540 - Drug Delivery Systems - Exam Iii - Biofilms

Front 1

Name the bio-film associated infections?

Back 1

IV catheter infections, Urinary catheter infections, Device Infections (Pacemakers, Prosthetic Joints)

Front 2

What is an "Antimicrobial Biofilm?

Back 2

Sophisticated communities of matrix-encased surface attached bacteria with hydrated structures with water channels to allow nutrients and oxygen diffusion

Front 3

What are the contents of a biofilm?

Back 3

1) Non-microbial host-derived components (platelets)
2) Cell-to-cell communication molecules
3) Dense matrix of polysaccharides
4) Bacterial Proteins (adhesins) and virulence factors

Front 4

What different routes can antimicrobials be delivered to the site of infection?

Back 4

1) Oral therapy
2) IV therapy
3) Material design (embedding/coating a device with antimicrobials)
4) Localized therapy

Front 5

What are the targets for antimicrobials?

Back 5

1) Cell wall synthesis
2) Protein synthesis
3) DNA synthesis
4) Anti-metabolites

Front 6

What are the clinical implications of bacterial biofilms?

Back 6

1) Attachment and growth of bacterial communities
2) Involved in prosthetic and catheter relation infections
3) Common in Staphylococci and many others
4) Much less susceptible (10-1000x) to antimicrobials

Front 7

What are common organisms found in clinical biofilms?

Back 7

1) Coagulase-neg Staphylococcus spp
2) Staph aureus
3) Gram - bacilli
4) Candida spp

Note: Almost any organism will form biofilms under the right condition!

Front 8

What is a "Peripheral Venous Catheter"?

Back 8

Device usually into the veins of the forearm or the hand; most common used short-term intravascular device

Front 9

What is a "Peripheral Arterial Catheter?"

Back 9

For short-term use, common used to monitor hemodynamic status and to determine blood gas levels of critical ill patients. Risk of infection may approach that of CVCs

Front 10

What is a "Midline Catheter"?

Back 10

Peripheral catheter is inserted via the antecubital fossa into the proximal basilic or cephalic veins, but it does not enter central veins; it is associated with lower rates of infection compared to CVCs

Front 11

What is a "Short-term CVC"?

Back 11

Most common used CVC, accounts for the majority of all catheter-related bloodstream infections

Front 12

What is a CVC?

Back 12

Central Venous Catheter

Front 13

What is a "Pulmonary Artery Catheter?"

Back 13

A device inserted through a teflon introducer and typically remains in place for an average duration of 3 days

Front 14

What is a "Pressure-Monitoring System"?

Back 14

Used in conjunction with arterial catheter, associted with both epidemic and endemic nosocomial bloodstream infections

Front 15

What are the main focus of preventive strategies of catheter-related infections?

Back 15

1) Catheter Hubs
2) Catheter insertion site

Front 16

What are the 2011 Guidelines for the Prevention of Intravascular Catheter-Related Infections?

Back 16

1) Educating and training health-care providers who insert and maintain caths
2) Using max sterile barrier precautions during CVC insertion
3) Using a 2% chlorhexidine prep for skin antisepsis
4) Avoid routine replacement of CVCs as a strategy to prevent infection
5) Use antiseptic/biotic impregnated short-term CVS if rate of infection is high despite adherence to other strategies

Front 17

What drug is used to treat methicillin-resistant Staphylococcus aureus (MRSA)?

Back 17

Vancomycin

Front 18

How should treatment for gram negative bacilli be based?

Back 18

Empirical coverage should be based on local antimicrobial susceptibility data and the severity of the disease

Front 19

What should not be used for empirical therapy (i.e. used when a patient is suspected, but not proven, to have an infection)?

Back 19

Linezolid

Front 20

What other coverage, aside from gram-positive pathogens, should be included involving suspected CRBSI involving femoral caths in critically ill patients?

Back 20

Coverage for gram-neg bacilli and Candida species

Front 21

What is an "Antibiotic Lock"?

Back 21

Technique used for catheter salvage, but if this cannot be used revert so systemic antibiotics administered through the colonized cath

Front 22

What is the formulation of an antibiotic lock solution?

Back 22

1) EtOH
2) Anticoagulants
3) Dose (Often multiple times higher than MIC)
4) Dwell time and stability
5) Prep practicality for pharmacy

Front 23

What are the pros of antimicrobial-coated catheters?

Back 23

1) Reduced risk of infection
2) Short term bridge for treatment

Front 24

What are the cons of antimicrobial-coated catheters?

Back 24

1) Increased costs
2) Local reactions
3) Lack of long term success

Front 25

What are some examples of antimicrobial-coated catheters?

Back 25

1) Chlorhexidine/Silver sulfadiazine
2) Minocycline/Rifampin
3) Plantinum/Silver
4) Silver cuffs

Front 26

What is the most common type of healthcare-associted infection?

Back 26

Catheter Associated Urinary Tract Infections (CAUTI)

Front 27

What is the comprehensive strategy for CA-UTI prophylaxis?

Back 27

1) High priority recommendations for urinary catheter use
2) Aseptic insertion
3) Maintenance
4) Routine use of systemic microbials is not recommended

Front 28

What type of CA-UTI prophylaxis should be used in recurrent diseases?

Back 28

Antimicrobial coated catheters

Front 29

What are the CDCs steps to prevent resistance?

Back 29

1) Vaccinate
2) Remove caths
3) Target pathogen
4) Access experts
5) Antimicrobial control
6) Use local data
7) Treat infection not contamination
8) Know when to say no
9) Stop treatment
10) Isolate pathogen
11) Break chain of contagion

Front 30

What are the risk factors for prostethic joint infections?

Back 30

1) Prior surgery at site
2) Rheumatoid arthritis
3) Immunocompromised states
4) Diabetes mellitus
5) Poor nutritional status
6) Obesity
7) Psoriasis
8) Extremely advanced age

Front 31

What is the use of antibiotic spaces/beards/cement?

Back 31

To treat or prevent local infection of bone and soft tissue

Front 32

What are the advantages of antibiotic spaces/beads/cement?

Back 32

1) Delivers direct local therapy at high concentrations
2) Fills dead space from debridement
3) Low system effects

Front 33

What antibiotics are used in local therapy?

Back 33

1) Vancomycin
2) Gentamicin
3) Daptomycin
4) Silver and SSD
5) Rifampin
6) Amikacin
7) Amphotericin