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80 Cards in this Set
- Front
- Back
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qualifications of a left shift
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>100,000 WBCs
>80% neutrophils >5% bands |
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what does the coagulase test differentiate?
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differentiates staph
coagulase +=staph aureus |
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indole positive organisms
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proteus vulgaris, morganella morganii
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when is the BAL considered significant?
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>105 CFU/mL
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when is UA considered significant?
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>100,000 CFU/mL
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AUC-based killing parameters
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Gram (-): AUC/MIC>125
Gram(+): AUC/MIC>30-35 Vancomycin for invasive MRSA AUC/MIC>400 |
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When can aminoglycosides be used as monotherapy?
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UTIs
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true/false- aminoglycosides cover pseudomonas
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true
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true/false- natural penicillins cover anaerobes
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true
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true/false- antistaph penicillins cover gram (-)
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false
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true/false- have to renally adjust nafcillin
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false- have to renally adjust oxacillin when creatinine clearance<10
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what is the drug of choice for listeria and enterococci?
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aminopenicillins
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true/false- aminopenicillins are not active against MSSA
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true
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rank the potency of beta lactamase inhibitors
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clavulanate> tazobactam>sulbactam
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which beta lactamase inhibitor covers acinetobacter?
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sulbactam
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true/false- cephalosporins cover enterococci and listeria
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false!
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true/false- 1st generation cephalosporins cover strep pneumo
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false
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true/false- have to renally adjust nafcillin
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false- have to renally adjust oxacillin when creatinine clearance<10
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true/false- have to renally adjust nafcillin
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false- have to renally adjust oxacillin when creatinine clearance<10
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cephalosporins with MTT side chain
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cefotetan, cefoperazone, moxalactam, cefamandole
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what is the drug of choice for listeria and enterococci?
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aminopenicillins
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what is the drug of choice for listeria and enterococci?
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aminopenicillins
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true/false- Cephamycins have anaerobic activity
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true-- Bacteroides
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true/false- aminopenicillins are not active against MSSA
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true
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true/false- aminopenicillins are not active against MSSA
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true
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rank the potency of beta lactamase inhibitors
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clavulanate> tazobactam>sulbactam
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name 2 cephamycins.
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cefotetan, cefoxitin
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rank the potency of beta lactamase inhibitors
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clavulanate> tazobactam>sulbactam
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which beta lactamase inhibitor covers acinetobacter?
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sulbactam
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which beta lactamase inhibitor covers acinetobacter?
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sulbactam
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true/false- cephalosporins cover enterococci and listeria
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false!
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true/false- cephalosporins cover enterococci and listeria
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false!
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true/false- 1st generation cephalosporins cover strep pneumo
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false
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true/false- 1st generation cephalosporins cover strep pneumo
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false
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cephalosporins with MTT side chain
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cefotetan, cefoperazone, moxalactam, cefamandole
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cephalosporins with MTT side chain
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cefotetan, cefoperazone, moxalactam, cefamandole
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true/false- Cephamycins have anaerobic activity
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true-- Bacteroides
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true/false- Cephamycins have anaerobic activity
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true-- Bacteroides
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name 2 cephamycins.
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cefotetan, cefoxitin
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name 2 cephamycins.
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cefotetan, cefoxitin
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true/false-3rd generation cephalosporins penetrate the CNS
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true
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True/False: Ceftaroline covers pseudomonas or anaerobes
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false
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true/false colistin not active against gram +
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true
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how is the resistance material (vanA) gene transferred in VRSA?
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transferred via conjugation on plasmids from Enterococcus faecalis
target site alteration |
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how is the vanA gene transmitted in VRE?
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inducible high level resistance transmitted via conjugation on a transposon- alteration of terminal binding stie for vancomycin from D-ala D-ala to D-ala D-lac
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how is the vanB gene transmitted in VRE?
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variable inducible resistance transmitted chromosomally or via conjugation- alteration in terminal binding site to D-ala D-lac
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what organisms is the vanC gene found in?
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E. casseliflavus, E. gallinarum, E. flavescens
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TX options for VRE
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linezolid, daptomycin, quinupristin/dalfopristin (only for E. faecium), tigecycline
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why do gram negative bacilli usually have more resistance than gram positive?
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bigger outer membrane therefore more resistance mechanisms
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describe ESBL
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extended-spectrum beta lactamases- plasmid mediated, constitutive enzymes
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what is the drug of choice for ESBL?
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carbapenems
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what organisms is ESBL commonly seen in?
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e. coli, klebsiella spp, proteus mirabilis
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describe ampC beta lactamases
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plasmid and chromosomally-mediated, inducible enzymes
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common organisms to have ampC beta lactamases
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SPACE/SPICE
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treatment options for ampC beta lactamases
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carbapenems and potentially cefepime
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what is KPC?
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klebsiella pneumonia carbapenemase
plasmid mediated |
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what drugs are KPC resistant to?
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penicillins, cephalosporins, aztrenonam, carbapenems
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what are treatment options for KPC-producing organisms?
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tigecycline or polymyxins
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what are the treatment options for ESBL-producing Klebsiella?
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imipenem or meropenem
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what is the treatment option for carbapenemase-producing pseudomonas?
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polymyxins
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list 3 protective mechanisms the skin has against infection
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1-acidic pH
2-sebacous secretions 3-frequent turnover of skin cells |
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which underlying diseases put a patient at risk for SSTIs?
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diabetes, vascular disease, obesity, alcoholism
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describe the appearance of staphlyococcus aureus.
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gram + cocci in clusters (looks like grapes)
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describe the appearance of strep pyogenes (GAS)
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gram + cocci in chains
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DOC for group A strep
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penicillin
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in what type of MRSA is PVL (panton valentine leukocidin) toxin present?
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CA-MRSA
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true/false- systemic manifestations are common with impetigo
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false
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causative organisms of impetigo
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strep pyogenes (GAS) or MSSA
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duration of antibiotic therapy for impetigo
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7-10 days
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superficial skin lesion with involvement of the lymphatics
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erysipelas (st. anthony's fire)
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predisposing factors to erysipelas
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nephrotic syndrome
pre-existing lymphatic obstruction or edema venous stasis diabetes alcoholism |
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true/false- erysipelas has a sharp demarcation
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true
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location of erysipelas
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usually on the lower extremities, sometimes on the face
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etiology of erysipelas
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Group A strep---most common
Group C or G strep MSSA infection is almost always caused by beta-hemolytic streptococci with the organisms gaining access via small breaks in the skin |
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treatment duration of erysipelas
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7-10 days
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true/false- eyrsipelas has systemic manifestations
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true- in severe erysipelas- IV therapy--- then de-escalate to PO therapy in about 48 hours
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pre-disposing factors to cellulitis
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trauma, obesity, diabetes, injection drug use, immune compromised, pre-existing skin infection
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true/false- cellulitis has strictly defined borders.
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false! poorly defined borders (differentiating factor with erysipelas)
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most causative organisms in cellulitis
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group A strep
MSSA MRSA Group B, C, or G streptococcus |
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antibiotic treatment for cellulitis should cover:
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group A strep and staph aureus- evaluate patient for MRSA risk
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