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Therapeutics V > Infectious Disease - Principles in Abx Selection Handout > Flashcards

Infectious Disease - Principles in Abx Selection Handout Flashcards

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1
Q

Gram Stain Positive color

A

PURPLE

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2
Q

Gram Positive Cocci in clusters: Coagulase positive

A

S. aureus

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3
Q

Gram Positive Cocci in clusters: Coagulase negative

A 
S. epidermidis
S. lugdunensis
S. hominis
S. saprophyticus
S. haemolyticus
S. capitis
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4
Q

Gram-positive cocci in pairs

A

Streptococcus pneumoniae

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5
Q

Gram-positive cocci in chains:

Viridans streptococci (α-hemolytic):

A 
S. milleri
S. mutans
S. salivarius
S. mitis
S. sanguis
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6
Q

Gram-positive cocci in chains:

Group streptococci (β-hemolytic):

A

Group A (S. pyogenes),

Group B (S.
agalactiae)

Group C (Streptococcus equi)

Group D (S. bovis, S. equinus),

Groups F and G streptococci (S. dysgalactiae)

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7
Q

Gram-positive cocci in pairs & chains

A

Enterococcus spp. (E. faecalis, E. faecium, E. durans, E. gallinarum, E.
avium, E casseliflavus, E. raffinosus)

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8
Q

Gram-positive bacilli classifications

A

non spore forming

spore forming

branching, filamentous

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9
Q

Gram-positive bacilli classifications:

non spore forming

A

Corynebacterium spp. (C. diphtheriae, C. jeikeium, C. striatum, etc.)

Lactobacillus spp.

Listeria monocytogenes

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10
Q

Gram-positive bacilli classifications:

spore forming

A

Bacillus spp. (B. anthracis, B. cereus, etc.)

Streptomyces spp.

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11
Q

Gram-positive bacilli classifications:

branching, filamentous

A

Erysipelothrix rhusiopathiae

Nocardia spp. (N. asteroides)

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12
Q

Gram Stain Negative color

A

red

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13
Q

Gram-negative cocci

A

Neisseria spp. (N. gonorrhoeae, N. meningitidis, etc.)

Moraxella catarrhalis

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14
Q

Gram-negative coccobacilli

A

Haemophilus spp. (H. influenzae, H. parainfluenzae, H. ducreyi, etc.)

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15
Q

Gram-negative bacilli examples

A

lactose-fermenting

non lactose fermenting

other gram negative bacilli

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16
Q

Gram-negative bacilli:

lactose fermenting

A

Aeromonas hydrophila
*Citrobacter spp. (C. freundii, C. koseri)
*Enterobacter spp. (E. cloacae, E. aerogenes [Klebsiella aerogenes])
*Escherichia coli
*Klebsiella spp. (K. pneumoniae, K. oxytoca)
Pasteurella multocida
Vibrio cholerae

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17
Q

Gram-negative bacilli:

non lactose fermenting

A

Acinetobacter spp. (A. baumannii)
Alcaligenes spp.
Burkholderia cepacia
*Morganella morganii
*Proteus spp. (P. mirabilis, P. vulgaris)
*Providencia spp. (P. rettgeri, P. stuartii)
Pseudomonas spp. (P. aeruginosa, P. putida, P. fluorescens)
*Salmonella spp. (S. typhi, S. paratyphi, S. enteritidis, S. typhimurium)
*Serratia marcescens
*Shigella spp. (S. dysenteriae, S. sonnei)
Stenotrophomonas maltophilia

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18
Q

Gram-negative bacilli:

other gram negative bacilli

A 
Brucella spp.
Bordetella spp.
Campylobacter jejuni
Francisella tularensis
Helicobacter pylori
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19
Q

Define gram variable

A

stain both Gram-positive and Gram-negative in the same smear

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20
Q

Gram-variable bacilli example

A

Gardnerella vaginalis

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21
Q

Miscellaneous organisms where Gram stain

is typically not useful: 2 groups

A 
atypical bacteria (Cell walls difficult to stain; Mycoplasma lack a
cell wall)

spirochetes (Motile, corkscrew-shaped organism visualized
using dark field microscopy)

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22
Q

Miscellaneous: atypical bacteria examples

A

Chlamydophila pneumoniae
Chlamydia trachomatis
Legionella pneumophila
Mycoplasma pneumoniae

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23
Q

Miscellaneous: spirochetes

A 
Treponema pallidum (syphilis)
Borrelia burgdorferi (Lyme disease)
Leptospira interrogans
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24
Q

