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69 Cards in this Set

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General principles of ID
`
normally sterile body sites
blood
urine
spinal fluid
normally colonized areas
skin
GI
fecal material
MIC

Breakpoints
lowest concentration of antimicrobial that prevents microbial growth after 18-24h

breakpoints
- susceptible
- intermediate
- resistant
neutrophil

bands

shift to the left
neutrophil
- first responder wbc
- count usually inc in infection

bands
- immature neutrophils

shift to the left
- marrow responding to infectious insult
resulting in more bands relative to
mature neutrophils
inflammatory markers
C-reactive protein
erythrocyte sedimentation rate
tumor necrosis factor
leukopenia

leukocytosis
penia - dec wbc count

cytosis - inc wbc count
In general, latin suffixes for increased and decreased (deficiency of)
increased
- cytosis

deficiency
- penia
empiric therpay

vs

culture-guided tx
empiric
usually broad-spectrum in nature

is therapy that is directed toward all common pathogens associated with a dz state
meningitis
inflammation of the meninges

abnormal # of wbc in cerebrospinal fluid
meningitis

empiric treatment for newborn to 1 month
ampicillin and aminoglycoside

or

cefotaxime

or

ceftriaxone
meningitis

1 month to 60 years old
cefotaxime or ceftriaxone

plus

vancomycin
meningitis

> 60 yo
ampicillin and aminoglycoside/vanc

or

cefotaxime

or

ceftriaxone
endocarditis

Chapter 59 in Applied Txics
see tables for doing if want
infection of the indocardium which is the membrane lining the heart chamber and valves

treatment depends on causative organism and presence of prosthetic devices (longer tx)
endocarditis

streptococci
penicillin-susceptible
penicillin G alone (4w)

or

penicillin G with gentamycin (2w)

or

ceftriaxone alone (4w)

or

vancomycin in allergic to penicillin (4w)
endocarditis

streptococci
relatively resistant to penicillin
penicillin G alone (4w)

or

penicillin G with gentamycin (2w)

or

vancomycin in allergic to penicillin (4w)
endocarditis

staphylococcus (methicillin-sensitive)
w/out prosthetic materials
-pt not allerigic to penicillin
nafcillin (4-6w)

or

oxacillin (4-6w)

w/optional gentamycin (3-5d)
endocarditis

staphylococcus (methicillin-sensitive)
w/out prosthetic materials
-pt allergic to penicillin
cefazolin (4-6w)

with optional gentamicin (3-5d)

or

vancomycin (4-6w)
endocarditis

staphylococcus (methicillin-resistant)
w/out prosthetic materials
vancomycin (4-6w)
endocarditis

staphylococcus (methicillin-resistant)
WITH prosthetic materials
vancomycin (>= 6w)

and

rifampin (>= 6w)

and

gentamycin (2w)
endocarditis

staphylococcus (methicillin-suseptible)
WITH prosthetic materials
nafcillin or oxacillin (>=6w)

and

rifampin (>=6w)

and

gentamicin (2w)
endocarditis

epidemiology
common in IV drug abusers

heart valve replacement

other IV access procedures
- hemodialysis
- central venous catheterizations
- IV catherterization
Acute / chronic bronchitis
inflammation of the bronchioles

chronic is largely associated with heavy smoking

virus responsible for half of causes

sputum cultures usually not helpful
acute bronchitis treatment

symptom control
treatment is controversial b/c primarily viral in origin

symptom control
-antitussive to control cough
-intermittant antipyretic (Ibup, APAP)
-adequate hydration
acute bronchitis treatment

abx indicatation
controlled trials say Abx not effective yet 6 million annual RXs for Abx (stupid)

if pertussis (whooping cough) suspected may treat w/Abx to prevent spread
- no clinical features...only suspected exposure
acute exacerbation of chronic bronchitis
(AECB)
treatment controversial...usually not necessary unless severe
- frequently caused by smoking

following have been adequately studied:
amoxicillin, tetracyclines (doxy, mino, tetra), TMP-SMX, chloramphenicol

fluoroquinolones and newer macrolides (clarithro, azithro) equally effective but not superior
Common antibiotic macrolides
* Azithromycin (Zithromax, Zitromax,
Sumamed) - Unique, does not inhibit
CYP3A4
* Clarithromycin (Biaxin)
* Dirithromycin (Dynabac)
* Erythromycin
* Roxithromycin (Rulid, Surlid,Roxid)
* Tulathromycin
treatment of simple AECB

