutol** used in **active TB**?
- **Increased LFTs, Optic Neurtitis** (dose related), **confusion, Hallucinations**, N/V
49
What is **endocarditis**?
- Infection of the **inner tissue** of the heart (typically **heart valves**)
50
what is the way that **endocarditis** is **diagnosed**?
- using **modified dukes criteria** (includes **echocardiogram** [to look at the vegeation] **& positive blood cultures**)
51
What are the **most common pathogens** that cause **endocarditis**?
- Staphylococci
- Streptococci
- Enterococci
52
What is the **infective endocarditis treatment** for someone with a **virdans group streptococci** organsim?
- Penicillin or Ceftriaxone (**+/-** genamicin)
- If beta lactam allergy: Vacnomycin monotherapy
53
What is the **infective endocarditis treatment** for someone with a **Staphylococci (MSSA)** organsim?
- Nafcillin or Cefazolin (**+** Gentamicin and Rifampin if **prostheitic valve**)
- If beta lactam allergy: Vancomycin (**+** Gentamicin and rifampin if **prosthetic valve**)
54
What is the **infective endocarditis treatment** for someone with a **sthaphylococci (MRSA)** organsim?
- Vancomycin (**+** Gentamicin and rifampin if **prosthetic valve**)
55
What is the **infective endocarditis treatment** for someone with a **Enterococci** organsim?
- Native and Prosthetic Valve: Penicillin or Ampicillin **+** Gentamicin, OR Ampicillin + high dose ceftriaxone
- If beta lactam allergy: Vancomycin **+** Gentamicin
- If VRE: Daptomycin or Linezolid
56
What is the **adult prophylaxis regimens** for someone that is getting **dental work** to decrease the risk of **endocarditis**?
- **Amoxicillin 2 g PO**
- Ampicillin 2 g IM/IV OR Cefazolin or Cefrixone 1 g IM/IV (If unable to take PO)
- **Azithromycin or Clarithromycin 500 mg** OR **Doxycycline 100 mg** (Can take PO but have Penicillin allergy)
57
What is **Spontaneous Bacterial Peritonitis**?
- Infection of the **peritoneal space** that often occurs in patients with **cirrhosis and ascite**
- Infection = **paracentesis** fluid showing **> 250 cells/mm^3 PMNs**
58
What is the **recommended treatment** for someone that has **spontaneous bacterial peritonitis**?
- **Ceftriaxone for 5 - 7 days** (due to Strep, Proteus, E. Coli, Kleb)
- Meropenem: used for more critically ill patients
59
What is the **secondary prophylaxis** treatment for someone that has recievd the **primary treatment** for their **spontaneous bacterial peritonitis**?
- **Bactrim** or **Ciprofloxican**
60
What is the **presentation** of **Impetigo**? What are the **common pathogens** that cause it?
- Common in kids; blister like rash that forms **honey colored crusts** over the area
- **S. Pyogenes, S. Aureus (MSSA)**
61
What are the **Treament/Comments** for **Impetigo**?
- Warm, Wet Compress to remove crusts (DO NOT SHARE TOWELS)
- **Topical Antibiotics** (Mupirocin)
- A lot of Lesions: **Cephalexin** or Dicloxacillin 250 - 500 mg PO QID
62
What is the **presentation** of **Folliculitis/Furuncle/Carbuncle**? What are the **common pathogens** that cause it?
- Infections of **Hair Folicules**
- **S. Aureus (CA-MRSA)**
63
What are the **treatments/comments** for **folliculitis/furuncle/carbuncle**?
- **Bactrim** DS 1 - 2 tabs PO BID or **Doxycyline** 100 mg PO BID (covering MSSA & MRSA)
64
What is the **presentation** of **mild cellulitis (non-purulent infection)**? What are the **common pathogens** that cause it?
- Localized pain, swelling, redness, warnth
- **Strep (Pyogenes [Group A], S. Aureus)**
65
What are the **treatments/comments** for **mild Cellulitis**?
- **Cephalexin** 500 mg PO QID
- Dicloxacillin 500 mg PO QID
- Beta Lactam Allergy: Clindamycin 300 mg PO QID
## Footnote
**5 day duration**
66
What is the **presentation** of **Mild Abscess (purulent infections)**? What are the **common pathogens** that cause it?
