Intro To ID Flashcards
1
Q
hallmark symptom of infection
A
fever
2
Q
fever is what temperature
A
> 38C or 100.4 F
3
Q
what is normal body temp
A
98-98.6 F
4
Q
false positive causes of fever
A
drugs
-beta lactams
-sulfonamides
-anticonvulsants
5
Q
false negative causes of fever
A
administration with antipyretics
(Tylenol, ibuprofen, ASA)
steroids
hypothermia
6
Q
what drugs do we not give with antibiotics
A
antipyretics scheduled (can mask fever and response)
7
Q
systemic signs of infection
A
blood pressure (SBP <90)
HR (tachycardia >90)
RR (>20)
increased/decreased WBC count
(>12k or <4k)
fever (>38C or <36C)
8
Q
systemic inflammatory response syndrome (SIRS) warns us for risk of what
A
if 2+ criteria then risk of sepsis
9
Q
what are the criteria for SIRS
A
HR
RR
fever
inc or dec in WBCs
10
Q
why might WBCs be elevated
A
infection or non infection (leukemia/steroids)
11
Q
mature neutrophils do what
A
most common WBC
fight infection
(first responders)
12
Q
immature neutrophils are called what
A
bands
13
Q
an increase in bands would indicate what
A
left shift
released by bone marrow
increased in infection
14
Q
eosinophils are what
A
allergic reactions, parasites
(more specialized defense)
15
Q
basophils are what
A
hypersensitivity reactions, release histamine
(alarm system)
16
Q
lymphocytes are what
A
B and T cells
17
Q
B cells do what
A
blueprint to create antibodies
18
Q
T cells do what
A
assassins, kill affected cell
19
Q
what are monocytes
A
macrophages, search for foreign material
(take out the trash)
20
Q
leukocytosis is an increase in what
A
neutrophils +/- bands
21
Q
leukocytosis indicates what kind of infection
A
bacterial
22
Q
leukopenia is what
A
low WBC count, could be sign of overwhelming infection and poor prognosis
23
Q
what is lymphocytosis
A
increased B and T cells
24
Q
what kind of infection do we see lymphocytosis
A
viral, fungal, TB
25
what is an ANC
absolute neutrophil count
seggs + bands
26
what is neutropenia
ANC < 500
ANC < 100 is profound
27
when do we start to worry about opportunistic organisms with ANC decreasing
< 1000
28
what are the acute phase reactants we can use to check for infection?
ESR
CRP
procalcitonin
29
ESR normal values
male : 0-15 mm/hr
female: 0-20 mm/hr
30
CRP normal value
< 0.5mg/dL
31
can we use CRP and ESR to confirm infection
NO, non-specific
we use to monitor over time and check trends
32
procalcitonin normal value
< 0.05 mcg/L
33
procalcitonin used for what
more specific bacterial
serial measure every 1-2 days to assess response to therapy and de-escalate
34
when do we want to sample infected body materials?
