Term
|
Definition
prevention of infection in high-risk situations
prior to surgery to reduce intra-op contamination
during profound immunosuppresion |
|
|
Term
| empiric or presumptive therapy |
|
Definition
treatment based on an educated guess at the most likely pathogens before cultures known
selection is based on patient factors, drug factors, and combination therapy |
|
|
Term
|
Definition
targeting the specific bacteria
once the results are known, narrow the spectrum
try to use the fewest antimicrobials with the narrowest spectrum for the shortest amount of time
helps prevent resistance, minimize side effects, and reduce cost
narrow spectrum antibiotics are less likely to produce super infections and collateral damage: MRSA, VRE, Clostridium difficile diarrhea |
|
|
Term
Step 1: establish the need for antimicrobial therapy
Step 2: attempt to identify the pathogen
Step 3: select empiric antimicrobial therapy
Step 4: monitor therapy for efficacy and toxicity
Step 5: refine antimicrobial therapy (definitive therapy) |
|
Definition
| antimicrobial drug therapy selection process (short version) |
|
|
Term
clinical clues: fever/chills, abnormal vitals, pain/discomfort, redness/swelling, malaise
laboratory findings: increased WBC count (differential indicates % of each), polymorphonuclear (PMN) or 'segmented' NEUTROPHILS -> response to bacteria
abnormal vital signs and sepsis/shock: increased temperature, decreased BP, increased heart rate, increased respiratory rate
pain, erythema, purulent discharge
imaging findings or infiltrate on radiography
isolation of the pathogen (rule out colonization and contamination) |
|
Definition
|
|
Term
WBC > 10,000 cells/mm^3
> 70% neutrophils (PMNs/segs)
> 5% bands (immature WBCs)
more young WBCs means a left shift |
|
Definition
| what numbers indicate increased WBC + "left shift"? |
|
|
Term
Staphylococcus aureus
gram stain, morphology, common colonizations, common diseases, respiration |
|
Definition
Gram +
cocci
aerobe
coagulase positive
grows in grape like clusters
often colonizes on the skin
common diseases include: skin and wound infections |
|
|
Term
Streptococcus pyogenes
gram stain, morphology, common colonizations, common diseases, respiration |
|
Definition
Gram +
cocci
aerobe
beta hemolytic
Group A
grows in chains or pairs
in children infects the upper respiratory tract and causes strep throat
in all ages: cellulitis |
|
|
Term
Streptococcus agalactiae
gram stain, morphology, common colonization, common diseases, respiration |
|
Definition
gram +
cocci
aerobe
beta hemolytic
Group B
grows in chains or pairs
colonizes lower female genital tract
causes post partum neonatal meningitis |
|
|
Term
Streptococcus pneumoniae
gram stain, morphology, common diseases, respiration |
|
Definition
Gram +
cocci
aerobe
alpha hemolytic
grows in pairs or diplococci
causes pneumonia, meningitis, upper respiratory tract infections |
|
|
Term
Enterococcus faecalis
gram stain, morphology, common colonization, respiration |
|
Definition
Gram +
cocci
aerobe
grows in chains
prevalent in the bowel |
|
|
Term
Enterococcus faecium
gram stain, morphology, common colonization, respiration |
|
Definition
Gram +
cocci
aerobe
grows in chains
prevalent in the bowel
less common and more resistant (VRE) |
|
|
Term
Peptostreptococcus spp.
