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32 Cards in this Set
- Front
- Back
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Common Organisms in UTI (Community/Nosocomial) |
Community (E. Coli, Staph saprophyticus, Klebsiella, Proteus mirabilis)
Nosocomial (E. Coli, Klebsiella, Staph aureus, Proteus mirabilis, Pseudomonas aeruginosa, Enterobacter spp., Fungus (candida) ) |
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UTI diagnosis involves urinalysis confirmed by these criteria
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Bacteruria
Pyuria (WBCs) Nitrite (+) - bacteria byproduct Leukocyte esterase (+) Casts --> pyelonephritis (from glomerulus of kidney) |
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Upper UTI can have all the symptoms of a lower UTI except these three
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Flank pain
Fever N/V |
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Complicated UTI involves these patient populations
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Male
Elderly Pregnant Children Nosocomial Recent antibiotic use Diabetes Immunosuppressed Catheterized |
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UTI guidelines (Uncomplicated uncomplicated, Uncomplicated Pyelonephritis, Complicated UTI)
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1) Bactrim or FQ for 3 days
2) Bactrim or FQ for 7-14 days 3) FQ or Aminoglycoside or Extended spectrum Beta-lactam for 10-14 days ***PCN-Cephalosporin cross reactivity ~10%*** |
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Common organisms in Pneumonia (Community)
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Community
Mycoplasma, Steptococcus, Chlamydia, Legionella Pneumonia's Haemophilus Influenzae, Moraxella catarrhalis, Virus |
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Common organisms in Pneumonia (Hospital (48 hours or more after admission)
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Staph aureus
Pseudomonas Klebsiella Enterobacter E. Coli Acinetobacter spp. Serratia spp. Anaerobes |
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PNA guidelines
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Community-acquired (outpatient)
Previously healthy/no antibiotics in last 3 months --> Macrolide (clarithromycin, azithromycin) or Doxycycline Comorbidities or antibiotics in last 3 months --> FQ (moxi, gemi, levo - respiratory) OR Macrolide or Doxycycline + High dose amoxicillin, Augmentin, or Cephalosporin (ceftriaxone, cefurxime, cefpodoxime) |
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Community acquired (Hospitalized - developed within 48 hours of admission)
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Moderate - same as outpatient
Severe - FQ (moxi, gemi, levo) or Azithromycin + Ampicillin, Ceftriaxone or Cefotaxime |
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Hospital acquired
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Hospitalized < 5 days and no RF's for MDR organisms
- 3rd generation cephalosporin (ceftriaxone, cefotaxime) - FQ (ciprofloxacin, moxi, levo) - Ampicillin/sulbactam - Ertapenem |
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Hospital acquired cont.
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Hospitalized > 5 days or risk factors for MDR organism
- Ceftazidime or cefepime - Imipenem/cilastatin or meropenem - Piperacillin/tazobactam |
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Duration difference between Community acquired and hospital acquired
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Community = 5 or more days
Hospital = 8 days and 14 if organism is pseudomonas |
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What comorbidities put you at risk?
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COPD
DM CKD Chronic liver failure Cancer Asplenia Immunosuppressed |
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What factors put you at risk for an MDR?
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Recent antibiotic therapy (last 3 months)
Hospitalized for 5 or more days Increased resistance in environment Nursing home resident Chronic dialysis Home infusion therapy* Immunosuppressed |
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Common organisms in Meningitis
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<1 months (Strep - group b, E.coli, Listeria, Klebsiella spp.)
1-23 months (Strep pneumo, Neisseria meningitidis, group b strep, H influenzae, E.coli) 2-50 years (Strep pneumo, Neisseria meningitidis) > 50 year (Steptococcus pneumoniae, Neisseria meningitidis, group be strep) |
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Diagnosis is confirmed via spinal tap - CSF. what will bacterial meningitis will show?
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Decreased glucose, Increase protein and WBC
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S/S of meningitis
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Typical symptoms of infection + nuchal rigidity, altered mental status, and Petechiae/purpura with Neisseria meningitidis
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Emperic treatment for meningitis
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< 1 month (Ampicillin + aminoglycoside OR Ampicillin + cefotaxime)
1-23 months (3rd generation cephalosporin - cefotaxime or ceftriaxone + Vancomycin) 2- 50 years (same) > 50 years (same + Ampicillin) |
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Common organisms for Sexually Transmitted Diseases
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Chlamydia trachomatis
Neisseria gonorrhoeae Treponema pallidum (syphilis) |
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Test for Chlamydia
Gonorrhea Syphilis |
Urine swab or urethra
Gram stained smears or culture from urethra/urine specimen Dark field examination and direct fluorescent antibody stains of exudates (serologic testing) |
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S/S of chlamydia vs gonorrhea
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Penile/vaginal discharge, dysuria in both + urinary frequency in gonorrhea
May be asymptomatic |
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S/S of syphilis
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Primary - chancre
Secondary - rashes/lesions, flu-like symptoms, lymphadenopathy Latent - (positive serologic test, no symptoms) Tertiary - Cardiovascular and neurologic abnormalities |
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Treatment guidelines for Chlamydia
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Azithromycin (1 dose) or Doxycycline (7 days)
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Treatment guidelines for Gonorrhea
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Ceftriaxone 1 dose IM or Cefixime 1 dose PO +
Chlamydia treatment if not ruled out |
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Treatment guidelines for Syphilis
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Primary, Secondary, Early latent (less than 1 year) --> Benzathine penecillin G 2.4 million units 1 dose IM
Late latent (more than one year) --> Benzathine penicillin G 2.4 million units IM once weekly x 3 weeks Neurosyphilis --> Aqueous penecillin G 3-4 million units IV q 4 hours x 10-14 days (inpatient) |
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Name the Bacteriocidal antibiotics
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Beta-Lactams (PCNs, Cephalosporins, Carbapenems, Aztreonam)
Vancomycin, Telavancin Daptomycin Metronidazole Fluoroquinolones Aminoglycosides Quinpristin/Dalfopristin |
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Name the Bacteriostatic antibiotics
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Sulfonamides
Tetracyclines Tigecycline Chloramphenicol Clindamycin Linezolid Quinpristin/Dalfopristin Macrolides |
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Name the mechanism of action of the bacteriocidal antibiotics
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Beta Lactams - Inhibit cell wall
Vanco, Telavancin - Cell wall Daptomycin - Cell membrane Fluoroquinolones - Topoisomerase/Gyrase Metronidazole - DNA synthesis Quin/Dalfo - 50 S subunit Aminoglycosides - 30 S subunit |
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Name the mechanism of action of the bacteriostatic antibiotics
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Sulfonamides - PABA --> Folate
Tetracyclines - 30 S Tigecycline - 30 S Chloramphenicol - 50 S Macrolides - 50 S Clindamycin - 50 S Linezolid - 50 S |
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Name the antibiotics that treat MRSA
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Vancomycin
Daptomycin Linezolid Telavancin Tigecyline |
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Name the antibiotics that treat Pseudomonas Aeruginosa
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Piperacillin/Tazobactam
Ticaricillin/Clavulanic acid Cefepime Ceftazidime Aztreonam Carbapenems (Not Erta) Aminoglycosides Ciprofloxacin |
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Name the 5 different types of PCN
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Natural PCNs
Penicillinase - resistant PCNs Aminopenicillins Aminopenicillins + Beta-lactamase inhibitor Antipseudomonal PCNs + Beta-lactamase inhibitor |