before initiation of antibiotic therapy
35
what is contamination
introduction of an organism into the clinical specimen during sample collection or process
36
who do we want to obtain blood cultures in and how
all acutely ill febrile patients
1 set on each arm (aerobic and anaerobic)
preferably 1 hr apart
37
what would happen if organism grew in both aerobic and anaerobic
might be a contaminant
38
colonization vs infection
colonization is a potentially pathogenic organism presnet but not invading host andnot iliciting a response so NO symptoms
infection is damaging and eliciting a host response
39
what is MIC
minimum inhibitory concentration
lowest concentration that prevents visibile growth
40
what is a breakpoint
highest possible plasma concentration of drug that is safe
41
what does suseptible mean
MIC is less than the breakpoint, likely efficacious
42
what does intermediate men
MIC approaching the breakpoint, might be effective at higher doses
43
what does resistant mean
MIC greater than breakpoint
can't achieve safe concentrations
44
what is non suseptible
does not respond to the antibiotic, no MIC
45
what is suseptible dose dependent
have to use higher doses than normal to achieve efficacy
46
gold standard for MIC testing
broth dilution
47
Kirby Bauer disk testing does what
can not show us MIC
measures zone of inhibition and we can see suseptibility
48
what can we find from gradient test strips
MIC
where ellipse intersects
(used with newer agents,expensive)
49
what is empiric therapy
targets the typical pathogens
before we have identification and suseptibility of organism
usually very broad
50
what is targeted or directed therapy
once we have identified the organism and suseptibility is known we switch the therapy
51
de-escalation
going from empiric to targeted
want the narrowest spectrum of activity
can be stepwise or all at once
52
what is a spectrum of activity
what bugs does the drug cover
53
definition of antibimrobial stewardship
interventions defined to improve appropriate use of antibiotics by promoting selection of optimal drug regimen, dosing, duration of therapy, and route of admin
54
what color is gram positive
purple
55
what color is gram negative
pink
56
characteristics of cell wall gram positive
thick cell wall
57
characteristics of cell wall gram negative
thin cell wall
58
how do atypical bacteria stain
they dont stain
59
what are acid fast bacilli
resistant to acids/ethanol
mycobacterium species
60
what is alpha hemolysis
partial hemolysis
61
what is beta hemolysis
full hemolysis
62
what is gamma hemolysis
no hemolysis
63
most medically important pathogens are what for gram positive
cocci
64
which bacteria form clusters
staphw
65
which bacteria form pairs/chains
strep + entero
66
what does catalase differentiate?
clusters from chains/pairs
(staph from strep)
67
what does coagulase differentiate
staph aureus from CoNS
68
alpha hemolysis represents which flora
oral flora
69
beta hemolysis represents which flora
skin, pharynx, genitourinary
70
gamma hemolysis represents which flora
GI
71
what can oxidase test do
distinguish enteric vs non
72
what are fastidious organisms
slow growers
require special supplemental media
73
gram positive cell wall structure
thick cell wall
periplasmic space
74
gram negative cell sructure
thin cell wall
lipopolysaccharides
porins
75
what are penicillin binding proteins
vital for cell wall synthesis, shape, structure
ex. transpeptidases
76
what do transpeptidases do
final cross linking in the peptidoglycan structure
77
what do lipopolysaccharides do
mediator of immune response
78
what do porins do
hydrophillic channels that permit diffusion of essential nutrients and hydrophillic molecules
79
what does the periplasmic space do
bacterial protien secretion, folding
80
where is the periplasmic space
gram +: between cell wall and cell membrane
gram - : between cell membrane and outer membrane
81
mechanisms of intrinisc resistnace
absence of target site
bacterial cell impermeability
82
mechanisms of acquired resistance
mutation in bacteria
acquisition of new DNA
83
what is a plasmid
DNA that is transferable between organisms
84
what is a transposon
move from plasmid to chromosome
85
what is a phage
virus that can transfer DNA from organism to organism
86
what is conjugation
trade bracelets
most common
direct contact
87
what is transduction
transver of genes between bacteria by phages
