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96 Cards in this Set
- Front
- Back
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What patients are more susceptible to nosocomial pneumonias?
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• abdominal surgery
• elderly • thoracic surgery |
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What is the definition of community-aquired pneumonia (CAP)?
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• acute infection of pulmonary parenchyma
• presence of acute infiltrate on chest X-ray or auscultory findings • patient is not hospital prior to presentation • patient can be in a long-term facility less than 14 days |
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What are symptoms of community-aquired pneumonia?
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• chest discomfort
• cough (with or without sputum) • fatigue • fevers • rigors • SOB • sweats * must have two of the above |
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What are factors that can predict a complicated course of CAP?
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• age > 65 y/o
• AMS • bacteremia • chronic disease (CHF, DM, lung, liver, & kidney disease) • high fever • immunosuppressed • multilobe involvement or pleural effusions |
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What are organisms that can cause CAP?
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• Unidentifiable 40-60%)
• M. Pneumonia (13-35%) • S. Pneumonia (9-20%) • H. Flu (3-10%) • C. Pneumonia (1-17%) • Legionella (0.7-12% |
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What is the definition of nosocomial pneumonia?
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• infection of the lung developing more than 48 hrs after hospitalization
• accompanied by a physical exam showing rales, dullness to percussion, or an infiltrate on X-ray |
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What clinical findings are required for a diagnosis of nosocomial pneumonia?
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• histopatholofic evidence of pneumonia
• isolation of pathogen from culture • isolation of a virus in respiratory secretions • purulent sputum * must have at least one of the above |
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What are risk factors for nosocomial pneumonia?
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• age
• COPD • decreased consciousness • ICU • immunosuppression • intubation • nasogastric tubes • prior antiobiotic therapy • severity of underlying disease • surgical procedures |
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What are microorganisms that can cause nosocomial pneumonia?
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• unidentifiable (50%)
• S. aureus (10%) • Pseudomonas (8%) • Enterobacter (5%) • Klebsiella (4%) • Candida (3%) • Acinetobacter (2%) |
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What is the duration of therapy for CAP?
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5-14 days
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What is the empiric treatment for healthy non-hospitalized patients suspected of having CAP?
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• Macrolide (Azithromycin) or Doxycycline (with no recent antibiotic use)
OR • Fluoroquinoline or Macrolide w/ high dose PCN, like Augmentin (with recent antibiotic use) * macrolide covers the atypical bacteria |
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What is the empiric treatment of a patient with comorbidity (ex. DM, CHF) and suspected of having CAP?
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• Macrolide or Fluoroquinoline (no recent antibiotic)
OR • Fluoroquinolone or macrolide w/ 2nd gen. cephalosporin (Ceftin, Cefuraxime) |
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What is the empiric treatment of non-hospitalized patients with suspected aspiration?
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• Augmentin
• Clindamycin |
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What is the empiric treatment for hospitalized patients with CAP?
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• fluroquinolone (Levaquin 750 mg x 3 days) OR
• macrolide with 3rd gen cephalosporin (Azithromycin & Rocephin) |
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What is the difference in bioavailability of Levaquin IV and Levaquin PO?
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both formulations have bioavailability of 99.9%
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What is the empiric treatment for hospitalized patients with severe pneumonia?
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• Zosyn (Pipercillin/Tazobactam) OR
• 3rd gen cephalosporin + fluoroquinolone or macrolide |
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What is the empiric treatment for a patient with nosocomial pneumonia with no risk factors?
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• Ticarcillin or Piperacillin
• 3rd gen. Cephalosporin • Fluoroquinolones |
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What is the empiric treatment for a patient with nosocomial pneumonia with aspiration or recent surgery?
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• Ticarcillin or piperacillin
• 3rd gen. cephalosporin + clindamycin • fluoroquinolone plus clindamycin * clindamycin covers anaerobes |
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What is the empiric treatment of a nosocomial pneumonia that you suspect to be caused by pseudomonas?
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• (Ticarcillin or pipercillin) + (aminoglycoside or fluoroquinolone)
• (Ceftazidime or Cefepime) + (aminoglycoside or fluroquinolone) |
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What is the empiric treatment for a nosocomial pneumonia that you suspect to be cause by MRSA?
