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25 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Bug?
Uncommon G(-) bacilli that is sometimes seen as a cause of healthcare associated pneumonia |
Stenotrophomonas maltophila
hint: Strange to have a home in Malta or uncommon to meet someon from Malta |
Strange to have a home in Malta
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Inpatient Txmt for aspiration pneumonia
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Amp / sulbactam
Clindamycin Moxifloxacin hint: Aspirate Clean Air aspire = aspiration pneumo clean = clindamycin air = amp sulbactam tie M in amp to Moxifloxicin |
aspirate clean air
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What is unique about the treatment of cystic fibrosis patients?
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•Often eliminate antibiotics much faster rate than most other patients
•Max dose often used if not does beyond what is normally considered max |
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Txmt of S. pyogenes pharyngitis
What is the doc? |
Doc = oral penicillin
Other options: Macrolides Clindamycin Quinolones hint: Princess and Queen like MaC P = penicillin Q = quinolones M = macrolides C = clindamycin |
Princess and Queen like MaC
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What are the HCAP organisms?
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S. aureus (MRSA is more common than MSSA)
G(+)cocci in cluster, catalase (+), coaulase (+) Pseudomonas aeruginosa G(-)rod, oxidase (+), Lactose (-) does NOT ferment, aerobic demonstrate with OF dextrose tubes E. coli G(-) bacilli, lactose (+) ferments, oxidase (-) Klebsiella pneumonia G(-) rod, lactose fermenter Hospital acquired aspiration pneumonia rarely leads to anaerobic infections Acinetobacter G(-) coccobacilli, oxidase (-), lactose (-), aerobe |
H = hosp aquired asp pneu
e. Coli A = acinetobacter and s. Aureus P - pseudomonas and Klebsiella Pneumoniae |
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Txmt for B. pertussis
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Macrolides
-erythromycin, clarithromycin, azithromycin Tmp/smx Tetracyclines -tetracycline, doxycycline, minocycline, demeclocycline hint: use T in B. perTussis to trigger your mind T = tmp/smx and tetracycline and use the M in tMp/smx to remember macrolides |
use T in B. perTussis to trigger your mind
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Main Bugs associated with common Community Acquired Pneumonia (CAP)
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S. pneumoniae
G(+) lancet shaped diplococci, catlase (-), alpha hemolytic, optochin senstive, bile soluble quellung rxn, no lancefield group H. influenza small G(-) coccobacillary rod, facultative anaerobe, can be encapsulated, grows on chocolate agar, NEEDS Factor V (NAD) & Factor X (hemin) M. pneumoniae very low infective dose, no cell wall, needs cholesterol go grow, VF:H2O2 and superoxide radicals C. pneumoniae no cell wall, VF: EB & RB, ID by immunoflorences and ELISA Legionella poor gram stain, stain with silver, needs amino acids, L-cysteine, and ferric ions to grow, VF: defect in organelle trafficking (dot)locus mutation |
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Other Bugs associated with common Community Acquired Pneumonia (CAP)
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M. catarrhalis -> G(-)coccobacilli
S. aureus (particularly post viral influenza) ->G(+) cocci Catlase (+) Coagulase(+) Klebsiella pneumonia G(-)rod lactose (+) -> fermenter Oral anaerboes (aspiration) |
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Outpt txmt of gross aspiration pneumonia
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Fewer options bc of need to tx oral anaerobes
Careful consideration if possible to the time course -Aspiration then pneumonia Vs -Pneumonia then aspiration Txmt: Clindamycin Moxifloxacin Amox/clav hint: grossly max out credit card -> should tie GROSS asp pnumo and out with out pt txmt also max = Moxifloxacin, credit = clindamycine card = clav in amox/clav |
grossly max out credit card
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What disease/sickness has txmt shown to be effective at only reducing duration of illness if given within 48 hrs of infection?
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influenza
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What drugs are in the column A of HCAP therapy?
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Cefepime (4th)
Ceftazidime (3rd gen ceph) Pip / tazo Imipenem Meropenem Allergy – aztreonam |
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Txmt for acinetobacter
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Sulbactam (need to use amp / sulbactam)
Imipenem or meropenem Amikacin Maybe tigecycline Note: •Most acinetobacter are resistant to most abx hint: seen in acute and Sever settings -most keep in mind if hostpital or ICU has high prevalence Acute = acinetobacter and amikacin and Amp Severe = sulbactam I from amIkacin use it to remember Imipenem and Meropenem |
seen in acute and Sever settings
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Txmt for Stenotrophomonas maltophila
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Very resistant
Tmp/smx Ticaricillin / clav Maybe tigeycline ->quinolones and ceftazidime are sometimes sensitive but resistance can occur on therapy Hint: 3T's in name and 3 drugs start with T |
3T's in name and 3 drugs start with T
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What is the debate over txmt of HCAP?
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In the past, tmxt 14 – 21 days
Recent paper states no difference between 8 or 15 days txmt. In fact, 15 days txmt are more likely to have subsequent infection with a resistant pathogen |
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What pt should receive therapy for influenza?
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Severly ill pt should receive therapy even if beyond 48 hrs
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Outpt txmt for CAP
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Macrolides
Doxycycline resp quinolones: levo, moxi, gemi can add oral beta-lactams -Macrolide resistance has been rising nationally hint: Matinee dance recital out at the community center M = macrolides D = doxycycline R = resp quinolones -levo, moxi, gemi or Quincy MD |
Matinee dance recital out at the community center
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What drugs are in column B for HCAP therapy?
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Tobramycin
Amikacin Cipro Levo Maybe genamicin |
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Inpt txmt for CAP
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3rd gen cep + macrolide
Respiratory quinolones: levo, moxi, gemi 3rd gen ceph = cefotaxime & ceftriaxone Macrolides =erythromycin, clarithromycin, azithromycin hint: what an outpt but then moved to 3rd floor ->txmt for inpt very close to outpt tx for CAP, Macrolide, doxycycline and resp quinolones -> with inpt tx add 3rd gen ceph to macrolides and doxycycline |
what an outpt but then moved to 3rd floor
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What other drugs should be added to HCAP therapy?
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Add either vancomycin or linezolid
hint: added Very Last! |
added Very Last!
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Should HCAP be tx with 3 abx for full length of txmt?
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No, in-vitro synergy had been shown but not proven clinically.
De-escalation critical and should be done whenever possible. |
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What drug can be used to tx Carbapenem resistant Acinobacter?
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Polymixins
-Polymixin B -polymixin E (colistin) |
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drug?
disrupts cell membrane potential specifically active against highly resistant organisms |
Polymixins
-polymixin B -polymixin E (Colistin) |
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Drugs used to tx resistant Acinetobacter but can not be used empericially on its own, must add other drug?
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Polymixins
-polymixin B -polymixin E (Colistin) can add cefipime or rifampin |
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What is the AE of:
Polymixins -polymixin B -polymixin E (Colistin) |
toxic to pt with renal insuffiencies - KEY
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What drug is toxic to pt with renal insuffiencies?
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Polymixins
-polymixin B -polymixin E (Colistin) IMP to know** |
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