<4 exacerbations/year
no comorbidities
low rate of pen resistance
macrolide
doxycycline
2nd, 3rd gen cephalosproin
amox/clav
treatment of complicated AECB

>=4 exacerbations/year
comorbidities
inc risk of pen resistance
amoxicillin/clavulanate

fluoroquinolone
treatment severs AECB

recurrent abx or steroid TX
based onculture
Pneumonia
inflammation of the lung parencyma

fills alveolar air spaces with exudates, inflammatory cells, and fibrin

sputum culture may be useful to id some pathogens but hard to get good deep culture
Pneumonia

neonatal

1-3m

3m - 5y

5y-18y
neonatal
ampicillin and gentamicin
or
cefotaxime and gentamicin

1-3months
erythromycin,clarithromycin,cefuroxime

3m-5y
clarithromycin,cefuroxime,cefotaxime

5-18y
clarithromycin,erythromycin,cefuroxime
CAP treatment - adult

ambulatory

hospitalized
anbulatory
- oral macrolide (azith, clarith, eryth)
or
- fluoroquinolone (levo, gati, moxi)

hospitalized
- cefotaxime or ceftriaxone
- w/ or w/out macrolide
or
- fluoroquinolone alone
Hospital aquired pneumonia - adult
aminoglycoside
(ie gentamycin, amikasin, tobramycin)

plus one of the following:

cefotaxime, ceftrizsone, cefepime, ticarcillin/clavulanic acid, pip-taz, meropenem, or imipenem

if MRSA suspected - add vancomycin
aspiration pneumonia - definition
Aspiration pneumonia is caused by aspirating foreign objects which are usually oral or gastric contents, either while eating, or after reflux or vomiting
aspiration pneumonia - adult
uncomplicated:
pen G, clindamycin

Hospital acquired:
ticarcillin-clavulanic acid, pip-taz

book didn't specify if AND or OR for above
Hospital acquired pneomonia - definition
also called nosocomial pneumonia, is pneumonia acquired during or after hospitalization for another illness or procedure with onset at least 72 hrs after admission
tuberculosis
communicable infectious dz

can be silent, latent infection as well as active

usual site is pulmonary but can be any tissue or organ
tuperculosis treatment
latent (probably isoniazide sensitive)
- isoniazide 9 months

latent (prob isoniazide resistant)
- rifampin + pyrazinamide
- 2 months

active
- isoniazid + rifampin + pyrazinamide
- 2-4 months
infectious diarrhea

treatable usually associated moderate to severe presentation w/fever, chills, cramping
usually treat with supportive care except

e. coli in hospitalized pts
- fluoroquinolone or TMP-SMX

salmonella if febrile
- flurorquinolones or TMP-SMX

shigella
- TMP-SMX
infectious diarrhea cont

treatable usually associated moderate to severe presentation w/fever, chills, cramping
contaminated water (campylobacter)
- macrolides or fluoroquinolones

seafood ingestion:
- yersinia enterocolitica
- flurorquinolones
- vibrio parahaemolyticus
- tetracycine or fluoroquinolone
infectious diarrhea supportive care
- antimotility - discouraged


- antipyretics


- antiemetics
skin and soft tissue infections

cellulitis
skin infections:
1. cellulitis
2. secondary to wound or incision

cellulitis
- usually one organism
- direct infection of the skin

generally - treatment is empiric based on likely organisms
cellulitis
group A step; staph aureus

outpatient
- dicloxacillin, cefadroxil, cephalexin,
erythromycin

inpatient
- cefazolin, erythromycin
diabetic foot infections
clindamycin or cephalexin

severe infections:
ticaracillin-clavulanic acid or other B-lactamase inhibitor

vanconycin if MRSA
Bacterial Venereal Dzs

name them
gonorrhea and syphilis
syphilis presentation

primary and secondary
PRIMARY
- painless lesion or chancre appearing at the site of infection about 21d after exposure
- spontaneously goes away - 8wks

SECONDARY
- develops 2-6 weeks after onset of prim
- flu-like sx and rash
- sx disappear - 2-6 weeks
syphilis

tertiary (messed up)
Untreated patients will develop TERTIARY syphilis within 2-25 years

