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27 Cards in this Set
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- Back
Enterobacter microbiology |
Gram neg, aerobic, motile bacilli Enterobacter family Major pathogenic species: cloacae |
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Enterobacter drug resistance |
Chromosomal AmpC betalactamases that are constitutive and inducible + plasmid-encoded ESBLs and carbapenamases prescence of beta-lactams required for activation of inducible beta-lactamses |
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ID carbapenamase producing enterobacter by |
Modified Hodge Test |
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Common nosocomial enterobacter Dx |
VAP, burn/surg wound infections, catherter or device related infections, post neurosurg meningitis |
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Enterobacter inherent resisance |
Ampicillin, 1G cephs, macrolides PNA/osteo treatment with beta-lctams may lead to formation of beta-lactamses |
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Treatment of carbapenamse-producing enterobacter |
gentamicin, tobra, amik, colisitin reserve nitrofurantoin and fosfomycin for uncomplicated UTIs |
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Drug resitance to which AB may develop while on therapy? |
cefepime
double coverage often needed empirically |
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Citrobacter micro |
Gram neg aerobic bacilli normal gut flora colonies on plates resemble e coli
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C. species |
freundii, amalonaticus, koseri |
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Clinical citrobacter Dx |
nosomal pathogen found in immunocompromised hosts (UTIs, PNA, line infections common)
frequently express B-lactamse Isolates may express ESBL or KPC
bacteria often polymicrobial |
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acinetobacter microbilology |
gram neg coccobacilli or rod common in environemnt and hospital
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acinetobacter species |
baumanni is major Others: wolfii, junii, baylyi
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a baumanni |
low-grade pathogen affects compromised hosts
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Clinical acineto |
Pan-resistant GNR Risks: hosp, ICU, surgery, antibiotic exposure, catheters, ventilators |
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Acinetobacter lab isolations |
often meaningless: common colonization unless 1. normally sterile site (ie blood) 2. found as dominant pathogen and heavy growth from potentially contam site 3. outbreak 4. good clinical correlation |
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Most active abx against acineto |
imipenem, unasyn, colisitin, tigecycline, amikacin |
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abx with variable acineto activity |
AG, cephs, minocycline, rifampin |
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Pseduomonas micro |
gram neg non fermenting motile bacillus blue-green pus biofilm non-fastidious (can inhibit variety of environments) fasti = complex nutrition requirement |
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Pseduomonas drug resistance mechs |
Efflux pumps Chromosomal and inducle beta lactamases Plasmid-mediated ESBL (TEM, SHV, CTX-M) Altered permeability Loss of protein porin OprD results in resist to carbapenemes |
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Clinical pseduo |
common nosocomail pathogen esp in immunocompromised setting or foreign body (central line, urinary cath)
chornic CF colonizer
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Pseduo MDR risk factors |
Mutilple recetn abx use (past 90 days) Hosp stay > 4 days LTC
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MDR strains treatment |
colistin, polymyxin B |
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Which patients may require higher doses of Abx for pseduomonas treatment? |
Prego, burns, CF, critical illness |
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Resistance to pip-tazo is not beta-lactamse realted |
really no benefit of tazo vs. pip alone |
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Pseudomonas virulence |
fimbriae EC polysaccharides flagella exotoxin A exoenzyme S EC ezymes (alkaline phosphatase, phospholipase C) |
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Pseudomonas exotoxin a |
important virulence factor blocks eukaryotic cell protein synthesis by inhibiting EF-2 similar to dipthereia) |
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Other pseudomonas (or similar species) |
burkholderia mallei, B pseduomalleli, B cepacia |