-can show inflammatory activity in the body - measure the distance RBC falls in a test tube within an hour - Further RBC have fallen the greater the inflammatory response of the immune system

- made in the liver - levels increase when there is an inflammatory response

- biomarker release in reponse to bacterial infections - used to distinguish etiology of infectious process

Introduction to infectious disease Flashcards by Mahiba Khan

What are ID caused by?

bacteria, viruses, pathogens, fungi

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what are the ways they are spread?

pateint to patient, vector to patient,(animal to patient), environment to patient (hospital), patients own flora

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Organisms that live on body concern?

no they can be harmless or even helpful, under certain conditions that may cause disease

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What are pathogens?

Organism that can cause host tissue damage and intitae a immune reponse that usualy reuslts in infection

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what is the basic approach to identifying ID?

establish infection
fever does not always mean infection
determine sites of infection
deternine pathogens
select apporpriate antimicrobial therpay

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how can we establish an infection?

careful history and phsycial
s and s
predisposing factors

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what are the signs and symptoms we can use to identify an infection?

-fever
-increased WBC
- Acute Phase reactants (ESR, CRP, Procalcitonin)

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what should we know about fever? other causes? specifically drugs?

fact: lowest in the morning and highest in the evening

other causes:
- maligancy (epecailly CNS), autoimmune diseae, stress, drugs

Drugs:
- anticonvulsants, sulfa-containing compounds, antiarrhythmics, antipsychotic, beta-lactams

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What should we know about WBC? other causes, and drugs

Fact: infection can cause mobilization of granulocytes and lymphocytes

Other causes:
malignancy, inflammatory disorders, stress, drugs

Drugs:
- corticosteroids
- epinephrine
- lithium

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if an increase in lymphocytes indicates what?

viral infection

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if an increase in neutrophils indicates what?

bacterial or fungal infection

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what are acute phase reactions?

ESR - erythrocyte sedimentation rate

CRP - C- reactive protein

procalcitonin -

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Expand on ESR

-can show inflammatory activity in the body

measure the distance RBC falls in a test tube within an hour
Further RBC have fallen the greater the inflammatory response of the immune system

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Expand on CRP

made in the liver
levels increase when there is an inflammatory response

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Procalcitonin

biomarker release in reponse to bacterial infections
used to distinguish etiology of infectious process

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S and S mild vs severe

mild - sore throat, small sore on skin

Severe - painful cough, gross production of sputum

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S and S localized vs deep-seated

localized: Skin - swelling , erythema, tenderness and purulent drainage

Deep-seated: meningitis, pneumonia - must be determined from tissue or fluid sample

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What do clinicans usualy look for? then what is the next step?

determine a focus:
- cough - prob lungs
- leg sore - prob and ulcer, cut
- child pulling ear - probably inner ear canal

the next step is to determine what organisms are common for that area?

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Gram-positive Cocci

Staph : S.aureus, S.epidermis
Strep : Pneumococcus, viridians
Enterococcus: E.Faecalis, E.Faecium

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Gram positive bacilli

Corynebacteria

Listeria

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Antimicrobial coverage for MSSA

Cloxacillin, cefazolin, Caphaleixin

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hospital-acquired MRSA

Vancomycin, daptomycin, clindymin( linezolid),

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Community-acquired pneumonia (penicillin-susceptible)

penicillin, ampicillin

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Community-acquired pneumonia (penicillin-resisitant)

3 gen cephalosporin (not ceftazidime), a quinolone (not cipro), vancomycin

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community acquired MRSA

Clindamycin, SNX-TMP, doxycycline

Enterococcus

Ampicillin or vancomycin (depending on resistance)

Gram-negative cocci

Moraxella, Neisseria: meningitis, gonorrhea

gram-negative bacilli

a bunch

Easy to kill gram-negative

HPEK M SS

antimicrobial to kill easy to kill gram-negative

amoxicillin, amox/clavulate, 2nd gen cephalosporines for milder infections

antimicrobial to kill hard-to-kill gram-negative

SPACE - MAFIA PCC: meropenem, aminoglycosides, FQ (not moxi), imipenem, pip/tazo, cefepime, ceftazidime

what HTK are hard to get?