- general paresis (dementia, progressive
muscular weakness, and paralysis)
- nerve deafness
- progressive dementia
- aortic insufficiency
gonorrhea presentation
urethritis (an inflammation of the urethra) w/in 2-3 days

dysuria (painful or difficult urination) purulent discharge common

majority become asymptomatic w/out treatment in 6 months

15% will develop Pelvic inflammatory Dz
- can lead to infertility
syphilis treatment

uncomplicated adult

infant born of untreated mother
uncomplicated adult
- benzathine penicillin G
- 2.4 million units IM x 1

infant born of untreated mother
- penicillin G
- 50-70K U/kg q12h x 10-21d

secondary latent
-
syphilis treatment (disseminated)

secondary latent

tertiary disease
secondary latent
- benzathine penicillin G
- 2.4million units IM qw x 3

tertiary
- penicillin G
- 2-4 million units q4h for 10-14 days
gonorrhea treatment

adult

child

disseminated (spread over a large area of body, tissue, or organ)
adult
ceftriaxone 125mg IM x 1
or
spectinomycin 2g IM q12h x 2

newborn
- cefotaxime 25mg/kg q12h x 7d

disseminated
- ceftriaxone 1g qd x 10d
gonorrhea

treatment considerations
also receive tx against chlamydial infection
- usually doxycycline 100mg bid x 7d
or
- azithromycin 1g once

all sexual partners must also be treated
sepsis
systemic inflammatory response syndrome (SIRS)

requires two of the following:
- T>38 or < 36
- HR > 90
- RR > 20 or PaCo2 < 32
- WBS > 12,000 or < 4000, or >10%
bands

gram +, -, and fungi too
sepsis

treatment
initially broad until culture obtained

life-threatening
- cefotaxime, ceftriaxone, cefepime, ticarcillin-clavulanic acid, pip-tax, meropenem, or imipenem w/ and aminoglycoside (tobra, genta, amikacin)
UTI - treatment

- acute uncomplicated cyctitis ( is
inflammation of the urinary bladder)

- acute pyelonephritis (inflammation of
the kidney and upper urinary tract)

- prostatitis (inflamm of the prostate)
cyctitis
- TMP-SMX x 3d or quinolone x 3d

pyelonephritis
- quinolone x 14d or TMP-SMX x 14d
- if severe
- parenteral tx w/quinolone, extended -
spectrum penicillin, and aminoglyco

prostatitis
- quinolone x 4-6 weeks
- TMP-SMX x 4-6 weeks
tick borne systemic febrile syndromes

primary treatments for:
lyme dz
rocky mountain spotted fever
ehrilichiosis
tularemia
lyme dz
- doxycylcine

rocky mountain spotted fever
- doxycycline

ehrilichiosis
- doxycycline

tularemia
- gentamicin or tobramycin
systemic fungal infections

define primary vs opportunistic

where do fungal infections like to go?
primary
able to cause infection in both healthy and immoncomprised

opportunistic
only in immunocomprimised

pulmonary focus b/c aerosol spread of mold spores
systemic fungal infections

treatment considerations
empiric until organism isolated

pts response is to treatment is guiding since it takes so long to culture fungi
systemic fungal infections

treatments (the players in general)
amphotericin B

itroconazole

caspofungin

voriconazole

fluconazole

flucytosine
viral infections
treatment not curative

tx decreases level of virus so immune system can handle the infection
hepatitis treatments

A, B, C, D, E
A, D, E - standard tx not developed

B, chronic
- lamivudine + interferon alpha-2b

C, chronic
- interferon alpha 2b + ribavirin

C, acute
- interferon alpha-2b
influenza
acute respiratory viral infection

three viruses, A, B, C

therapy is prophylactic and determined by community patterns

no tx for C exist
influenza A

prophylaxis and treatment
prophylaxis
- oseltamivir

- rimantadine

- amantadine

treatment
- zanamivir
- oseltamivir
- ramantadine
- amantadine
influenze B

prophylaxis and treatment
prophylaxis
- oseltamivir

treatment
- oseltamivir
- zanamivir
herpes simplex family

3 types
herpes genetal

cytomegalovirus (CMV) in the immunocompromised

chickenpox/shingles (varicella-zoster)
herpes genetal treatment
initial episode - acyclovir

reoccurrence - famciclovir

chronic suppression - valacyclovir

immunocompromised - acyclovir

resistant to acyclovir - foscarnet
cytomegalovirus

areas affected and treatment
areas
- retinitis
- colitis
- esophagitis

treatment
- ganciclovir
- valganciclovir
flocarnet
cidofovir
fomivirsen
varicella zoster

-shingles, chickepox
acyclovir

resistant to acyclivir and in immunocompromised pts:
- foscarnet