To Kill a Bug

Question 1

A pt presents w/an erythematous fluctuant area on her right bicep. She is dx with an abscess w/surrounding cellulitis. An I&D is done an wound cultured. What is next?

Answer 1

Prescribe an antibiotic and discharge home, check cultures in 48 hours

Question 2

A preliminary report is reported the next day (pt with abscess). Gram + cocci in clusters. What is most likely organism?

Answer 2

Staphylococcus species

Question 3

25 YO female present with dysuria, frequency and urgency. What is the best tx plan for her?

Answer 3

Initiate antibiotics based on the most likely offending organism

Question 4

What are some common gram + cocci organisms?

Answer 4

Streptococcus, Staphylococcus, Enterococcus, Peptostreptococcus

Question 5

What are some common gram + bacilli organisms?

Answer 5

Bacillus anthracis, Clostridium sp, Corynebacterium sp, Listeria sp

Question 6

What are some common gram - cocci organisms?

Answer 6

N. gonorrhea, N. meningitides, Moraxella catarrhalis

Question 7

What are some common gram - Lactose-fermentors?

Answer 7

Serratia sp, Enterobacter sp, E.coli, Klebsiella sp, Citrobacter sp

Question 8

What are some common gram - Non-Lactose Fermentors?

Answer 8

Psuedomonas, Proteus, Shigella, Salmonella, Stenotrophomon, Campylobacter, Legionalla, Bacteroides, Yersinia, Acinetobacter

Question 9

Which organism normally colonizes the skin, nares, and respiratory tract?

Answer 9

Staph aureus

Question 10

Staph aureus can cause what?

Answer 10

Cellulitis, abscess, bone, joint, endocarditis

Question 11

What else is a common bacteria on the skin?

Answer 11

Staph epidermidis

Question 12

What organism is associated with prosthetic and device infections?

Answer 12

Staph epidermidis

Question 13

Staph epidermidis can contaminate what?

Answer 13

Blood cultures

Question 14

What are the two organisms that are alpha hemolytic?

Answer 14

Strep. pneumoniae, strep viridans

Question 15

What are the two organisms that are beta hemolytic?

Answer 15

Group A hemolytic strep (pyogenes), Group B hemolytic strep

Question 16

What are the two organisms that are gamma hemolytic?

Answer 16

Enterococcus, Peptostreptococcus

Question 17

What is an example of an opportunistic pathogen?

Answer 17

Enterococcus. Effects immunocompromised, prolonged hospitalizations, etc.

Question 18

Enterococcus commonly causes what type of infection?

Answer 18

Urinary tract

Question 19

Enterococcus normally colonizes which part of the body?

Answer 19

Intestine

Question 20

Which two Enterococcus species have increasing resistance (VRE)?

Answer 20

Faecalis and Faecium (Gram + chains)

Question 21

What are the enteric gram negatives?

Answer 21

Enterobacteriaciae family

Question 22

Which organisms are in the Enterobacteriaciae family?

Answer 22

E.coli, Proteus, Serratia, Acinetobacter, Citrobacter, Enterbacter, Salmonella, Klebsiella

Question 23

Enteric gram negatives can cause what types of infections?

Answer 23

Community: UTI, abdominal infections
Hospital: Late Hospital Acquired or Ventilator assisted pneumonia, complicated UTI

Question 24

What are the H-N-M organisms?

Answer 24

Gram - cocci, Haemophilus, Neisseria, Moraxella

Question 25

Common infections of Haemophilus and Moraxella include what?

Answer 25

Upper and lower respiratory tract infections

Question 26

Common infections of Neisseria are what?

Answer 26

Meningitis and STIs

Question 27

What is a gram - non-lactose fermenting organism?

Answer 27

Pseudomonas Aeruginosa

Question 28

Common infections with P. Aeruginosa

Answer 28

Wounds, osteomyelitis, corneal ulcer (contact lens), hot tub folliculitis, Late hospital acquired of healthcare associated pneumonia

Question 29

What are some common gram + anaerobes?

Answer 29

Clostridium sp, Actinomyces, Lactobacillus, Propionibacterium, Peptostreptococcus

Question 30

What are some common gram - anaerobes?