respiration, morphology, common colonization, common diseases |
|
Definition
cocci
anaerobe
common mouth flora
found in aspiration pneumonia and dental abscesses |
|
|
Term
|
Definition
|
|
Term
Clostridium difficile
morphology, respiration, common colonization, common diseases |
|
Definition
bacilli
anaerobe
colonizes in the GI tract
causes a severe form of toxin induced diarrhea due to overgrowth during antibiotic use |
|
|
Term
Clostridium perfringens
morphology, respiration, common colonization, common diseases |
|
Definition
bacilli
anaerobe
found in the GI tract
may cause severe necrotizing soft tissue infections |
|
|
Term
Clostridium tentani
morphology, respiration, common disease |
|
Definition
bacilli
anaerobe
causes tetanus |
|
|
Term
Neisseria gonorrhoeae
gram stain, morphology, respiration |
|
Definition
|
|
Term
Neisseria meningitidis
gram stain, morphology, respiration, common diseases |
|
Definition
Gram -
cocci
aerobe
diplococci
can cause meningitis |
|
|
Term
Haemophilus influenzae
gram stain, morphology, respiration, common colonization |
|
Definition
gram -
cocci
aerobe
found in the upper respiratory tract |
|
|
Term
Moraxella catarrhalis
gram stain, morphology, respiration, common diseases, common colonization |
|
Definition
Gram -
cocci
aerobe
colonizes in the upper respiratory tract
causes sinusitis and otitis media especially in children |
|
|
Term
Escherichia coli
gram stain, respiration, morphology, common colonization, common diseases |
|
Definition
gram -
bacilli
aerobe
Enterobacteriaceae family "enterics"
normal flora found in GI tract
causes both hospital and community acquired urinary tract infections and intra-abdominal infections
enteric |
|
|
Term
Klebsiella (pneumonieae)
gram stain, respiration, morphology, common colonization, common diseases |
|
Definition
gram -
bacilli
aerobe
Enterobacteriaceae family "enterics"
normal flora found in GI tract
similar to E. coli but more likely to cause hospital acquired pneumonia also |
|
|
Term
Enterobacter spp.
gram stain, respiration, morphology, common colonization, common diseases |
|
Definition
gram -
bacilli
aerobe
Enterobacteriaceae family "enterics"
normal flora found in GI tract
similar to E. coli but more likely to cause hospital acquired pneumonia also |
|
|
Term
Proteus (mirabilis)
gram stain, respiration, morphology, common colonization, common diseases |
|
Definition
gram -
bacilli
aerobe
Enterobacteriaceae family "enterics"
normal flora found in GI tract
similar to E. coli but more likely to cause hospital acquired pneumonia also |
|
|
Term
Pseudomonas aeruginosa
gram stain, respiration, morphology, common diseases |
|
Definition
gram -
bacilli
aerobe
non-enteric
common cause of nosocomial infections (not likely in the community)
causes pneumonia
HIGHLY PATHOGENIC AND RESISTANT |
|
|
Term
Bacteroides fragilis
respiration, morphology, common colonization, common disease |
|
Definition
bacilli
anaerobe
common GI flora
frequent cause of intra-abdominal abscesses |
|
|
Term
Mycoplasma spp. including Mycoplasma pneumoniae
Clamydia spp. including Clamydia pneumoniae
Legionella pneumoniae |
|
Definition
| microorganisms not seen on gram stain |
|
|
Term
gram stain: done first by hand with results in a few hours. some special tests can also be completed to further narrow down the organism (coagulase)
cultures: usually incubated 12-24 hours before further identification
susceptibility testing: typically automated using broth microdilution. requires another 12-24 hours
manual methods: broth macrodilution test, disk diffusion test, Etest method |
|
Definition
| ways of identifying a pathogen |
|
|
Term
allergy
preexisting dysfunctions
site of infection
metabolic abnormalities
renal and hepatic function
genetic factors
age
pregnancy and nursing |
|
Definition
| patient factors for empiric drug selection |
|
|
Term
pharmacokinetics: half life, serum concentration, AUC
pharmacodynamics: relationship between drug concentration and the effects of the microorganism |
|
Definition
| drug factors for antimicrobial drug selection |
|
|
Term
bacteremia (sepsis) and endocarditis
CNS infections
immunocompromised hosts
bacteriostatic is ok for most other infections |
|
Definition
| bactericidal pharmacodynamic activity needed for these 3 types of infections |
|
|
Term
synergism
decreased toxicity
prevention of resistance
infection at sequestered sites
mixed infection
initial therapy of severe infection |
|
Definition
| reasons for the use of a combination therapy |
|
|
Term
1) First, how or why do you suspect an infection?
2) Then, what are the most likely pathogens?
3) What drugs have the best activity against them?
4) Is bactericidal activity necessary? (PD)
5) What route of administration is acceptable? (PK)
6) Which of these reaches the site of infection? (PK)
7) Which of the remaining are safest for this patient (consider both toxicities and drug interactions)
8) Which is most cost effective?
