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ICU infections
Pharmacotherapy Exam 2
79
Pharmacology
Professional
03/25/2014

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Term
leukocytosis
Definition
WBC > 12000 cells/mL
Term
leukopenia (immune exhaustion)
Definition
WBC < 4000 cells/ mL
Term
bandemia (left shift)
Definition
> 10%
Term
bacteremia
Definition
presence of bacteria in blood culture
Term
fungemia
Definition
presence of fungus in blood culture
Term
bands
Definition
young neutrophils
Term
bacteremia is a symptom
Definition
coming from a source
Term
fever
Definition
single temp > 38.3C
Term
infection without fevers
Definition
elderly, open abdominal wounds, large burs, antipyretic or anti-inflam drugs, immuno suppressed
Term
central fevers
Definition
stroke, intracranial bleed, severe head trauma
Term
post op fevers
Definition
to be expected
Term
drug induced fevers
Definition
malignant hyperthermia, neuroleptic malignant syndrome, immune/ inflammatory reactions
Term
antimicrobial related fevers
Definition
b-lactams, sulfonamides, abacavir, amphotericin B
Term
antiepileptic related fevers
Definition
phenytoin
Term
antiarrhythmic related fevers
Definition
quinidine, procainamide
Term
peripheral lines
Definition
temporaty: peripheral venous catheter, midline catheter, higher risk of infection
Term
central lines
Definition
non-tunneled lines, PICC, tunneled lines and totally implanted lines (less infection)
Term
arterial lines
Definition
high infection rates, used for cardiac monitoring
Term
localized infections of catheter
Definition
around the catheter
Term
exit-site infections
Definition
larger infection within 2cm of the catheter exit site
Term
tunnel infections
Definition
along the subcutaneous tract
Term
pocket infections
Definition
subcutaneous pocket of an implanted device
Term
systemic line infection
Definition
can be with or without a local infection or visible manifestations
Term
luminal infection
Definition
bacteria is living on the inside of the line
Term
infusate-related
Definition
uncommon pharmacy specific problem: either contamination at compounding or contaminated stock solution
Term
pathogen of suspected infusate-related infections
Definition
cultures from both infusate and blood cultures to verify with sudden onset of symptoms soon after start of an infusion
Term
pseudobacteremia
Definition
blood culture contamination, low ratio of pos/neg blood cultures
Term
bacterial species of pseudobacteremia
Definition
coagulase-neg staph spp., bacillus spp., diphtheroids (corynebacteria)
Term
neutropenic patients
Definition
most likely not pseudobacteremia, should consider that it's a true infection
Term
how do you know if it's a line infection
Definition
pull the line and culture the line
Term
"plate roll" line tip section rolled on agar plate
Definition
> or = to 15 colony forming units (CFU), sensitivity is 60%
Term
flushing, vortexing or sonicating in broth
Definition
sensitivity of this method is 80% but it's much more expensive, must have > or = to 100 CFU's
Term
pathogens of the line infection
Definition
gram pos cocci (staph aureus, coag neg staphylococcus), gram neg bacilli (pseudomonas, enterobacter) and candida spp (rare and more common with TPN)
Term
Gram + cocci
Definition
staphylococcus aureus, Streptococcus
Term
Gram - bacilli
Definition
pseudomonas, enterobacter
Term
empiric treatment of line infections
Definition
DOC: vancomycin
Term
alternative empiric treatment for line infections
Definition
daptomycin or linezolid
Term
vanco, daptomycin, linezolid
Definition
active against MRSA, coag-neg staph; choice depends on complications
Term
daptomycin
Definition
good for endocarditis scenarios, not good for pulmonary
Term
linezolid
Definition
very good for osteomylitis, not good for endocarditis
Term
use Nafcillin or alternatively cefazolin for empiric line infection
Definition
local rate of MRSA low ***doesn't know where this is not high rates of MRSA
Term
gram neg infections
Definition
antipseudomonal b-lactam, antipseudomonal cabapenems and aminoglycosides
Term
antipseudomonal b-lactam
Definition