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Vancomycin or linezolid
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Describe the difference between the flu and a cold, regarding onset
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• Flu: onset is sudden
• Cold: onset is gradual |
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Describe the difference in the flu and a cold, regarding fever.
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• Flu: fevers can be high
• Cold: fevers are rare |
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Describe the difference between the flu and a cold, regarding cough.
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• flu: cough is dry
• cold: cough is hacking |
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Describe the difference between the flu and a cold, regarding headache
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• flu: headaches are common
• cold: headaches are rare |
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Describe the difference between the flu and a cold, regarding weakness
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• flu: weakness can last 2-3 weeks
• cold: weakness is rare |
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Describe the difference between the flu and a cold, regarding chest discomfort.
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• flu: chest discomfort is common
• cold: mild to moderate chest discomfort |
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Describe the difference between the flu and a cold, regarding stuffy nose.
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• flu: can sometimes have a stuffy nose
• cold: stuffy nose is common |
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Describe the difference between the flu and a cold, regarding sore throat.
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• flu: can sometimes have a sore throat
• cold: sore throat is common |
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List 3 drugs that can be used for flu proophylaxis
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• Amantadine
• Rimantadine • Oseltamivir (Tamiflu) |
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What type of drug is Oseltamivir (Tamiflu)? What is its dosage?
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• Oseltamivir (Tamiflu) is a neuramidase inhibitor
• Dosage: 75 mg po daily within 2 days of symptoms |
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What is the MOA of Amantadine and Rimantadine?
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inhibits viral uncoating and release of viral nucleic acid
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Amantadine is effective against which strain of the influenza virus?
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influenza A
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When is Amantadine or Rimantadine given to prevent the development of flu symptoms?
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• given as prophylaxis during presumed outbreak OR
• within 1-2 days of symptoms |
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What can given to a patient to prevent or reduce the symptoms of pneumonia?
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• pneumococcal vaccine (23 purified capsular polysaccharide antigens of S. pneumoniae)
• antibodies remain elevated for 5 years |
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What patients are recommended to get the pneumococcal vaccine?
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• alcoholics
• age > 65 • Cardiac disease • Chronic lung disease • COPD • DM • patients with funcitional or anatomic asplenia • patient living in special settings (orphanage, jail, ALF) • smokers |
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What people should be offered the influenza vaccine?
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• person at high-risk for influenza-related complications (age > 50, comorbidities, COPD, nursing home residents, pregnant women in 2nd or 3rd trimester during flu season)
• person who can transmit influenza to those at high risk (ex. health-care workers) • AIDS patients |
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What are organisms that can cause community-aquired UTI?
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• E. Coli (73%)
• S. Saprohyticus (13%) • P. Mirabilis (5%) • K. Pneumoniae (4%) • Enterococcus (2%) |
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What are organisms that can cause nosocomial UTI?
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• E. coli (31%)
• Fungal (14%): usually in patients with indwelling catheters or immunosuppresion) • Pseudomonas (10%): usually in patients with chronic catheters • Gram-negative bacilli (10%) • K. Pneumoniae (9%) • S. Aureus (6%) • Proteus (4%) • Enterococcus (2%) |
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What are predisposing factors for UTI?
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• age
• DM • females • immunosuppresion • pregnancy • renal disease • Urinary obstruction |
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What are signs and symptoms of a lower UTI (cystitis)?
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• Dysuria
• Foul-smelling urine • Frequent urination • Occasional hematuria • Urgency |
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What are signs and symtpoms of an upper UTI (pyelonephritis)?
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• CVA tenderness
• dysuria • fevers and chills • frequency w/ urination • hematuria • increased WBC • nausea/vomiting |
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What patients are considered high-risk for complicated UTI?
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• DM
• elderly (more prone to AMS due to elevated ammonia levels) • hospital-acquired • immunosuppression • indwelling catheter • males • pregnancy |
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How do you treat hyperammoniumemia?
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lactulose
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What do you look for in the urinalysis when diagnosing UTI?
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• casts (in pyelonephritis)
• cloudiness of the urine • leukocyte esterase • nitrates • RBCs • yeasts |
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What is the treatment of uncomplicated cystitis?
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3 day regimens of:
• Bactrim • Fluoroquiolones • Nitrofurantin |
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When is single dose therapy recommended for UTI?