Gram stain positive (anaerobic): gram positive cocci in chains

A 
Peptostreptococcus spp. (P. anaerobius, P. intermedius)
Finegoldia magna (formerly P. magnus)
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25
Gram-positive bacilli (anaerobic): examples
non-spore forming spore forming branching, filamentous
26
Gram-positive bacilli (anaerobic): non spore forming examples
Cutibacterium spp. (C. acnes [formerly Propionibacterium acnes])
27
Gram-positive bacilli (anaerobic): spore forming
Clostridium spp. (C. perfringens, C. tetani, C. botulinum) Clostridioides difficile
28
Gram-positive bacilli (anaerobic): branching, filamentous
Actinomyces spp. (A. israelii)
29
Gram negative (anaerobic) cocci
Veillonella spp. (V. parvula)
30
Gram negative (anaerobic) bacilli
Bacteroides spp. (B. fragilis, B. thetaiotamicron, B. ovatus, B. distastonis) Fusobacterium spp.
31
Normal flora: Skin
Diphtheriods (e.g., Corynebacterium spp.) Staphylococci (esp. S. epidermidis) Streptococci Propionibacterium spp.
32
Normal flora: Oropharynx
Haemophilus spp. Streptococci (viridans group) Diphtheriods (e.g., Corynebacterium spp.) Neisseria spp. Oral anaerobes
33
Normal flora: gastrointestinal tract
Bacteroides spp. Enterobacteriaceae Enterococci Fusobacterium spp. Peptostreptococcus spp. Clostridium spp.
34
Normal flora: Genital tract
Corynebacterium spp. Enterobacteriaceae Lactobacillus spp. Mycoplasma spp. Staphylococci Streptococci Anaerobes Candida spp.
35
Fever is a ________ of infection
hallmark
36
Fever significant if oral temperature
> 38.0°C (100.4°F)
37
Rectal temperature generally 0.6°C (1°F) ______; axillary temperature generally 0.6°C (1°F) ______
higher lower
38
non-infectious causes of fever
Malignancy, collagen vascular disease (autoimmune) Drug fever – fever coincides temporally with administration of the offending agent and disappears promptly with withdrawal of the offending agent Blood transfusions
39
Drug fever offending agents
β-lactam antibiotics, anticonvulsants, allopurinol, hydralazine, nitrofurantoin, sulfonamides, phenothiazines, methyldopa
40
Absence of fever in a patient with signs and symptoms consistent with an infection (false-negatives) EXAMPLES
Antipyretics – discourage during treatment of infection (may mask poor therapeutic response) Corticosteroids Antimicrobial therapy (partial) Overwhelming infection
41
Signs and symptoms of infection
Fever (temp > 38°C) Increased white blood cell count Chills, rigors Tachycardia (> 90 beats/min) Tachypnea (> 20 breaths/min) Hypotension (SBP < 90 mmHg or MAP < 70) Malaise Mental status changes
42
Normal WBC count
4,500 to 10,500/mm3
43
Mature neutrophil (PMNs, polys, segs) normal range
50 - 70%
44
Immature neutrophils (bands) normal range
0 - 5%
45
Eosinophils normal range
0 - 5%
46
Basophils normal range
0 - 2%
47
Lymphocytes normal range
15 - 40%
48
Monocytes normal range
2 - 8%
49
Leukocytosis (increased neutrophils ± bands) – associated with
bacterial infection
50
Presence of immature forms (left shift) is an indication of
an increased | bone marrow response to the infection
51
elevated neutrophils +/- bands potentially due to
non-infectious diseases (e.g., leukemia, stress) or drug therapy (e.g., steroids, lithium)
52
elevated neutrophils +/- bands may be absent due to
neutropenic hosts; blunted in elderly
53
Leukopenia (abnormally low WBC count) may be sign of
an overwhelming infection; poor prognostic sign
54
B-lymphocytes ® proliferate into _________, which produce antibodies involved in ________ immunity; some develop into memory cells
plasma cells humoral
55
T-lymphocytes – involved in ____________ immunity
cell-mediated
56
T helper/inducer cells (CD4) --> regulation of the immune system; help with ________ _________ and secrete ____________ that help protect against bacterial/viral infections and tumors; the major marker of immunocompetence in patients with ___________ (this cell line is depleted with HIV infection)
antibody production lymphokines HIV infection
57
``` T suppressor (CD8) ® bind to and directly kill ____ _____; help with regulation of _________ and ________ immunity ```
tumor cells humoral cell-mediated
58
Define monocytosis
important phagocytic cells responsible for antigen processing and presentation; associated with tuberculosis or lymphoma
59
Define eosinophilia
associated with allergic reactions or protozoal/parasitic | infections
60
Localized signs and symptoms of infection
a. Pain and inflammation – swelling, erythema, tenderness, purulent or abnormal drainage • Easily detected in superficial infections or infection of the bone or joint b. Inflammation in deep-seated infections (e.g., pneumonia, meningitis, urinary tract infection) – must examine tissues/fluids (sputum, CSF, urine) c. May be absent in neutropenic hosts
61
ESR and CRP and infection
Elevated in the presence of an inflammatory process but does not confirm the presence of infection
62
Normal ESR values
0 to 15 mm/hr in males 0 to 20 mm/hr in females
63
Normal CRP values
0 to 0.5 mg/dL
64
ESR and CRP elevated in presence of which infections
otitis media, osteomyelitis, prosthetic joint infections, endocarditis, pelvic inflammatory disease, and infections in transplant patients
65
Serial measurement of ESR and CRP may be useful in assessing response to...
treatment of deep-seated infections, such as endocarditis or osteomyelitis
66
PCT and infections
A precursor of calcitonin, a calcium regulatory hormone, which is a more specific marker for bacterial infections than ESR or CRP Some data suggest that PCT levels may be useful for assessing the efficacy of empiric antibiotic therapy as well as for determining when antibiotic therapy can be discontinued during the treatment of an infection
67
Normal PCT value
Normal value = < 0.05 μg/L
68
Meaning of PCT ≥ 10 μg/L ®
sepsis/systemic bacterial infection
69
Meaning of PCT between 2 and 10 μg/L
suggestive of sepsis
70
Meaning of PCT between 0.25 and 2 μg/mL
other condition or localized infection
71
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Therapeutics V (17 decks)

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