Answer 30

Bacteroides fragillis, Fusobcaterium, Porphyromonas, Veillonella

Question 31

Anaerobes usually cause what types of infections?

Answer 31

Co-infections

Question 32

Erysipelas is caused by which pathogen?

Answer 32

Beta-hemolytic strep (S.pyogenes)

Question 33

Uncomplicated cellulitis is caused by which pathogens?

Answer 33

Beta-hemolytic streptococci and s. aureus

Question 34

Furuncles, carbuncles, or abscess are caused by which pathogen?

Answer 34

S. Aureus including MRSA

Question 35

Which 4 pathogens cause conjunctivits?

Answer 35

1. S. aureus 2. S. pneumoniae 3. H. influenza 4. M. catarrhalis

Question 36

Throat infections are caused by which pathogens?

Answer 36

Group A beta-hemolytic streptococcus (S. pyogenes)

Question 37

Mouth/tooth infections caused by which pathogens?

Answer 37

Streptococcal species, Peptosctreptococcus and other gram + anaerobes

Question 38

Community acquired pneumonia is caused by which 4 pathogens?

Answer 38

SMCH (smooch) 1. Streptococcus pneumonia 2. Mycoplasma pneumonia 3. Chlamydia pneumonia 4. Haemophilus influenza

Question 39

Empiric therapy

Answer 39

Antibiotics chosen prior to knowing identification and sensitivity of pathogen

Question 40

Broad spectrum

Answer 40

Effective against a broad range of bacteria

Question 41

De-escalation

Answer 41

Narrowing therapy from broad agents

Question 42

Anti-microbial stewardship

Answer 42

Preserving broad-spectrum antibiotics, limit development of resistance

Question 43

Opportunistic infection

Answer 43

An infection caused by an agent (bacteria, virus, fungi, protozoa) that is capable of causing disease only when the host's resistance is lowered by a disease or drug

Question 44

Nosocomial infection

Answer 44

An infection acquired in a hospital setting or health care facility

Question 45

What is colonization?

Answer 45

Identification of an organism that normally grows in the organ system, NOT considered pathogenic in the context of the pts clinical picture

Question 46

What is an example of colonization?

Answer 46

Lactobacillus found in a vaginal culture

Question 47

What is contamination?

Answer 47

An unintended introduction of a bacterial organism that isn't infectious

Question 48

What is an example of a contamination?

Answer 48

Coagulase - staph species in a single set of blood cultures

Question 49

What is an infection?

Answer 49

Invasion of a host by disease causing agents. Identification of a likely pathogen in a pt with symptoms consistent w/expected signs and symptoms of the disease

Question 50

What is an example of an infection?

Answer 50

+ strep pyogenes throat culture in setting of exudates, odynophagia and erythema

Question 51

6 examples of sterile sites

Answer 51

CSF, blood, peritoneum, synovial fluid, pleural fluid, urine

Question 52

A female present with urinary symptoms, she has a culture which reports E.coli. Which does the organism most likely reflect?

Answer 52

Infection

Question 53

20 YO female has a throat swab. It is + for strep pyognes. She is afebrile, w/out any symptoms. What is the most likely significance of this organism?

Answer 53

Colonization

Question 54

All of the following are opportunistic pathogens except?

Answer 54

*Enterobacteriaciae* | Enterococcus, Pseudomonas, Clostridium Dificile

Question 55

What are the SPACE organisms?

Answer 55

``` Serratia Pseudomonas Acinetobacter Citrobacter Enterobacter Klebsiella ```

Question 56

Which drugs cause highest seizure risk?

Answer 56

Cefepime, Fluoroquinolones, Carbapenems

Question 57

Which drugs are hepatotoxic?

Answer 57

Nafcillin, Oxacillin, Fluoroquinolones

Question 58

What is and ADR with aminoglycosides?

Answer 58

Nephrotoxicity and ototoxicity

Question 59

Which drugs frequently cause CDIFF

Answer 59

Clindamycin, ampicillin, amoxicillin, fluoroquinolones, cephalosporins

Question 60

How to treat CDIFF

Answer 60

Metronidazole IV or PO; Vanco PO