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CDM 3 Exam 2 > Lecture 1 - Bloodstream Infections & Infective Endocarditis > Flashcards

Lecture 1 - Bloodstream Infections & Infective Endocarditis Flashcards

(58 cards)

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1
Q

Most common Community Acquired Pathogen for infection

A

E.coli
S.aureus
Streptococcus

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2
Q

Most common Healthcare associated Pathogen for infection

A

Staphylococcus
Other gram neg

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3
Q

How to diagnose Blood stream infection

A

Blood cultures

Draw 2 sets of cultures -> 12hrs/5 days it turns positive -> after positive do stain/subculture & rapid diagnostics -> 18-24hr after subculture ID organism and start susceptibility test 0> 6-24hrs ID organism and susceptibility results

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4
Q

Gram + cocci clusters vs pairs/chains

A

Clusters = staph
Chain/pairs = strep/Enterococci

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5
Q

Primary infection

A

Direct introduction into bloodstream
Idiopathic, source unclear

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6
Q

Secondary infection

A

Translocation form other source of infection
Continual seeding from non-infected area

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7
Q

Empirc management of suspected sepsis

A

obtain >2 blood cultures
initial brand antimicrobial therapy, guided by suspected source

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8
Q

If no clear source of infection, empiric therapy is..

A

Broad gram + (MRSA) & Borad GNR & Anaerobes/Atypiclals/ Candida/Toxins maybe

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9
Q

Med specific monitoring Vanco

A

renal toxicity

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10
Q

Med specific monitoring Dapto

A

creatinine kinase

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11
Q

Med specific monitoring Linezolid

A

thrombocytopenia

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12
Q

2 reasons for treatment failure

A

inadequate coverage or source control

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13
Q

2 Gram + cocci in clusters

A

Staph aureus
Coagulase negative staph

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14
Q

Risk factors for S.aureus bacteremia

A

> 70yrs old
HD requirements, PICC lines, Urinary catheter
Foreign material
Immunosuppression

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15
Q

MRSA specific risk factors

A

Hospital / HC exposure
Recent IV ABX exposure
Injectable drug use

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16
Q

3 main agents for MRSA bacteria

A

Vanco = AUC/MIC 400-600
Dapto = 8mg/kg ABW
Linezolid = 600mg Q12h

Vancomycin tends to be used first, but none is better

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17
Q

MSSA Bacteria treatment

A

cefazolin 2g Q8H or oxacillin/nafcillin 2g Q4h

both better than vanco

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18
Q

Gram positive cocci in cluster, MRSA Txm =

A

Vanco
Dapto
Linezolid

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19
Q

Gram positive cocci in clusters, MSSA Txm =

A

Cefazolin
Nafcillin
Oxacillin

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20
Q

Gram positive cocci in pair/chain, Streptococci

A

PCN-S = penicillin G IV
PCN-R = ceftriaxone

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21
Q

Gram positive cocci in pair/chain, Enterococci

A

E.faecalis = ampicilin
E.faecium = variable

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22
Q

S. aureus txm duration

A

uncomplicated = 14 +/- 2 days
complicated 24-42 +/- 2 days, > 4wk most pts

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23
Q

Basic different between complicated and uncomplicated

A

pts who respond to therapy quickly and don’t have any other concerning site for infection = uncomplicated

