Therapeutics - General Principles PT1 Flashcards by amanda kastel

name the 3 types of antimicrobial therapy

-prophylactic

-empiric

-definitive

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name2 particular populations that get prophylactic antimicrobial therapy

high riskk patients, like HIV patients with CD4 count less than 200, OR for surgical prophylaxis

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when giving prophylactic antibiotics to surgical patients, around how long before surgery do they take it

around 1 hour prior because that’s when the concentration of AB will be highest at incision time

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explain what empiric therapy is

there’s a suspected or proven infection, but the specific pathogen hasn’t been identified yet

we give broad spectrum as a best guess to what we think the potential pathogens are -want to cover all potential pathogens it may be

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when is definitive therapy given

AFTER the culture and susceptibilities results come back – we give a more targeted antibiotic for that specific pathogen identified (based on its suceptibility)

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what are the 3 things in the “triangle” approach to antimicrobial therapy

patient, drug, bug

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confirming the infection is which of the 3 things in the “triangle” approach to antimicrobial therapy

patient

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normal range of WBC count

4-10,000 cells/mm cubed

BUT can vary based on age, gender, comorbidities and also based on different labs where it’s done

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what is normal body temp (oral)

what about rectal and axillary

98-98.6

rectal – 1 degree fahrenheit over

axillary - 1 degree farhenheit lower

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what temp does the CDC define a fever as

100.4 degrees farhenheit (38 celsius)

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is a fever a specific or nonspecific marker

NONSPECIFIC

just because someone has a fever doesn’t mean they have an infection

could be related to an autoimmune disease, malignancy, drug-induced….etc

therefore, diagnosing an infection is a diagnosis of exclusion - must rule out EVERYTHING ELSE FIRST

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WBC’s are also known as ________

leukocytes

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leukocytosis

term for elevated WBC’s

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is leukocytosis specific for infection or nonspecific

NONSPECIFIC - may be due to many other things like stress, malignancy, corticosteroid side effect, etc

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leukocytosis may be absent in what patients that actually do have an infection

the elderly, ppl with severe sepsis

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a patient has elevated WBC and high fever

is it a fever

cant say for sure

both of these could be due to other factors, but could very well also be a fever

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which particular WBC are high in a patient with a BACTERIAL infection

neutrophils

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in the case of a bacterial infection, a CBC with differential will usually have neutrophils greater than _____%

80%

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what will the neutrophil bands be like in a patient with a bacterial infection

greater than 10% (immature)

making neutrophils so quickly to fight the infection

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which WBC are high in parasitic infections and allergic reactions

eosinophils

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which WBC are typically high in viral or fungal infections

lymphocytes

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which WBC are typically high in chronic infections

monocytes

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what are “segs and bands”

segs = mature neutrophils
bands = immature neutrophils (will be greater than 10% in bacterial infection)

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name 2 biomarkers of infection that are nonspecific markers of inflammation

they are not used to ____, but used to ____

CRP and ESR

not used to confirm infection, but for monitoring (ie - osteomyelitis)
for ex, monitoring if the patient is responding to the antibiotic – want to make sure pt is improving and inflammation going down

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normal CRP

less than 10ng/mL

normal ESR for men vs women

men - less than 22mm/hr women less than 29

what biomarker is a marker for sepsis and what is norm value

LACTATE 0.5-1mmol/L

what is a marker of inflammation what is more specific for bacterial infections it is a tool used to ____________

procalcitonin tool used to discontinue antibiotics

how is lactate a marker for sepsis

bc high in impaired tissue oxygenation -- happens when pt is septic

important consideration when using markers

NEVER used as sole evidence to diagnose infection

tissue or fluid samples can be used to see the presence of _________________ which particular fluids can be tested

WBC and bacteria sputum, urine, spinal or joint fluid -- pretty much anything can be cultured

how are X-rays, CT scans, MRIs, and echos used in diagnosing infection

for signs of inflammation like infiltrate and fluid

name 3 things that can be looked at to find out the SEVERITY of the infection

hemodynamic changes like change in heart rate and blood pressure respiratory changes like SOB, rapid breathing neurologic issues like lethargy, altered mental status, confusion

as mentioned, hemodynamic changes such as blood pressure can be used to estimate the severity of the infection a low blood pressure could indicate what

sepsis

pt has dysuria, flankpain, and abnormal urinalysis where is infection

urinary tract

pt has headache, altered mental status, +LP

CNS infection (meningitis) +LP means positive lumbar culture

pt has cough, chest pain sputum, +CXR

lung infection +CXR = infiltrates in chest XRAY

pt has fever, heart murmer, +blood cultures and + TTE

+TTE = trans thoracic echo heart infection (endocarditis) + blood cultures means bacteremic!!!!

pt has pain at IV site, swelling, and erythema and + cultures

IV site infection

why is it important to know where the infection is

may need more than just antibiotics to treat for EX if IV line infection - need AB and need to take the line out also if endocardidits, may need surgery to remove the vegitation -- antibiotics alone isnt gonna work

"non lactose fermenting, gram negative rods" suggests what bacteria??

