Lecture 4 Flashcards
(146 cards)
1
Q
What are the gram + cocci bacteria?
A
Staphylococcus
Streptococcus
Enterococcus
2
Q
What are types of staphylococcus?
A
S aureus (most pathogenic)
S epidermidis (on skin, hospital acquired)
S saprophyticus (urinary tract infection)
S lugdunensis (foreign body/prosthetic devices)
3
Q
What is the coagulase positive species of staphylococcus?
A
S aureus
4
Q
What are the coagulase negative specs of staphylococcus?
A
S epidermidis
S saprophyticus
S lugdunensis
5
Q
What are some features of S aureus?
A
Produces enzymes that has the ability to clot blood
Most virulent of species
Increasing resistance (MRSA)
6
Q
What are the modes of transmission for staphylococcus?
A
Direct tissue invasion (most common)
Exotoxin production
7
Q
What are examples of direct tissue invasion?
A
Skin and soft tissue infections
Osteomyelitis
Septic arthritis
Pneumonia
Endocarditis
8
Q
What are examples of exotoxin production?
A
Staphylococcal food poisoning
Toxic Shock Syndrome
Scalded Skin Syndrome
9
Q
What does severe local infection lead to?
A
Bacteremia
10
Q
What does a staphylococcal skin infection present as?
A
Erythema
Purulent drainage
Pustules
Crusting
Cellulitis
11
Q
What are staphylococcal skin infections common in?
A
Wound and burn infections
12
Q
How do you treat staphylococcal skin infections?
A
Drain abscess
Empiric antibiotics (outpatient)
13
Q
What cultures we may need when we drain abscess?
A
From the abscess
Blood culture (if systemic signs of infections)
14
Q
What are considered systemic signs of infections?
A
Fever
Elevated WBC count
15
Q
If there’s no risk of MRSA, what abx do we give for staphylococcal skin infection?
A
cephalexin
dicloxacillin
16
Q
If there’s high risk of MRSA, what abx do we give for staphylococcal skin infection?
A
clindamycin
doxycycline/minocycline
sulfamethoxazole/trimethoprim (Bactrim)
17
Q
What advantages does Bactrim have over clindamycin?
A
Bactrim is cheaper and given twice a day vs the 3 times a day for clindamycin
18
Q
If a patient has resistance to Bactrim and clindamycin what could you give for MRSA?
A
Linezolid
19
Q
What is the first line for staphylococcal skin infections?
A
Vancomycin
20
Q
What is staphylococcal osteomyelitis?
A
Deep soft skin tissue infection or direct inoculation (open fracture or wound)
60% of the time caused by S aureus
21
Q
How do you confirm staphylococcal osteomyelitis?
A
With an x-ray (bone-scan most sensitive)
22
Q
How do you treat staphylococcal osteomyelitis?
A
ALWAYS culture
Broad spectrum empiric coverage
Adjust abx pending C&S (culture and sensitivity)
May require surgery
23
Q
If Staphylococcal Osteomyelitis is thought to be MSSA, what abx do you give?
A
Nafcillin IV
Oxacillin
Cefazolin
24
Q
If Staphylococcal Osteomyelitis is thought to be MRSA, what abx do you give?
A
Vancomycin IV
25
What causes toxic shock syndrome(TSS)?
From the toxins of S aureus
Vagina: tampon use
Nasopharynx: packing
Direct inoculation through wound or abscess
26
What does TSS present as?
Sudden onset high fever, hypotension, myalgia, N/V, watery diarrhea
Diffuse erythematous rash, particularly on palms and soles, that desquamates
27
If TSS is not treated quickly what further effects could occur?
Hepatic damage
Thrombocytopenia
Confusion
Renal impairment
Syncope
Shock
28
What are treatments for TSS?
Hospital
Supportive measures (antipyretics, IV fluids)
Debride/decontaminate local sources of infection
Empiric antibiotics
29
What is the empiric abx treatment for TSS?
Vancomycin + clindamycin
Plus
Pip/taz
Cefepime(Maxipime)
Carbapenem (imipenem or meropenem)
30
What are symptoms of scalded skin syndrome?
Widespread bullae with sloughing
Fever, malaise
Lead to sepsis, electrolyte abnormalities
31
How is scaled skin syndrome developed?