9) Finally, will your patient adhere to the regimen? |
|
Definition
| steps in the decision making process for treating infectious disease (long version) |
|
|
Term
Staphylococcus epidermidis
gram stain, morphology, common colonization, common diseases, respiration |
|
Definition
gram +
cocci
aerobe
coagulase negative
common colonizer of the skin
less pathogenic = wimpy
infections often associated with foreign devices: catheters, shunts, heart valves, prosthetic joints
may be multi-drug resistant
grows in clusters |
|
|
Term
Viridians group Streptococci
gram stain, morphology, common colonization, common diseases, respiration |
|
Definition
gram +
cocci
aerobe
alpha hemolytic
grows in chains or pairs
found in oral flora
common cause of endocarditis |
|
|
Term
Staphylococci: primarily S. epidermidis, but also S. aureus
Streptococci: Group A = S. pyogenes and Group B = S. agalactiae |
|
Definition
| normal microbial flora of the skin |
|
|
Term
| Streptococci: especially S. pneumoniae |
|
Definition
| normal microbial flora of the upper respiratory tract |
|
|
Term
Enterobacteriaceae: enteric gram (-) bacilli = E. coli, Klebsiella, and Proteus spp.
anaerobes
Enterococcus spp. |
|
Definition
| normal microbial flora of the gastrointestinal tract |
|
|
Term
| Enterobacteriaceae = E. coli, Klebsiella, Proteus, Enterobacter |
|
Definition
| normal microbial flora of the genitourinary tract |
|
|
Term
blood
central nervous system
lower bronchi and alveoli
most internal organs: heart, kidney, liver, tissue and bone (from surgery)
any organism from these sites should be taken seriously and treated immediately |
|
Definition
| normally sterile body fluids |
|
|
Term
|
Definition
don't have well defined cell walls
they are hard to grow and therefore hard to detect in the clinical microbiology laboratory by traditional methods
drugs that target the cell wall won't work b/c these don't have a traditional cell wall |
|
|
Term
Mycoplasma pneumoniae
classification, common disease |
|
Definition
atypical
common cause of community acquired pneumonia |
|
|
Term
Chlamydophila pneumoniae
classification, common disease |
|
Definition
atypical
causes community acquired pneumonia |
|
|
Term
Chlamydia trachomatis
classification, common disease |
|
Definition
atypical
causes STD and infects the GU region |
|
|
Term
Legionella pneumophilia
classification, common disease |
|
Definition
atypical
most severe cause of atypical pneumonia |
|
|
Term
| concentration-dependent antibiotic |
|
Definition
large doses can be given less frequently
higher concentrations will kill the bacteria more than lower concentrations |
|
|
Term
| time-dependent antibiotic |
|
Definition
small doses needed more frequently
doesn't matter how much you give, just how long you give it |
|
|
Term
Group A Strep (Streptococcus pyogenes)
Group B Strep (Streptococcus agalactiae) |
|
Definition
| spectrum of activity of Penicillin G IV and Penicillin VK PO |
|
|
Term
|
Definition
| spectrum of activity of Oxacillin IV, Nafcillin IV, and Dicloxacillin PO |
|
|
Term
aminopenicillins
alpha hemolytic Strep: Streptococcus pneumoniae and Viridans
Enterococcus faecalis
Gram (-) Resp: Haemophilus influenzae and Moraxella catarrhalis |
|
Definition
spectrum of activity of ampicillin IV and amoxicillin PO
classification |
|
|
Term
anti-pseudomonal
enterics: E. coli, Klebsiella
non-enteric: Pseudomonas aeruginosa |
|
Definition
spectrum of activity of Piperacillin IV and Ticarcillin IV
classification |
|
|
Term
beta-lactamase inhibitor added
enterics: E. coli, Klebsiella
anaerobes: Bacteroides, Clostridium (non-difficile), Peptostreptococcus |
|
Definition
spectrum of activity of ampicillin/sulbactam IV, amoxicillin/clavulanate PO, ticarcillin/clavulanate IV, and piperacillin/tazobactam IV
