Treatment of Endocarditis, Abdominal, and Skin/Tissue Infections Flashcards
(20 cards)
Infective Endo: Background + Empiric Tx
Commonly by:
-staphylococci, streptococci, enterococci
EMP TX:
-Vanco and CTX
*definitive tx dependent on pathogen, valve, cx
-Add gentamicin for synergy for more difficult-to-eradicate infections (prosthetic valve or resistant bugs)
Duration:
4 - 6 weeks of IV antibiotic treatment is required
Biofilm in IE
-Some bacteria can form a biofilm (especially on prosthetic valves)
-Difficult for some abx to penetrate
-Rifampin may be used in cases of staphylococcal prosthetic valve endocarditis due to its ability to treat organisms in a biofilm
Viridans streptococci: IE TX
PCN or CTX +/- Gent
If BL allergy: Vancomycin monotx
Viri is a P3 VaG
Staph (MSSA): IE TX
Naficillin or Cefazolin +/- Gent and RIF if prosthetic valve
If BL allergy: Vancomycin +/- Gent and RIF if prosthetic valve
-Daptomycin can be alt if BL allergy and no prosthetic valve
Staph (MRSA): IE TX
Vancomycin +/- Gent and RIF if prosthetic valve
Enterococci: IE TX
For both native and prosthetic valve:
-PCN or Ampicillin + Gent
-Ampicillin + high dose CTX
If BL allergy:
-Vanco + Gent
If VRE:
-Daptomycin or Linezolid
Enter the GAP A3 VaG DL
IE Dental PPX: Whomst?
High risk patients
Dental work needed (like root canal)
+
Select cardiac conditions (CTIP)
-Prosthetic valve (or artificial repair)
-IE hx
-Heart txp with abnormal heart function
-Congenital heart defects (heart/valve disease)
IE Dental PPX: Abx Options
All given as a single dose 30-60 min prior
- AMOX 2 g PO
If no PO:
2. AMP 2 g IM/IV or
3. CEFAZ or CTX 1 g IM/IV
If no PO + PCN allergy:
4. Azithro or Clari 500 mg
5. Doxy 100 mg
Spontaneous Bacterial Peritonitis: Background
Common in cirrhosis and ascites
Suspected when ascitic fluid sample (collected via a paracentesis) is:
-250+ cells/mm3 PMNs (polymorphonuclear leukocytes)
SBP: TX
Empiric
-CTX 5-7 days
(for streptococci, Proteus, E. coli, Klebsiella)
Alt
-Carbapenem (mero) in critically ill pts or high risk for MDR bugs
Those who get tx:
-Should get secondary PPX with Bactrim (SMX/TMP) or a quinolone (Cipro)
357 CARB BQ
Intra-abdominal (other) Infections: OW
-Appendicitis, cholecystitis (GB), cholangitis (BD), diverticulitis
-Abscess: I/D, coverage of polymicrobial (streptococci, enteric Gram -, anaerobes like Bacteroides fraqilis)
-If risk of MDR = cover PM
(hos 48+ hr, abx in 90d, critically ill)
-Tx can be 1 agent, but if no anaerobe coverage then usually METRONIDAZOLE is added
-Duration 4-5d is enough if source control is accomplished (can be longer)
Intra-abdominal (other) Infections: TX
Community (Proteus, E. coli, Klebsiella anaerobes, streptococci)
-Ertapenem
-Moxifloxacin
-CTX or furox + metronidazole
-Cipro or levo + metronidazole
(ME BQm in the community)
Resistant/Nosocomial (PEK, PM, Enterobacter, anaerobes, streptococci, +/- enterococci)
-Carbapenem (not erta)
-Zosyn
-Pime or TAZ + metronidazole
(CZ MTm)
*Ampicillin or vanco can be added to cephalosporin reg if need enterococcus
*Vanco can be added if MRSA risk
SSTI Classifications
Mild
-No systemic signs/sx
Moderate
-Systemic signs/sx
(>100.4F, HR 90+, WBC 12k+ or <4k)
Severe
-Systemic sx, signs of deeper infection (fluid blisters, skin sloughing, low BP, organ dysfunction)
-Pt is IC or failed oral abx, had I/D for purulent infections
Types
-Superficial: impetigo, furuncle, carbuncle
-Subcutaneous tissue: cellulitis
-Nonpurulent or purulent (pus, like abscess)
Impetigo: OW/TX
Pyogenes, S. aureus (MSSA)
Children, contagious, blister-like rash usually around nose/mouth/hands/arm
-Honey colored crusts over area (from pustules rupturing of thick/yellow fluid)
TX
-Warm, wet compresses (dried crusts)
-Limited lesions:
*Topical mupirocin
*Retapamulin (Altabax) and ozenoxacin (Xepi) are alts
-Extensive lesions:
*Cephalexin 250-500 mg PO QID
*Dicloxacillin 250-500 PO QID
Im Pet MR OCD
Folliculitis/furuncle/carbuncle: OW/TX
S. aureus (MRSA)
-Folliculitis: a superficial infection of hair follicles (looks like red pimples)
-Furuncle (boil): a purulent infection of the hair follicle
-Carbuncle: a group of infected furuncles
I/D +/- abx for large furuncle/carbuncles
-MSSA and MRSA coverage
*SMX/TMP DS 1-2 tablets PO BID
*Doxycycline 100 mg PO BID
*Occasionally due to fungus = ketoconazole cream
Cellulitis: Mild TX
Streptococci, pyogenes (Group A
Streptococcus), S. aureus
Abx must be active against streptococci and MSSA: (CELL call the CDC)
-Cephalexin 500 mg PO QID
-Dicloxacillin 500 mg PO QID
-Beta-lactam allergy: clindamycin 300 mg PO QID
Duration of treatment:
-5 days (longer if no improvement within 5 days)
Abscess: Mild TX
MRSA
Recurrent: consider nasal decolonization with mupirocin and skin decolonization with chlorhexidine or dilute bleach
Source control: I/D
ABX (cover MSSA and MRSA): CLB CMD
-SMX/TMP DS 1-2 tablets PO BID
-Doxycycline 100 mg PO BID
-Minocycline 200 mg x1 -> 100 mg BID
-Clindamycin 300 mg PO QID
-Linezolid 600 mg PO BID
If shows MSSA = use cephalexin
Severe Purulent SSTIs: TX
Duration: 7-14 days
Treatment: MRSA coverage
-Vancomycin (trough 10-15)
-Daptomycin
-Linezolid
Others: ceftaroline, tedizolid, telavancin
*IV to PO once clinically stable
Necrotizing Fasciitis (Severe Nonpurulent): TX
Urgent surgical debridement
Empiric tx is broad:
-Vancomycin or daptomycin + BL (zosyn, meropenem) + clindamycin
DB give me the CV FAST (FASH)
Diabetic Foot Infections: MRSA, PM, MDR GN, ANA
No MRSA needed (UM CEL)
-Unasyn, Erta, CTX, Levo/Moxi
MRSA needed
-Add vanco, line, dapto
PM and/or MDR G- needed (MC)
-Zosyn, Cefepime, Mero/imi/doripenem
Anaerobic needed
-Use BL with coverage (BL/
BLmase inhibitor combination, carbapenem)
-Or add metronidazole