Due to S aureus toxins
Common in infant and children
Transmitted via birth canal
Transmitted via hands of adult carriers
32
How do we treat scaled skin syndrome?
Supportive measures (fluid management, treating it like a real burn)
Abx (MSSA: nafcillin or oxacillin, MRSA: vancomycin)
33
What causes Staphylococcal Food Poisoning?
Ingestion of exotoxin
Food contaminated by individuals with active skin infections
Food improperly cooked or left at room temp
34
How fast do symptoms of Staphylococcal Food Poisoning present and what are they?
2-8hours after ingestion
N/V/D
Abdominal cramps
Note: resolves within 12hours
35
How do Coagulase Negative Staphylococcal Infections occur?
Usually hospital acquired
Postoperative
Prosthetic devices
Indwelling catheters
36
What is something bad about coagulase negative staphylococcal infection?
Beta-lactams
37
What is the treatment for coagulase negative staphylococcal infection?
Vancomycin
Remove prosthetic device if infected
38
What are types of streptococcus?
S pyogenes(group A)
S agalactiae(group B)
S bovis(group D)
39
What can GABHS cause in pharyngitis?
Strep throat
Peritonsillar abscess
Scarlet fever
40
What can GABHS cause in skin infections?
Impetigo
Erysipelas
Cellulitis
41
What can GABHS cause in delayed systemic complications?
Rheumatic fever
Acute glomerulonephritis (can occur 2 weeks after infection)
42
What are symptoms of GABHS pharyngitis?
Abrupt onset of fever
Malaise
Nausea
Sore throat
Abdominal pain
Odynophagia
43
What are signs of GABHS pharyngitis?
Tonsillar hypertrophy with erythema
Tonsillar exudates possible
Beefy red uvula
Palatal petechiae
Tender anterior cervical lymphadenopathy
May have sandpaper rash
44
How do we diagnose GABHS?
Clinical presentation
Rapid strep test
Positive: treat
Negative: throat culture if suspicious of bacterial infection
45
How do you treat GABHS?
Benzathine PCN G (IM)
Penicillin VK (oral)
Amoxicillin
46
What do you give to treat GABHS if they are allergic to penicillin?
Keflex
47
What are symptoms of scarlet fever?
Sandpaper rash
Strawberry tongue
Blanches on pressure, may become petechial and fades, leaving a fine desquamation
Face is flushed with circumoral pallor
48
What is impetigo?
Focal, vesicular, pustular lesions with a thick, honey-colored crust with a "stuck-on" appearance
49
What can cause impetigo?
S aureus
GABHS
50
What are the treatment for impetigo if low risk for MRSA?
Topical mupirocin (Bactroban)
Cephalexin (Keflex) (best choice)
Dicloxacillin
51
What are the treatment for impetigo if high risk for MRSA?
Sulfamethoxazole/trimethoprim (Bactrim)
Doxycycline
Clindamycin
52
What children sport usually have impetigo with MRSA?
Wrestling
53
What is erysipelas?
Painful superficial cellulitis with dermal lymphatic involvement that frequently involves the face
54
What can cause erysipelas?
S aureus
GABHS
55
How do we treat outpatient (no systematic involvement) erysipelas?
Penicillin - Pen VK
Amoxicillin
Dicloxacillin
Cephalexin
Clindamycin / erythromycin
56
How do we treatment inpatient (w/ systemic involvement) erysipelas?
Vancomycin (if severe and S aureus suspected)
Cefazolin (Ancef)
Ceftriaxone (Rocephin)
Clindamycin
57
What can cause cellulitis?
GABHS
S aureus
58
What is the treatment for cellulitis?
Empiric treatment
59
What are other GABHS infections?
Necrotizing fasciitis (common in IV drug users, and difficult to distinguish from clostridium perfringens)
Streptococcal TSS
Arthritis
60
What are the characteristics of Strep agalactiae?
10-30% of pregnant women are asymptomatic carriers
Screening at 35th week
Vaginal and rectal swab
Can lead to neonatal sepsis
61
How do we treat Strep agalactiae (GBBHS)?
PCN G or ampicillin
Cefazolin (Ancef)
Alternative - clindamycin or vancomycin
62
Do we still treat for GBBHS if a baby is being delivered by C section?