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honeymoon cystitis
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What is the dosing of Bactrim?
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Bactrim DS (double strength) Q24 x 3 days
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Describe the treatment for recurrent cystitis
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• treatment is longer: 2-6 weeks
• Less than 2 UTI/year, give 3 day regimens • greater than 3 UTI/year or post-intercourse: prophylax with Bactrim or Nitrofurantoin |
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Describe the treatment for uncomplicated pyelonephritis
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• patient has no nausea/vomiting and is not immunocompromised
• treatment: 7-14 days of Bactrim or Fluoroquinolone |
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Describe the treatment for complicated pyelonephritis
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fluoroquinolone or extended spectrum beta-lactam (Augmentin or Unasyn) for 10-14 days
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Describe the treatment for a patient with pyelonephritis and a catheter
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TX: 7-10 days of treatment if symptomatic
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What type of bacteria usually causes prostatitis?
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gram-negative bacteria
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Describe the treatment for acute prostatitis
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• 4 weeks of treatment
• Bactrim, Cephalosporin, or Fluoroquinolone • usually: Levaquin 500 mg QD x 4 weeks |
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Describe the treatment for chronic bacterial prostatitis
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• difficult to treat
• Bactrim or fluoroquinolone for 1-4 months |
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What is the definition of cellulitis?
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an acute spreading skin infection which involves subcutaneous tissue but excludes muscle
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What organisms exists as the normal flora on the skin?
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• Streptococcus
• S. epidermis • S. aureus • yeasts |
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What are the 3 main types of cellulitis?
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• acute cellulits
• Erysipelas • necrotizing fascitis |
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What are characteristics of acute cellulits?
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• involves deep dermis and subcutaneous tissue
• non-elevated, poorly defined • warm, pain, edema, tender • can have malaise, fever, & chills |
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What is the treatment of acute cellulitis?
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treatment usually 7-10 days:
• anti-staphylococcal PCN (Nafcillin, oxacillin, or Dicloxacillin) or 1st generation cephalosporin (Cephazolin/Ancef) • Penicillin G (if streptococcal) • Vancomycin (for MRSA); Linezolid for discharge |
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What are characterisitcs of erysipelas?
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• infects the superficial dermis
• spreads rapidly • edge of infection is elevated and sharply demarcated |
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What areas of the body are most commonly affected with erysipelas?
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occurs most commonly in legs and feet
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What is the most common cause of erysipelas?
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group A streptococcus
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What is the treatment for erysipelas?
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Tx: 7-10 days
• Pencillin G or erythromycin |
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What are characteristics of necrotizing fasciitis?
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• an acute necrosis involving sub-q and superficial fascia
• associated w/ gangrene • seen in diabetics • commonly caused by Strep pyogenes |
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What is the treatment for necrotizing fasciitis?
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• Tx: surgical debridment (antibiotics are not curative)
• empiric treatment: B-lactamase inhibitor (Augmentin or Unasyn) OR 3rd gen ceph. + clindamycin * Clindamycin to cover anaerobes |
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What is a major cause of diabetic foot ulcers?
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neuropathy
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What are some organisms that can cause diabetic foot ulcers?
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• B. Frag
• E. Coli • Enterobacter • Enterococcus • Klebsiella • Peptococcus • Proteus • Psuedomonas • S. aureus • Streptococcus |
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What is the treatment for diabetic foot ulcers?
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• for shallow, non-threatening food ulcers: can treat as cellulitis
• deep ulcers: broad spectrum; 1-2 weeks if skin/soft tissue; 6-12 weeks if osteomyelitis • ampicillin/sulfabactam (Unasyn) • Ticarcillin/Clavulanic (Timentin) • Pipercillin/Tazobactam (Zosyn) • fluoroquinolone + Clindamycin |
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What are characterisitcs of osteomyelitis?
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• infection of bone w/ subsequent bone destruction
• clinical presentation: fevers/chills, localized pain • labs show: elevated WBC, ESR, & C-reactive protein • diagnosed by: CT/MRI & bone scans |
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What is the treatment for an adult w/ osteomyelitis?
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• Nafcillin or Cefazolin or Vancomycin
• Acute osteo: 4-6 weeks • Chronic osteo: 6-8 weeks |
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What is the treatment for a patient with a prosthetic joint infection?