- Localized fluid collection
- **CA-MRSA**
67
What are the **treatments/comments** for **Mild Abscesses**?
- **Bactrim** DS 1 - 2 tabs PO BID
- **Doxycyline** 100 po BID
- Minocycline 200 mg PO x 1, then 100 mg PO BID
- Clindamycin 300 mg PO BID
- Linezolid 600 mg PO BID
## Footnote
Covers **MSSA & MRSA**
68
What is **diabetic foot infections**?
- Foot ulcers that are caused by **neurpathic damage, compromised blood flow** ( due to peripheral artery disease) **and poor wound healing** (due to hyerpglycemia)
## Footnote
Can lead to amputations
69
What is the **treatment options** if **no MRSA activity is needed** for someone that has **moderate to severe diabetic foot infection**?
- Unasyn
- Etrapenem
- Ceftriaxone
- Levo or Moxi
70
What is the **treatment options** if **pseudomonas and/or MDR gram-negtive activity needed** for someone that has **moderate to severe diabetic foot infections**?
- Zosyn
- Cefepime
- Meropenem, Doripenem, or Imipenem/Cilastatin
71
What is the **treatment options** if **MRSA activity is needed** for someone that has **moderate to severe diabetic foot infections**?
- **+** Vancomycin, Daptomycin or Linezoild
72
What is the **treatment options** if **Anaerobic activity is needed** for someone that has **moderate to severe diabetic foot infections**?
- Beta-lactam/Beta lactamase inhibitor combo, Carbapenem OR
- **+** Metronidazole
73
What are the **types** of **urinary tract infections**?
- **LOWER**: basic UTI
- **UPPER**: Kidney infections (Puelonephritis)
## Footnote
MORE common in females than males
74
What are the **common UTI symptoms** for **Cystitis (lower UTI)**?
- Urgency and Frequency of Peeing (including overnight)
- Painful Urination
- Suprapubic tenderness
- Blood in the urine
75
What are some **common UTI symptoms** for **Pyelonephritis (Upper UTI)**?
- **FLANK PAIN**
- Fever, Chills, malaise
76
# What
What is the **UTI Treatment** for someone with **acute cycstitis**?
## Footnote
**E. Coli**
- **Nitrofurantoin (Macrobid)** 100 mg PO BID x 5 days OR **Bactrim** DS 1 tab PO BID OR **Fosfomycin** 3 g x **1 dose**
- If Pregnant: **Amoxicillin, Cephalexin**
## Footnote
Alt options: Amoxicillin/Clavulanate or Cephalosporins x 5-7d, Cipro, Levo (DO NOT use quinolone in kids)
77
What is the **UTI Treatment** for someone that is **moderatly ill outpatient for Acute Pyelonephritis**?
- If Local Quinolone **resistance is < 10%**: **Cipro or Levo**
- If Local Quinolone **resistance is > 10 %**: **Ceftriazone** 1 g IM/IV x1, **Ertapenem** 1 g IM/IV x1 or **AGs** IM/IV x1 --> back with Quinolone
78
What is the **UTI Treatment** for someone that is **Severely ill in hospital for acute pyelonephritis**?
- initial: **Cefriaxone** or Quinolone (**Cipro or Levo**)
- Resistance?: **Zosyn, Carbapenem** (if ESBL)
79
What **medication** is used to help with **Urinary Pain**?
- Phenazopyridine (Pyridium, Azo Urinary Pain Relief)
## Footnote
**OTC** and Rx
80
What is the **dosing** for **Phenazopyridine**?
- 200mg PO TID x **2 days MAX**
- **Take with 8oz of water with food** to deceases stomach upset
81
What is **C. Diff**?
- Inflammation of the colon (**Colitis**) cause by C. Difficile releasing **Toxin A & B** to attack the intestinal lining
## Footnote
Can also be caused by **PPIs, Advanced Age, Immunocompormised, Previous C. Diff**
82
What are some of the **symptoms** of **C. Diff**?
- Three, watery stools per day
- Abdominal Cramps
- Fever
- Elevated WBCs
83
What is the **treatment** for the **first episode** of **C. DIff**?