No
63
What are the types of streptococcus Incomplete hemolytic (alpha-hemolytic)?
S pneumoniae
S viridians
64
What causes pneumococcal infections?
Colonized in respiratory tract
Spread via airborne droplets
Common proliferation in winter and early spring
65
How can sterp pneumoniae be distinguished?
Gram + diplococci
66
What common diseases are associated with strep pneumoniae?
Otitis media
Sinusitis
Pneumonia
Meningitis
Endocarditis
67
What is the most common cause of CAP(community acquired pneumonia)?
S pneumoniae
68
What are risk factors for strep pneumoniae otitis media?
Smoking in household
Family history
Bottle feeding
69
What are symptoms of otitis media?
Otalgia(pulling at ear), hearing loss
F/N/V
Irritability
70
What are signs of otitis media?
Erythematous, bulging TM
Absence/displacement of light reflex, poor mobility
Otorrhea with TM rupture
71
How do we diagnose and treat otitis media?
Clinical(no testing required), tympanogram
Treated with...
Analgesics/antipyretics
First line antibiotic treatment (amoxicillin)
72
What can cause strep pneumoniae acute sinusitis?
Usually starts as viral
S pneumoniae
S aureus
H influenza
M catarrhalis
73
What are risk factors for acute sinusitis?
Allergic rhinitis
Structural abnormalities
Nasal polyps
74
What are symptoms of acute sinusitis?
Purulent rhinorrhea/PND
Sinus pressure/HA
Nasal congestion
75
What are signs of acute sinusitis?
10-14 days of symptoms of no improvement
Tenderness
Erythematous, swollen nasal turbinates and mucosa
Maxillary/frontal sinus pressure
Purulent rhinorrhea
76
How do we diagnosis acute sinusitis?
Clinically
CT PRN
77
What is the first line treatment for acute sinusitis?
Amoxicillin/Clavulanic acid (Augmentin)
2nd line:
Doxycycline
Clindamycin
78
What are symptoms of pneumococcal pneumonia?
High fever, chills
Early onset rigors (shaking chill)
Productive cough (rust colored sputum)
Shortness of breath
Pleuritic chest pain (pain with deep inspiration)
79
How do we diagnosis pneumococcal pneumonia?
CXR (gold standard) lobar consolidation, sometimes with effusion
Dont need sputum culture in healthy outpatient treatment
Obtain sputum culture if they have comorbidities and/or impatient treatment (if they're in ER/ICU, or they're not getting better)
80
What are first-line treatments for pneumococcal pneumonia?
Amoxicillin
Doxycycline
Azithromycin (Zithromax) - only in areas w/ <25% resistance
*Call lab to check the area resistance*
81
What are the treatment for pneumococcal pneumonia if pt has COPD/comorbidities, recent abx treatment within last 3 months?
Levofloxacin (Levaquin)
Amoxicillin/clavulanate (Augmentin) Cephalosporin + Zmax(Azithromycin) or doxycycline
82
What is the inpatient treatment for pneumococcal pneumonia?
Levofloxacin
Macrolide(Zmax) + beta-lactam(amoxicillin or can use ceftriaxone)
83
What do we use to determine inpatient or outpatient?
Curb 65
Pneumonia Severity index(PSI)
84
How many pneumococcal vaccines are there and what are they?
4
Pneumovax 23
Prevnar 13
Prevnar 15
Prevnar 20
85
When does the CDC recommend to use pneumovax?
Adults 65+
2-64yo with chronic health problem and immunocomromised
19-64yo who smoke or have asthma or in nursing homes
86
When does the CDC recommend to use prevnax?
Children at WCC(well child check) ages 2,4,6, and 12-15months
65+ if they have not been vaccinated with Prevnar 13
87
What is the most common causative organism for meningitis based on patient age?
Strep pneumoniae
88
What bacterias cause meningitis in adults?
S pneumoniae
S aureus
N meningitidis (less common)
89
What bacterias cause meningitis in elderly?
S pneumoniae
S aureus
Listeria monocytogenes
*if immunocompromised, consider...
Pseudomonas
Listeria
Gram -
90
What are types of enterococcus?
E faecalis
E faecium
91
What can enterococcus infection cause?
UTI
Bacteremia
Endocarditis
Intra-abdominal infections
Wound infections
92
How do we treat enterococcus infection?