(give a bracelet and run away)
88
what is transformation
picks up DNA from environment
pick up a bracelet
89
4 mechanisms of antibiotic resistance
efflux pumps
decreased porin production
drug inactivating enzyme
modified drug target
90
what are beta lactamases
enzyme tht hydrolyze the beta lactam by splitting amide bond and opening the ring
91
types of beta lactamases
serine and metallica
92
Ambler class A beta lactamases
ESBLs
serine carbapenemases
93
Ambler class B beta lactamase
metallo beta lactamase
94
Ambler class C beta lactamase
cephalosporinases
95
Ambler class D beta lactamases
OXA- type
96
examples of beta lactams
penicillins
cephalosporins
carbapenems
cephamycins
monobactams
clavams
97
ESBL enzyme
CTX-M-15
98
serine carbapenemase enzyme
KPC
99
metallo beta lactamse enzyme
NDM-
100
cephalosporinase enzyme
amp-c
101
OXA-type enzyme
OXA-48
102
ESBLs most prevalent in which bacteria
e. coli
Klebsiella pnemoniae / oxytoca
proteus mirabilis
103
treatment for ESBLs
carbapenems
104
carbapenemase most prevalent in which bacterias
Klebsiella pneumoniae / oxytoca
e. coli
proteus mirabilis
e. coloacae
e. aerogenes
105
treatment for carbapenemase
meropenem + bactam
106
metallo beta lactamases treatment
aztreonam + ceftazidine /avibactam
very limited, we cant inhibit with beta lactamase inhibitors
cefiderocol is trojan horse
107
OXA- type found in what bacteria
acinetobacter aumannii
pseudomonas aeruginosa
108
treatment for OXA type
cefiderocol
sulfabactam
109
treatment for ESBL urinary
piperacillin/tazobactam
110
which beta lactamase is inducible
AmpC
111
AmpC inducer organisms
Hafnia alvei
Enterobacter cloacae
Citrobacter freundii
Klebsiella aerogenes
Yersinia enterocolitica
Serratia marcescens
Morganella morganii
Aeromonas hydrophila
heck yes maam
112
which common drug is high risk suseptibility to AmpC hydrolysis
ceftriaxone
113
what do we give if stably depressed mutants? if initially suseptible and then resistant
cefepime 1st
carbapenem
non beta lactams
114
aminoglycoside resistance happens how
aminoglycoside modifying enzymes
acetylation
nucleotidylation
phosphorylation
impairs cellular uptake and binding
115
vancomycin resistance looks like what on a test
Van A or VanB present
produces vancomycin resistant enterococccus (VRE)
116
treatment for vancomycin resistant enterococcus
linezolid
daptomycin
117
how does vancomycin resistance work
altered target site
118
penicillin binding protein resistance happens how
decreased affinity of PBPs for antibiotic or decreased PBPs produced by bacteria
119
would a beta lactamase inhibitor help with penicilinn binding protein resistance
no since it is an altered target not an enzyme
120
how would we know if someone had methicillin resistance staph aureus?
mecA or PBP2A gene
121
what does the mecA gene mean
MRSA
122
treatment for MRSA
ceftaroline
ceftobiprole
vancomycin
linezolid
daptomycin
123
efflux resistance important for what
pseudomonas aeruginosa against carbapenems
sterp nerumonia against macrolides
124
porin channel resistnace important for what
seen in enterobacterales and carbapenem resistnt pseduomonas aeurginosa
125
bacteriocidal
bacteria actively being killed
126
bacteriostatic
inhibiting bacterial replication without killing the organism
127
which classes exhinit PAE (post antibiotic effect)
concentration dependent
(aminoglycosides and fluroquinolones)
also vanc
128
aminoglycosides activity measured how
Cmax/MIC
AUC/MIC
129
fluroquinolones activity measured how
AUC/MIC
130
optimal dose of aminoglycosides found how
high dose and extended interval
therapeutic drug monitoring
131
which drug classes are time dependent
beta lactams
132
which drug classes are concentration dependent
aminoglycosides
fluroquinolones
133
how are time dependent drugs optimized
fT>MIC
time above MIC
134
do beta lactams have PAE
no, time dependent
135
dosing optimization for carbapenems
>40%
136
dosing optimization for penicillins
>50%
137
dosing optimization for cephalosporins
>60%
138
how can we maximize ft>MIC
increase the dose and keep same interval
same dose shorter interval
continuous infusion
prolonged infusion
139
is vancomycin time dependent or concentration dependent
both - more time dependent tho
140
PD target for vanc
AUC/MIC
141
what is the PAE like for vancomycin
very long for gram positivw
142
prolonged and elevated AUC in vancomycin patients can lead to what
nephrotox