Ceftazidime, piperacillin-tazobactam, cefipime
Term
antipseudomonal cabapenems
Definition
Imipenem, meropenem, doripenem
Term
aminoglycosides (active agains psuedomonas)
Definition
gentamycin, tobramycin, amikacin
Term
ertapenem
Definition
no pseudomonal activity, not appropriate for line infection suspected for pseudomonal
Term
amphoteracin B (lipasomal/ non-lip)
Definition
highly active against candida
Term
lipisomal amph B
Definition
more spendy but less toxicity
Term
azole
Definition
fluconazole and voriconazole, cost resistance common (can't switch)
Term
don't use azole
Definition
when patient is trying to die
Term
echinocandins
Definition
caspofungin, MICAfungin :), anidulafungin
Term
clinically stable candida spp line infection
Definition
chose fluconazole
Term
clinically UNstable candida spp line infection
Definition
chose echinocandin
Term
antibiotic lock therapy
Definition
mixed with normal saline or heparin, used to penetrate biofil and get good antibiotic circulation systemically
Term
heparin + vanco for Antibiotic lock therapy
Definition
must have high doses of heparin to prevent precipitation
Term
antibiotics used for antibiotic lock therapy
Definition
vanco, gent/amikacin, or cipro
Term
best outcomes for ALT(lck therapy)
Definition
coag neg staph spp and 10-14 days in addition to systemic Abx
Term
coag neg staph (staph epidermidis); UNcomplicated
Definition
many lines salvaged with systemic Abx + ALT for 10-14 days; line not retained shorten duration to 5-7 days
Term
staph aureus
Definition
shorter duration only if catheter REMOVED, resolution of infection within 3 days, no prosthetic intravascular device, no metastatic infection, not diabetic and not immunosuppressed
Term
staph aureus abx duration
Definition
4-6 wks therapy because of metastatic infections (osteomylitis); line not salvageable most cases
Term
gram-neg bacilli (e. coli, klebsiella)
Definition
recommended to remove line, systemic abx 7-14 days; salvage with systemic + ALT for 10-14 days (no response remove line)
Term
candida spp.
Definition
remove line and treat 14 days (14 days start once blood cultures are CLEAR of candida)
Term
febrile after day 3 or persistent bacteremia (2-4 days on abx)
Definition
PULL LINE
Term
may use oral abx
Definition
high bioavailability, clinically stable pt, NOT ok for endocarditis
Term
ventilator associated pneumonia
Definition
> 48-72 hours after intubations
Term
VAP S/Sx
Definition
chest radiograph with progressive infiltrate + two of the following: fever, leukocytosis or leukopenia, purulent sections
Term
early onset VAP
Definition
abx sesitive pathogens more likely <4 days of hospitalization better prognosis
Term
if at risk for multi-drug resistant pathogens (MDRP)
Definition
treat as if late onset VAP
Term
pathogens of VAP
Definition
strep pneumoniae, H. influ, staph aureaus, enteric gram neg bacilli
Term
gram neg bacilli
Definition
E. coli, klepsiella pneumoniae, enterobacter, proteus, serratia marcenscens
Term
late onset VAP
Definition
>/= 5 days of hospitalization, increased morbidity/ mortality and rate of multidrug resistant pathogens
Term
ceftriaxone or cefotaxime for VAP
Definition
no multi-drug resist bags for early onset VAP (covers all bugs)
Term
levofloxacin and moxifloxacin for VAP
Definition
anti-pneumococcal fluoroquinolones, good for strep pneumoniae
Term
ciprofloxacin
Definition
poor strep pneumo activity
Term
amp-sulb
Definition
check E. coli, only use if there is not suspected E. coli
Term
Ertapenem for VAP
Definition
usually restricted, used for resistant bugs
Term
Multi-drug resistant pathogens risk factors (one of the following)
Definition
antimicrobial therapy in past 90days, current hospitalization > 5 days, high feq. of local antibiotic resistance, immune suppressed and has risk factors for HCAP
Term
HCAP risk factors
Definition
prior hospitalization, nursing home or extended care facility, home infusion, dialysis, long term wound care, close contact with MDR pathogen
Term
late onset VCAP bugs
Definition
Aerobic gram-neg bacteria, resistant strains of gram pos cocci
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