Endocarditis: ampicillin + gentamicin
Skin/wound/UTI infections: ampicillin or vancomycin
Resistance (VRE): linezolid, daptomycin
93
What are the characteristics of Bacillus anthracis?
Encapsulated toxin producing bacteria
Naturally transmitted via contact with infected animals or their products
Bioterrorism agent (CDC tier 1, category A)
Toxins(spore) can be weaponized into a fine powder
94
What are S/S of cutaneous bacillus anthracis infection?
Painless black eschar
Regional adenopathy
Fever, malaise, HA
Occurs within 2 weeks of exposure to toxin
95
What causes an ingestion/GI anthrax infection?
Ingestion of inadequately cooked meat in animals infected with organism
96
What are S/S of ingrestion/GI anthrax infection?
F/N/V
Bloody diarrhea
GI bleeding
Ulcerations from oral mucosa throughout intestine
Obstruction
Perforation
97
How do we diagnosis anthrax?
Culture/biopsy
Gram stain
Nasal swab for spores if suspect inhalation
CXR if pulmonary symptoms
LP(lumbar puncture) if systemic
98
How do we treat anthrax?
Ciproflaxacin (can be used a prophylaxis as well)
Treat for 7-10 days if cutaneous
Up to 60 days for inhalation
Can use multiple abx
Doxycycline
99
How does bacillus cereus cause infection?
Produces toxins causing diarrhea and emetic(N/V)
100
How can listeria monocytogenes be transmitted/
Ingestion of contaminated foods
Dairy
Raw vegetables
Meat
101
What is corynebacterium diphtheria?
Toxin producing Gram + bacillus
102
How do we treat a corynebacterium diphtheria infection?
Diphtheria equine antitoxin (only from CDC)
Antibiotic therapy (PCN, erythromycin)
Treat contacts (erythromycin)
103
How does neisseria meningitidis spread?
Human reservoir (40% of adults are carriers)
Spread via person to person
Outbreaks common in close communities, winter and spring
Common in children, adolescents, and young adults
Previous infection/vaccination grants immunity
104
What is the treatment for Neisseria Meningitidis?
PCN G
Ceftriaxone(rocephin)
Abx therapy continues with pt is afebrile(feverish) for 5 days
Close contact receives prophylactic abx
105
What is the treatment for Neisseria Meningitidis?
PCN G
Ceftriaxone(rocephin)
Abx therapy continues with pt is afebrile(feverish) for 5 days
Close contact receives prophylactic abx
106
How do we prevent Neisseria Meningitidis infection?
Meningococcal Vaccine (covers strains A,C,Y, and W, another vaccine that covers strain B)
Recommended for children at age 11-12 and booster at 16
107
What are some characteristics of Neisseria Gonorrhoeae?
Sexually transmitted
Drug resistance increasing
108
How do we treat Neisseria Gonorrhoeae?
Ceftriaxone: single dose
Note: has to be reported to local health department
109
What bacteria contributes to green discharge?
Psuedomonas
Neisseria Gonorrhoeae
110
What causes a Pseudomonas infection?
Found in water and soil
Opportunistic infections
111
Pseudomonas is the number 1 pathogen for what diseases?
Otitis externa
Corneal ulcers from bacterial keratitis in contact lens wearers
ICU-related pneumonia
Osteochondritis after puncture through tennis shoe
112
Pseudomonas is the number 2 pathogen for what diseases?
Gram - organism in nosocomial pneumonia
113
What are some outpatient treatment/oral options for pseudomonas?
Ciprofloxacin
Levofloxacin
114
What are some inpatient/IV options for pseudomonas?
Pip/taz (Zosyn)
Ceftazidime (Fortaz)
Cefepime (Maxipime)
Meropenem
Aztreonam
115
What are the characteristics of bordetella pertussis?
Highly contagious
Increasing incidence (due to no vaccination)
Occurs mostly in children
Transmitted via aerosolized droplets (Invades respiratory mucosa)
Incubation period 7-14 days
116
What are the characteristics of bordetella pertussis?
Highly contagious
Increasing incidence (due to no vaccination)
Occurs mostly in children
Transmitted via aerosolized droplets (Invades respiratory mucosa)
Incubation period 7-14 days
117
What is the treatment for bordetella pertussis?