Pseudomonas and acinobacter

What are the anaerobes?

Peptococcous, Peptostreptoccoucs, bacteroides, fuscobacterium, prevotella

When treated do we need o know the pathogen right away to pick an agent?

no we can use a broad spectrum and then use a more specific one when we need more trageted therapy

Colonization def

presence of an organism without inflammatory response

Contamination def

the presence of an orgaism acquired during specimen sampling without evidence of host inflammtoyr repsonse

Infections

presence of an organism that initiates a host inflammatory response

when patients is acutley ill febrile what should we do?

do blood cultutres before antibbiotics are initiated T>= 38.5 degress celsius

what types of results should be evaluated? useful results

blood, sputum, urine, wound, or sinus drainage - not always useful reuslts

what can we evalute to detrmine the lilkeyl pathogen?

Blood cultutre, blood, sputum, urine, sinus darainge, wound, spinal fluid in menigitis, joint aspirations in septic joints, abcess/cullulitis drainag

what areas are heavily colonized with a variety of bacteria?

skin, oropharynx, ears, throat, and perineum - concern if revocered from blood, venous cathether or prosthetic devices

what are some considerations for interpreting results if the sample is from the CSF?

glucose, WBC, proteins

what are some considerations for interpreting results if the sample is from the Sputum?

diffiucly to interpret, most reliable if from bronchoscopy or deep suctioning or an intubated patient

what are some considerations for interpreting results if the sample is from the urine?

cats, nitrites, polymicrobila. pyruia

MIC and types

minmum inhibtory concentration - lowest Ab dose that prevents growth after 24 hours S - susuctible, I - intermediate or indtermine R - resistant

Pharmacokinetics

what body does to drug

Pharmacodynamics

what drug does to body

What info do we need from he patient's history?

1. acquitsion of infection 2. previous infections or colonization 3. Previous antibiotic use 4. site of infection and most liley pathogen

Time-dependent killing

- above MIC by 2-4 times - higher cocnetraion doesn't work better - minimla to no PA

Concentration-dependent killing

- more durg more death - have P- need 10more then MIC AE

drug class most knonw for PAE?

Aminoglycosides

when do we prefer bacteriocidial?

- when immuncomprmises - in sever life threatening infection ) endocarditis or meningitis)

Baterostatiic drugs?

M T L

Drug factors: tissue pentration

if it cannot reach the site of infection, usueless

Abscess

they can inactiavte drugs so muct be drained

meningitis

cafazolin can work against bacterila but not penetrate CNS

Moxifloxicin

low renal clearance, don't use for UTI

Nitrofuratoin

is metabolized before reached urinary tract in poor renal failure

Daptomycin

inactivated by lung surfactant - bad for lung infection

If we are severly ill what should we be aware of?

oral absorption may be hindered

drug that can cause increase in seizures

imepenem

Aminoglycosdies SE

nephrotocityc, ototcity

Glycopetides SE

red man syndorme

Datomycin (lipopetide)

hepatoxicity

Sulfonamides and trimethoprim

HIV patients caution

When is combination therapy indicated?

1. boraden spectrum of acticivty 2. Synergisc effects 3. when risk of failure is catastrphic (rex: resp infection in ICU with SPACE)

How can we monitor effectiveness?

1. fever resolves in 24-48 hours 2. patient compliants dimish 3. pneumia scans will still show evdience fo damage for a while

when is IV - PO stepdown therapy indicated?

1. overall improvemnt 2. lack of fever for 24 hours 3. decrease in WBC 4. Functioning GI tract 5. taking other meds by mouth 6. tolerating oral diet (no nauseou or vomiting)

draugs that have better oral bioavailibilty then IV

FQ, Metronidazle, SMX-TMP, clindamycin,

Duaration of therpay for UTI Drugs

nitor- 5 d TMP -SMX - 3 days Fosfomycin - 1 d febrile UTI 7-14 d rest 7 d

Pneumoina

5-7 d

COPD

5-7 days

Streptococoal pharyangitis

10 days

acute otis media

10 days

Intraabodimal appendicitis Absecss infection

no more then 24 post opertaion only before less then 7 days

Bacteremia

7 days

osteoarticular

weeks

Introduction to infectious disease Flashcards

(77 cards)