- **Fidaxomicin** 200 mg PO BID x 10 days **OR**
- **Vancomycin** 125 mg PO QID x 10 day (**Stadard Regimen**)
- **Metronidazole** 500 mg PO TID x 10 day (**for NON-severe or if PO Vanc is unavailable**)
## Footnote
Basically Metro --> Vanc --> Fida
84
What is the **treatment** for the **second episode (first reurrence)** of **C. Diff**?
- **Fidaxomicin** 200 mg PO BID x 10 days **OR**
- **Vancomycin** 125 mg PO QID x 10 days + pulse taper (**NO** taper if Metronidazole was used for 1st epi)
85
what is the **treatment** for the **third or subsequent episodes** of **C. Diff**?
- **Fidaxomicin** 200 mg PO BID x 10 days **OR**
- **Vancomycin** + Pulse taper **OR**
- **Vancomycin** + Rifaximin 400 mg TID x 20 days **OR**
- **Fecal Mircobiotic Transplantation**
86
What is the **treatment** for **fulminant/complicated disesase** of **C. Diff**?
- **Vancomycin** 500 mg PO/NG/PR **+ metronidazole** 500 mg IV Q8H
87
What is the **Drug of choice** and its **dosing/duration** for someone with **Syphilis (primary, secondary, or early latent)**?
- Penicillin G Benzathine (**Bicillin L-A**) **2.4 million units IM x 1**
88
What is the **Drug of choice** and its **dosing/duration** for someone with **Syphilis (late latent or tertiary)**?
- Penicillin G Benzathine (**Bicillin L-A**) **2.4 million units IM weekly x 3 weeks** (7.2 million total)
89
What is the **Drug of choice** and its **dosing/duration** for someone with **Neurosyphilis**
- **Penicillin G Aqueous** 3-4 million units **IV** Q4H x 10 - 14 days
90
What is the **Drug of choice** and its **dosing/duration** for someone with **Gonorrhea**
- **Ceftriaxone < 150 kg**: **500 mg IM x 1** & **> 150 kg**: 1 g IM x1
- **+** doxycyline if clamydia has NOT been excluded
91
What is the **Drug of choice** and its **dosing/duration** for someone with **chlamydia**
- Not Pregnant: **Doxycyline 100 mg PO BID x 7 days**
- Pregnant: **Aztiromycin 1 g PO x1**
92
What is the **Drug of choice** and its **dosing/duration** for someone with **Bacterial Vaginosis**
- **Metronidazole** 500 mg PO BID x 7 days
- **Metronidazole 0.75% Gel** 1 applicator intravaginally daily x 5 days
- Clindamycin 2% cream 1 applicator intravaginally at bedtime x 7 days
93
What is the **Drug of choice** and its **dosing/duration** for someone with **Trichomoniasis**
- **Metronidazole** (Females: 500 mg PO BID x 7 days & Males: 2 g 1 PO x 1)
94
What is the **Drug of choice** and its **dosing/duration** for someone with **gental warts**
- **Imiquimod Cream** (Zyclara) apply toicapply to clean, dry, warty tissues and wash off in 6 - 10 hours
95
What are some **alternative treatment/notes** for someone with **Syohilis (Primary, Secondary or Early Latent)**?
- Beta Lactam Allergy: **Doxycyline** 100 mg PO BID x **14 days**
- If pregnant, nonadherent with treatment, or unlikey to follow up: **Desenstize** with **Bicilin L-A**
96
What are some **alternative treatment/notes** for someone with **Syphilis (late latent or tertiary)**?
- Beta Lactam Allergy: **Doxycyline** 100 mg PO BID x **28 days**
- If Pregnant, nonadherent with treatment or unlikely to follow up: **Desensitize** with **Bicilin L-A**
97
What are some **alternative treatment/notes** for someone with **Bacterial vaginosis**?
- Females with vaginosis **SHOULD NOT** douche
98
What are some **alternative treatment/notes** for someone with **Trichomoniasis**?
- Pregnancy: **CDC recommends Metronidazole in ALL tris** (even tho pack labeling says not too in 1st tri)
99
What is the **most common tickborne disease**?
- **Rocky Mountain Spooted Fever**
- Lymes Disease
- Ehrlichiosis
100
What is the **preferred treatment** for someone with a **tickborne disease**?
- Doxycyline
