Term
what are the two questions you should ask when treating blood stream infections?
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Definition
1. what is my source?
2. is is community or hospital? |
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Term
lung, CA
What pathogens are you thinking about?
What antibiotics should you use? |
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Definition
in a CA, lung case you should think Strep pneumo, h flu, legionella, chlamydia pneumoniae.
Use FQ or (cefipime + macrolide) |
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Term
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Definition
Think aerobic gram - bacteria
treate with (cefepime or piperacillin) + AG |
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Term
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Definition
E. coli, b frag
pip/tazo or amp/sulbactam
or
FQ + metronidazole |
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Term
source: abdomen
commensal/HA |
|
Definition
aerobic gram -
anaerobes
candida sp.
carbapenem
or
pip/tazo +/- AG
(consider antifungal) |
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Term
|
Definition
Strep pyogenes
Staph aureus
polymicrobial
(Vanc or linezolid or daptomycin) +/- pip/tazo |
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Term
|
Definition
MRSA
aerobic gram - bacilli
vanc + (cefepime or pip/tazo) |
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Term
|
Definition
pathogens: e. coli
klebsiella sp.
enterobacter sp.
proteus sp.
enterococci
FQ
if gram positive cocci: amp + gentamicin
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|
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Term
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Definition
aerobic gram - bacilli
enterococci
vanc + (cefepime or FQ) |
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Term
|
Definition
S. pneumo
Neisseria meningitidis
Listeria monocytogenes
H. influenzae
Vanc + (ceftriaxone or cefepime) |
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Term
|
Definition
aerobic gram - bacilli
staphylococci
cefepime + vanc
be very aggressive with positive and negative! |
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Term
| Name three situations when you pull the line? |
|
Definition
| S. aureus, tunneling, candida |
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Term
| What are most cases of severe sepsis caused by? |
|
Definition
normal flora due to significan immune effect
(epithelial barrier disruption or immunosuppression) |
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Term
| What are the top three sites of infection in bacteremia cases? |
|
Definition
1. lung
2. abdomen
3. urinary tract
However, there is not an identifiable source 30-50% of the time! |
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Term
| What is the most common pathogen in gram negative sepsis? |
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Definition
E. coli
others are Klebsiella, serratia, enterobacter, proteus, p. aeruginosa, h flu
generally requries a compromised state: (broad sprectrum ab or integrity of GI mucosa has been compromised) |
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Term
| Does gram - or gram + sepsis have a higher mortality rate? |
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Definition
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Term
| What are the common gram + pathogens? |
|
Definition
S. aureus, S. epi (coag negative staph), strep pneumo, enterococcus faecalis
|
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Term
| What is coag negative staph? and what is is related to? |
|
Definition
Staph epidermidis
devices -- artificial heart valves, stents, catheters |
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Term
| What bacteria do the cephalosporins not cover well, this lack in coverage can lead to overgrowth and gram + sepsis? |
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Definition
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Term
| I am in IV drug user, what bacteria should you be thinking of? |
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Definition
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Term
| the patient has a peticial rash, you should think: |
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Definition
|
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Term
| What bacteria might be to blame for endocarditis? |
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Definition
| Viridans strep, strep bovis, enterococci, staph |
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Term
| IV catheter related, think: |
|
Definition
CNS
s. aureus
klebsiella
enterobacter
serratia
if it is tunneling, add candida!
TPN also increases candida risk |
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Term
| in a burn patient one should think of: |
|
Definition
s. epi
s. aureus
p. aeruginosa
enterobacteriaceae
cornebacterium |
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Term
| I forgot to take my tampon out...ooops...now these bacteria are everywhere causing toxic shock syndrome.. |
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Definition
| group A streptococci, s. aureus, clostridium |
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Term
What normally causes fungal sepsis?
what drugs may you use to treat empirically? |
|
Definition
candida
amphotericin B, voriconazole, caspofungin
pull catheter if line infection
d/c antimicrobials if possible |
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Term
| If you suspect p. aeruginosa, what two drugs does Dave suggest? |
|
Definition
|
|
Term
| if you suspect enterobacter, what two drugs does DAve recommend? |
|
Definition
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Term
| What should you cover if the source is unknown? |
|
Definition
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