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20 Cards in this Set
- Front
- Back
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What is the most commonly isolated bacteria to cause CAP? What causes of PnA are common in healthy young adults? In COPD? |
1. Strep pneumoniae 2. Mycoplasma, chlamydia, viral 3. Moraxella catarrhalis, H. influenza |
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What populations of patients would you suspect legionella pneumonia in? What signs/symptoms would suggest it? |
1. Elderly, immunosuppressed, Tnf alpha inhibitors, smokers 2. High, recurrent fevers, increased liver enzymes, hyponatremia |
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What clinical scenario suggest possible Staph Areus PnA? |
Post viral, very ill |
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When would you suspect Bordatella Pertussis PnA? |
In unvaccinated patients or elderly adults with waning immunity, history of "whooping cough" |
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What bugs do you have to cover for in health-care associated pneumonia? |
Pseudomonas and other gram negative rods like klebsiella, E. coli, Enterobacter, serratia, acinetobacter, as well as (MR)SA |
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In suppressed individuals, after the common causes of Pneumonia, what other organisms do you have to consider? |
- pneumocystis jirovecci (fungi) - other Fungi - Nocardia (gram + rod, requires septra) - non-tuberculous mycobacteria - CMV - HSV |
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In patients with Pneumonia, when should effusions be tapped? |
When they are moderate to large (>5 cm on x-ray), or if the pneumonia is severe (rule out empyema) |
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How sensitive is legionally urinary antigen |
60-70% sensitive, as it only detects L1 serotype |
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When should you consider bronchoscopy in a patient with pneumonia? |
Bronch can be considered if they are failing to respond to treatment, are critically ill, immunosuppressed, or if you're considering TB or PCP but can't get adequate sputum |
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what are 6 reasons pneumonia can fail to improve with initial treatment? |
1. not enough time (can take >72 hours) 2. Inadequate dosing (i.e. vanco trough 15 for lung penetration) 3. resistant organism (i.e. pseudomonas, MRSA) 4. Wrong diagnosis (i.e. fungal infx, PE, ILD) 5. Metastatic infections (i.e. endocarditis, arthritis) 6. Empyema - esp. with strep - needs source control |
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What are the complications and opportunistic infections of HIV that have CD4 count thresholds? |
<500 - TB, neurosyphilis, recurrent bacterial infections, HSV, VZV, candidiasis, lymphoma, oral hair leukoplakia (EBV), kaposi's sarcoma <200 - PCP, toxoplasmosis, bartonella, cryptococcus, coccidio, histo <100-50 - CMV, MAC, invasive aspergillosis, disseminated bartonella, CNS lymphoma, PML |
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What is the treatment for PCP pneumonia? |
to determine the severity check an ABg: PaO2 >70 - septra 20 mg/kg divided TID PaO2 <70 or A-a gradient >35 - prednisone 40 mg PO BID, taper after 5 days, and septra |
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A patient is admitted to the ICU with severe sepsis. Initially, blood cultures are negative and she is started on broad spectrum antibiotics. After 72 hours her cultures eventually return positive for yeast, presumptive candida. |
Based on the IDSA guidelines, a non-neutropenic patient with invasive candida infection should be treated with an echinocandin - Caspofungin 70 mg loading dose then 50 mg daily - this can be stepped down to fluconazole after clinical stability - infected lines should be removed - the patient should have a dilated opthalmological exam - the patient should have daily blood cultures to document clearance - if there are no metastatic complications, the patient should receive 2 weeks of therapy after documented clearance of blood stream |
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A patient is initially candidemic from a TPN line, then imaging of their abdomen shows microabscesses in their liver and spleen. A sample of an abscess grows yeast, presumably candida. What is the treatment? |
According to IDSA guidelines, for chronic disseminated (hepatosplenic) candidemia initial therapy with amphoterecin B or an echindocandin (caspofungin) is reccomended and can be stepped down to fluconazole once improving |
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In a patient admitted to the ICU, when is there a role for empiric antifungal therapy? |
IDSA - Empiric antifungal therapy should be considered in critically ill patients with risk factors for invasive candidiasis and no other known cause of fever and should be based on clinical assessment of risk factors, surrogate markers for invasive candidiasis, and/or culture data from nonsterile sites (strong recommendation; moderate-quality evidence). Empiric antifungal therapy should be started as soon as possible in patients who have the above risk factors and who have clinical signs of septic shock (strong recommendation; moderate-quality evidence). |
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A patient with dyspnea NYD undergoes a bronchcosopy; culture and sensitivity reveals candida albicans. Her echo shows an Ef of 35% with no valvular lesions. How should the candida be managed? |
According to IDSA, in patients with candida growing in their respiratory flora this usually represents colonization and does not require treatment; this patients dyspnea can be explained by her heart failure, so that should be treated rather than the candida. |
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What is the treatment for candida endocarditis |
- initial therapy should be high dose echinocandin (caspofungin 150), or amphotericin with or without flucytosine |
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What defines invasive group a strep infection? How should this be treated? |
Invasive group A strep infection is defined by the presence of the organism at a typically sterile site, i.e. in the blood or under the dermis. Therapy is typically provided for 2 weeks starting after sterility is achieved |
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What is the treatment for necrotizing fasciitis? |
According to IDSA suspected nec fasc: 1. prompt surgical referral 2. broad spectrum antibiotics - vancomycin + piperacillin tazobactam or + meropenam 3. Documented GAS should receive penicillin and clindamycin |
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What are acceptable initial anti-fungal agents for each of the following fungi infections? a) Candida blood stream infection b) invasive pulmonary aspergillosis c) cryptococcus meningitis d) histoplasmosis or blastomycosis pneumonia e) mucormycoses rhino-orbital infection |
a) caspofungin if criticall ill, fluconazole if stable/no recent azole therapy b) voriconazole d) amphotericin B e) itraconazole, if severe amphotericin B e) amphotericin B *Amphotericin B is broad spectrum and is like the carbapenam equivalent of antifungals, and is used in any CNS infection or can be used if the etiology is uncertain initially |