Supportive care
Abx (Azithromycin)
Alternative: Bactrim if they cannot azithromycin
118
What is the main cause of epiglottis?
Haemophilus influenzae
119
What usually contributes to legionnaires outbreaks?
Contaminated water sources
Showerheads and faucets in patient rooms and air conditioning cooling towers
CPAP machine
Car wash
120
How do we treat legionnaires disease?
Macrolides (azithromycin, clarithromycin)
Fluoroquinolone (levaquin)
10-14day treatment
21-day for immunocompromised pts
121
What does Klebsiella Pneumoniae present as?
SOB
Pleuritic CP
Red, currant-jell sputum
Lung abscess
122
What are symptoms of Escherichia Coli - Traveler’s Diarrhea?
Tenesmus (needing to poop but you have none)
Increased freq, vol, and weight of stool
Frequent loose stools
Abdominal cramps
F/N/V
Floating
Dehydration
123
Why is Bismuth subsalicylate (Pepto-Bismol) not recommended for children pregnant women, or ASA allergy?
It contains aspirin properties
124
Most diarrheal causing infections are cured by what abx?
Ciprofloxacin
125
What is the treatment for Vibrio Cholerae - Cholera?
Tetracycline / doxycycline
TMP-SMZ DS (Bactrim)
Azithromycin - single dose
Quinolones (Cipro)
126
What are the symptoms of salmonella - typhoid fever?
Exhaustion
N/V
Abdominal cramps
Bloody “pea soup” diarrhea
HA
Rose spots
Fever
If no complications, gradual improvement over 7-10 days
127
What types of culture would be positive for salmonella if infected?
Blood
Stool
Urine
128
What is the treatment for salmonella, typhoid fever(enteric fever)?
Ciprofloxacin (Cipro) / levofloxacin (Levaquin)
Ceftriaxone (Rocephin)
Azithromycin
129
What is the treatment for UTIs?
TMP-SMZ DS (Bactrim)
Nitrofurantoin
Fosfomycin
Cephalosporins (cephalexi, cefdinir)
Ciprofloxacin
130
What can cause the bubonic plague?
Yersiniz pestis
Infection of wild rodents
Mainly the bites of fleas
131
What are some characteristics of the bubonic plague?
Virulent
CDC category A
132
What are the three forms of the bubonic plague?
Pneumonic
Septicemia
Bubonic plague
133
What is the treatment for the bubonic plague?
Start with...
Streptomycin
Gentomicin
Doxycycline
Fluoroquinolone
Then put into isolation
Then give prophylactic therapy to those who get in contact (doxy, cipro)
134
What is considered a fever?
>38.3(101.9F) with oral
Greater than 3 week duration
Failure to make diagnosis despite 1 week of inpatient investigation
135
How do we take temp on a baby?
Rectal is most accurate
Axillary is the next best
136
What are types of fever?
Classic FUO
Hospital-acquired FUO
Immunocompromised or neutropenic FUO
HIV-related FUO
137
What noninfectious disease can cause fevers?
Connective tissue diseases
Vasculitis
Granulomatous disorders
138
How do we full evaluate for when someone comes in with a fever?
Take full history and full PE
Lab studies
139
How do you treat fevers?
Do not treat until we figure out what is causing it
140
What is SIRS (systemic inflammatory response) defined as?
Fever >38C(100.4F) or <36C(96.8F)
HR >90
RR >20 or PaCO2<32mmhg
Abnormal WBC >12k or <4k or >10% bands
141
What are some causes of SIRS?
Ischemia
Inflammation
Trauma
Infection
Several combined factors
142
How likely do those with bacteremia are associated with sepsis?
95% are associated with sepsis
143
What are the S/S of sepsis?
Hypotension (SBP<90)
Elevated temp or hypothermia
HR>90
144
What test do we use to help determine sepsis?
Sequential Organ Failure Assessment score (SOFA)
qSOFA(baby version) ≥2
145
What is associated with a qSOFA score of ≥2?
RR ≥ 22 / min
Altered mentation
Systolic BP ≤100 mmHg
146
How do we treat sepsis?
Abx therapy(empiric) within 1hr of diagnosis
Multiple empiric abx depending on source of infection
IV fluids
Vasopressors
Central lines
Other means of organ perfusion(dialysis)
