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24 Cards in this Set

  • Front
  • Back
MRSA -
-humans are a natural reservior of staph aureus
-50% of all healthy adults are colonized
-historically a nosocomial infx
CA-MRSa
-skin and soft tissue infxs mostly
-can progress to serious, perhaps fatal necrotizing conditions
CA-MRSA whos at risk
-younger pops:dermatologic conditions, attendance in day care and the presence of infection in another family member
-older pops:IVDU, prison inmates, low socioeconomic status/crowded living conditions or chronic disease (HIV, diabetes, chronic steroid use)
presentation CA-MRSA
-often present with boils or pruritic papules
-may progress to form abscesses or cellulitis
-may also progress to necrotizing -pneumonias, necrotizing fasciitis, scalded skin syndrome and TSS
CA-MRSA dx
-inc index of suspicion
-wound cx
-nasal swab
CA-MRSA tx
-TMP/SMZ, tetracyclines, clindamycin
-quinolones
-rifampin
-linezolid (stop SSRIs)
-mupirocin ointment intranasally
-anti-bacterial soaps
-household contacts: should be tx with mupirocin
C. Diff
-causative agent in pseudomembranous colitis
-leading to severe diarrhea and colitis
-Initially thought to affect hospitalized patients or those on antibiotics or in long-term facilities
-C. diff is now affecting healthy patients
C. diff etiology
-may occur when broad-spectrum abx eradicate nml GI flora
-C. diff infxs have been known to occur most often with pts taking clindamycin and second-and third generation cephalosporins
C. diff transmission
-person-to-person
-spores are resistant to alcohol or other antiseptic wipes
C. diff a new strain
-resistant to quinolones
-showing up more frequently in pts taking H2blockers and PPIs
-affecting patients in the community and those who have not taken antibiotics or recently hospitalized
C.diff dx and tx
-check stools for C.diff toxin
-tx: PO metronidazole or vanco
multi drug-resistant S.pneumoniae
-causative agnet: meningitis, PNA, OM, bacterial RS, bacteremia
-patterns of resistance: PCN resistance may be as high as 30% in US
-prevention: pneumovax
S. pyogenes
-the causative agent of: strep throat, impetigo
-all isolates of S.pyogenes were PCN susceptible
-the rate of resistance to the macrolide erythromycin was 5.5%
-the majority of erythromycin-resistant strains were also resistant to clarithromycin and azithromycin..but susceptible to clindamycin
Pertussis
-bordatella pertussis
-childhood vaccination does not provide immunity into adulthood
-a sig proportion of infx occurs in adults and adolescent whose levels of ABs have declined
pertussis clinical presentation
-cough lasting >2wks
-paroxysms of coughing
-inspiratory whooping
-posttussive emesis
pertussis sequelae
-in infants, the disease may result in apnea, pneumonia, encephalopathy and death
-severe coughing may produce conjunctival and scleral hemorrhages, subcutaneous emphysema, PTX, rib fractures, hernias, seizures
pertussis transmission
-highly contagious, can develop in up to 90% of family contacts
-spread by resp droplets
-very contagious during the first week of illness
pertussis dx
-CBC with diff: leukocytosis with lymphocytosis may be present
-preferred test is the nasal swab for PCR and culture confirmation
pertussis tx
-erythromycin x 14 days
-macrolide-allergic: use TMP/SMZ
-cough may persist beyond tx with abx
-goal of therapy is to reduce transmission to others
pertussis prophylaxis
-household contact should be treated, regardless of immunization status
-new vaccines are avail: Tdap
-reportable disease
Respiratory synctial virus
-pediatric illness on the rise inthe elderly
RSV in elderly
-accounted for 11% of hospitalizations for pneumonia, 11% for COPD, 5% for heart failure and 7% for asthma
-death rate was 8% for hospitalized patients and 7% for influenza patients
-more dangerous in the elderly
RSV sx
1. nasal congestion
2. sore throat
3. hoarsness
4. new or worsening cough
5. sputum production
6. +/- fever
RSV dx and tx
-reverse-trascriptase PCR
-tx: largely supportive, ?Ribaviron, no vaccine