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• Nafcillin + Rifampin OR
• Vancomycin + Rifampin * Rifampin allows for higher level to penetrate the bone |
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What are some bacterial causes of meningitis in newborns?
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• E. coli
• Enterobacter • Herpes Simplex (type 2) • Klebsiella • Listeria • S. agalactaie * bacteria come from the birth canal |
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What are some bacterial causes of meningitis in a 1-2 month old?
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• E. coli
• H. Flu • N. meningitidis • S. agalactaie • S. pneumoniae |
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What are some causes of meningitis in patients ages 2-50?
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• N. meningitidis
• S. pneumoniae • viruses |
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What are some causes of meningitis in patients older than 50?
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• gram-negative bacilli
• N. meningitidis • S. pneumoniae |
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What are risk factors for meningitis?
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• alcoholism
• CNS shunts • fistulas • head trauma • immunosuppresion • local infections • sickle cell disease |
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How do patients with meningitis clinically present?
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• backache
• fevers & chills • headache • nuchal rigidity • petechiae/purpura (esp. in N. meningitidis) |
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How do you diagnose meningitis?
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• history and physical
• lumbar puncture (looking for WBC, protein, & lactic acid) • gram stain, acid fast stain, or India ink test (for cryptococcus) * get CT scan before performing LP |
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What is empiric treatment of meningitis for neonates?
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• Ampicillin + aminoglyocide OR
• Ceftriaxone |
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What is empiric treatment for meningitis in a 1-23 month y/o?
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3rd gen. cephalosporin (Ceftriaxone) + Vancomycin
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What is empiric treatment for a 2-50 year-old patient with meningitis?
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3rd gen. cephalosporin (Ceftriaxone) + Vancomycin
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What is empiric treatment for a patient with meninigitis age 50 or over?
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3rd gen. cephalosporin (Ceftriaxone) + Ampicillin + Vancomycin
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What is empiric treatment for a patient with meningitis due to either penetrating head trauma, post neurosurgery, or CSF shunt?
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Vancomycin + (Cefipime or Ceftazadime)
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What is the treatment of meningitis caused by S. pneumoniae?
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• Pen G 4 mu Q4hrs OR
• Ampicillin 2gm Q 4hrs |
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What is the treatment for meningitis caused by N. meningitidis?
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• 3rd gen. cephalosporin (Ceftriaxone) OR
• fluoroquinolone |
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What is the treatment for meningitis caused by H. Flu?
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• if Beta-lactamase negative: Ampicillin
• if Beta-lactamase positive: 3rd gen. cephalosporin (Ceftriaxone) or Cefipime |
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What is the treatment for meningitis caused by S. agalactiae?
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• Pen G 4mu Q4hrs OR
• Ampicillin 2gm Q4hrs |
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What is the treatment for meningitis caused by Listeria?
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• Pen G 4mu Q4hrs OR
• Ampicillin 2 gm Q4hrs |
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What is endocarditis?
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• infection of heart valves or other tissue
• platelets-fibrin complex becomes infected with organisms, causing vegetation |
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What are major risk factors for endocarditis?
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• IV drug abuse
• mitral valve prolapse • prosthetic valves |
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What are signs and symptoms of endocarditis?
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• anorexia
• arthralgias • cardiac murmur • fatigue • low-grade fever • myalgias • weight loss |
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What are some significant lab findings in a patient with endocarditis?
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• CBC shows leukocytosis
• elevated ESR & C-reactive protein • positive blood culture |
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What are complications of endocarditis?
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• aneurysm
• CHF • emboli |
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What are organisms that can cause endocarditis?
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• Steptococci (50%)
• Staph aureus (25%) • Enterococci (8%) • Coag-negative Staph (7%) • gram-negative bacilli (6%) • Candida Albicans (2%) |
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What is the standard drug and dose used endocarditis prophylaxis for dental procedures?
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• Amoxicillin 2 gm (in adults)
• Amoxicillin 50 mg/kg PO 1hr before procedure (in children) |
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What drugs are used for endocarditis prophylaxis for high-risk patients undergoing abdominal surgery?
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• Ampicillin 2 gm IM or IV + Gentamycin 1.5 mg/kg within 30 minutes of starting the procedure
• 6hrs later: Ampicillin 1 gm IM/IV |