other = complicated

most S.aureus is complicated

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24
Q

Coag Neg Staph txm Duration

Study These Flashcards
A

Simple = 0-3 +/- 1 day
uncomplicated = 5 +/- 1 day
Complicated = 7-28 +/- 2 day

25
Pseudomonas Aeruginoas Risk Factors
Modifiable: immunosuppression, housing insecurity, IDU non-modifiable: hospitalization, recent IV ABX use < 90 days, history of PsA
26
Empiric GNR Bacteremia Txm w/o ESBL history
Cefepime 2g Q8H Ceftazidime 2g Q8H Pip/Tazo 4.5g IV Q6h
27
Empiric GNR Bacteremia Txm w/ ESBL history
Meropenem 1g Q8H
28
Pts eligible for Oral Therapy ABX Gram -
Enterobacterales BSI Afebrile & Hemodynamically stable for > 48hrs Isolate susceptible to agents with reliable serum conc Able to take oral meds
29
Pts eligible for 7 day treatment Gram -
enterobacterales BSI Afebrile & Hemodynamically stable for >48hrs Adequate source control
30
Unclear eligibility for 7 day therapy Gram -
PsA BSI pts with immunocompromising condition/meds Men with UTI
31
Short term catheter, uncomplicated CoNs
remove line and treat with systemic agents for 5-7 days or retain line and treat w/ lock therapy and systemic agents for 10-14 days
32
Short term catheter, complicated or any other organism
remove line and treat w/ systemic agents for > 7 days
33
Long term catheter, complicated, S.aureus, or Candida spp.
remove line and treat w/ systemic agents for > 7 days
34
Long term catheter, uncomplicated w/ other organism
remove line and treat w/ systemic agents for > 7 days or line salvage w/ lock therapy and systemic agent for > 7 days
35
Lock therapy
uses high conc but low volume of antimicrobial in line itself sits in line for 24-48hrs needs to be given W/ systemic therapy for treatment
36
Candidemia initial therapy
Echinocandin = Caspofungin or micofungin alternative if not critically ill or low risk of resistance = fluconazole
37
Candidemia Definitive therapy
based on susceptibilities different species have different breakpoints
38
Candidemia Txm duration
uncomplicated = 2 weeks complicated = based on site of infection
39
Right side IE more common in...
IDU due to impure ingredient that damage right side of heart
40
Left side IE more common in...
non-IDU due to turbulent flow the damage left side of heart
41
General risk factors for Endocarditis
Hear structure abnormalities Comorbidities - CKD, DM, HD Prior infection - prior endocarditis, skin-soft tissue infection w/ DM Patient factors - IDU, indwelling catheter, HD, devices, poor oral hygiene
42
Endocarditis immunologic reactions
Osler nodes = painful papules pads of toes/fingers Roth spot = retinal infarct w/ surrounding hemorrhage
43
Endocarditis Thromboembolic complication
Janeway lesions = painless lesion on palms Finger clubbing = long standing disease Splinter hemorrhage = occurs in nail bed Petechiae = painless lesions typically on trunk Septic emboli = stroke or PE
44
Most common way to ID endocarditis
Blood cultures + Imaging > 3 blood cultures TTE (more specificity) 1st and then can do TEE (higher sensitivity)
45
Definitie Endocarditis using modified Duke Criteria
2 major, 1 major + > 3 minor and/or 5 minor criteria
46
Possible Endocarditis using modified Duke Criteria
1 major + 1 minor or 3 minor
47
Empiric therapy, Native valve Txm
Vanco + ceftriaxone
48
Empiric therapy, Prosthetic valve w/ <1 year of placement txm
Vanco + cefepime + rifampin + gentamicin
49
Empiric therapy, Prsthetic valve > 1 year of placement txm
Vanco + ceftriaxone
50
what group is S.bovis?
Viridians group strep
51
Pts ineligible for short 2 week treatment for VGS in Native valve PCN-S
known cardiac or extra-cardiac abscess History of renal dysfunction/AKI, CrCl < 20 Impaired eight cranial nerve Non-traditional sp (ie Gemella)
52
Gentamicin duration in therapy for VGS in Native value PCN-R?
add on only for 2 weeks, but course is for 4weeks
53
Typical Txm duration for native vs Prosthetic valve
4 weeks vs 6 weeks
54
Most common causes of IE
S.auerus and Coagulase Negative Staph
55
Why are rifampin and Gentamicin add ons for prosthetic valve?
to help penetrate biofilms potentially
56
Prophylaxis indications Endocarditis
dental procedures w/ perforation of oral mucosa or manipulation of gingival tissue incision or biopsy of mucosa
57
Pts who are at high risk of adverse endocarditis outcomes
Prosthetic valve or prostheses from valve repair history of infective endocarditis Cardiac tranplan w/ valvulopathy congenital HD, unreparired or repaired with retained foreign material
58
Common prophylaxis txm endocarditis
Amoxicillin PO Cefazolin IV Clindamycin if B-lactam allergy

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