pseudomonas aeruginosa

is e coli gram positive or negative?? lactose fermenting or non lactose fermenting

negative lactose fermenting

staph aureus and strep pneumoniae are gram positive or negative

positive

"gram positive cocci in clusters" suggests what bacteria

staph species (staph aureus or epidermidis)

differentiate between the pathogenecity of staph aureus vs staph epidermidis

staph aureus is always a true pathogen staph epidermidis may not always be a true pathogen -- its normally all over skin

how do streptococcus species grow

in chains or pairs NOT clusters like staph

name the 4 nonsterile specimen types, meaning that it's normal for them to contain bacteria and the presence of bacteria does not indicate an infection

stool throat swab wound swab genital swab may not be reliable

is sputum considered a sterile specimen

only deep sputum

explain when and how blood cultures should be collected

2 sets and from 2 different body sites each set has aerobic and anaerobic bottle collect when pt is acutely ill bc the yield is higher, and incubate 5-7 days (may be longer for fungus) MUST BE STERILE

explain how sputum cultures should be obtained

first rinse mouth with water pt should breathe deep and cough several times to get DEEP SPECIMEN - more reliable - into a dry sterile container

if a pt is unable to give a high quality sputum sample, what can be done?

get induced sputum

explain how urine cultures should be obtained

catch midstream!! or straight catherization if pt cant pee do NOT collect urine from the bag of an indwelling catheter - not reliable. use a needle to aspirate directly from the tubing instead

difference between urine dipstick and urinalysis

urine dipstick is rapid screening - shows leukocytes, nitrites, blood, etc urinalysis w microscopy shows appearance, bacteria, WBC, epithelial cells, and RBC

why do urine dipsticks detect nitrites

some bacteria (like e. coli) convert nitrate (normally in urine) to NITRITE - therefore, can be marker of bacterial infection

bacterial specimen is treated with crystal violet and then iodine when the iodine is washed off, what will the difference be between gram (+) vs gram (-) bacteria

in gram positive, the color will remain and the counter stain won't do anything - it will still be purple BC OF THICK CELL WALL in gram negative, the color will WASH OFF and the counter stain (safranin) will make it pink - bc peptidoglycan layer is covered by outer membrane and the cell wall is very thin

what is the first clue to determine the type of organism involved in causing the infection

gram stain with microscopy can see if (+) or (-), can show number of organisms, and the type of cells present (ie: WBC, epithelial cells)

gram positive cocci that grows in chains and pairs name 2 potential bacteria

enterococci and streptococci

gram positive bacilli that grow in rods name 2 potential bacteria

listeria corynebacterium

why do we care if there are epithelial cells in our sample of urine

poor quality sample - not catching good midstream void

sputum or blood culture has a lot of epithelial cells good or bad sample

bad

staph epi can be called coagulase __________. why?

coagulase negative it can sometimes be a contaminant

true or false corynebacterium and listeria are anaerobic gram positive rods

FALSE all true but they're AEROBES

are strep and staph aerobic or anaerobic

aerobic

gram positive cocci anerobes

peptococcus and peptostreptococcus (NOT STAPH - THEY'RE AEROBES)

anaerobic gram positive bacilli (rods)

clostridium (NOT corynebacterium or listeria - they're aerobic)

gram negative aerobes that grow in rods and are lactose fermenting

e. coli enterobacter klebsiella

gram negative bacilli (rods) aerobes that are non lactose fermenting

THINK NOSOCOMIAL pseudomonas and acinetobacter

aerobic gram negative cocci

neisseria N. gonorrhoeae h. influenzae

gram negative anaerobes that grow in rods are typically part of...... name 3 of them

our gut! bacteroides fusobacterium prevotella

name 3 ATYPICAL bacteria that are not gram (+) or (-) they are common in what infection

common in CAP mycoplasma legionella chlamydophila

fungi infections are typically common in which type of patients

immunocompromised

gram positive cocci that grow in clusters

STAPH

gram positive cocci that grow in chains or pairs

streptococci, enterococci

gram negative rods, lactose fermenting

e. coli enterbocater klebsiella

gram negative rods, NON lactose fermenting

THINK NOSOCOMIAL pseudomonas aeruginosa, acinetobacter

differentiate between a contaminate, colonizer, and pathogen

contaminate - introduced from external source due to poor technique or poor sample colonizer - normal flora that does not cause harm pathogen - damages the tissue and elicits a host response

"1/2 sets of blood cultures reveals gram positive cocci in clusters, coagulase negative"

this is staph epidermidis!!! coagulase negative is the giveaway must be a contaminent - repeat the sample. only grew in 1/2 and staph epi is normally on the skin

staph epi loves to grow on....

medical devices

give an example of a risk factor that may make a person prone to a real staph epi infection

IV drug use

which covers pseudomonas pipercillin-tazobactam vancomycin

pipercillin-tazobactam

name 2 of the most common antibiotics used in practice to cover pseudomonas

pipercillin-tazobactam and cefepime (3rd gen cephalosporin)

Therapeutics - General Principles PT1 Flashcards

(82 cards)