classification |
|
|
Term
1st generation Cephalosporins
MSSA
Group A Strep = Streptococcus pyogenes
Group B Strep = Streptococcus agalactiae |
|
Definition
spectrum of activity of Cefazolin IV and Cephalexin PO
classification |
|
|
Term
2nd generation Cephalosporin
alpha hemolytic strep = Streptococcus pneumoniae and Viridans
resp Gram (-) = Haemophilus influenzae and Moraxella catarrhalis |
|
Definition
spectrum of activity of Cefuroxime IV and PO
classification |
|
|
Term
cephamycins
enterics = E. coli and Klebsiella
anaerobes = Bacteroides, Clostridium (non-difficile), and Peptostreptococcus |
|
Definition
spectrum of activity of Cefoxitin IV and Cefotetan IV
classification |
|
|
Term
3rd generation Cephalosporins
alpha hemolytic Strep = Streptococcus pneumoniae and viridans
Resp Gram (-) = Haemophilus influenzae and Moraxella catarrhalis
enterics = E. coli, Klebsiella; resistance developing |
|
Definition
spectrum of activity of Ceftriaxone IV and Cefotaxime IV
classification |
|
|
Term
3rd generation Cephalosporin
enterics = E. coli, Klebsiella; resistance is developing
non-enterics = Pseudomonas aeruginosa |
|
Definition
spectrum of activity of ceftazidime IV
classification |
|
|
Term
4th generation cephalosporin
enterics = E. coli, Klebsiella
non-enterics = Pseudomonas aeruginosa |
|
Definition
spectrum of activity of cefepime IV
classification |
|
|
Term
Carbapenems
enterics = E. coli, Klebsiella
non-enteric = Pseudomonas aeruginosa
anaerobes = Bacteroides, Clostridium (non-difficile), and Peptostreptococcus |
|
Definition
spectrum of activity of Doripenem IV, Imipenem IV, and Meropenem IV
classification |
|
|
Term
carbapenem
alpha hemolytic Strep = Streptococcus pneumoniae and Viridans
enterics = E. coli, Klebsiella
anaerobes = Bacteroides, Clostridium (non-difficile), and Peptostreptococcus
does NOT work against Pseudomonas aeruginosa |
|
Definition
spectrum of activity of ertapenem IV
classification |
|
|
Term
monobactam
enterics = E. coli, Klebsiella; resistance is developing
non-enteric = Pseudomonas aeruginosa |
|
Definition
spectrum of activity of aztreonam IV
classification |
|
|
Term
Aminoglycosides (use in combo)
Synergy for Enterococcus faecalis
enterics = E. coli, Klebsiella
non-enteric = Pseudomonas aeruginosa |
|
Definition
spectrum of activity of Gentamicin IV, tobramycin IV, and amikacin IV
classification |
|
|
Term
Polymyxins
last line of defense against Pseudomonas aeruginosa (non-enteric) |
|
Definition
spectrum of activity of Polymixin B IV and Colistin IV
classification |
|
|
Term
sulfonamide
minor MRSA infections
enterics = E. coli, Klebsiella |
|
Definition
spectrum of activity of Trimethoprim-sulfamethoxazole IV/PO
classification |
|
|
Term
Rifamycin
used in COMBINATIONS for MRSA |
|
Definition
spectrum of activity for Rifampin IV/PO
classification |
|
|
Term
macrolide
alpha hemolytic Strep = Streptococcus pneumoniae and Viridans
Resp Gram (-) = Haemophilus influenzae and Moraxella catarrhalis
atypicals = Mycoplasma pnuemoniae, Chlamydophila pneumoniae, Legionella pneumoniae |
|
Definition
spectrum of activity of Azithromycin IV/PO
classification |
|
|
Term
tetracycline
minor MRSA infections
alpha hemolytic Strep = Streptococcus pneumoniae and Viridans
atypicals = Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella pneumoniae |
|
Definition
spectrum of activity of doxycycline IV/PO
classification |
|
|
Term
fluroquinolone
enterics = E. coli, Klebsiella
non-enterics = Psuedomonas aeruginosa
atypicals = Mycoplasma pneumonia, Chlamydophila pneumoniae, Legionella pneumoniae |
|
Definition
spectrum of activity of ciprofloxacin IV/PO
classification |
|
|
Term
fluoroquinolone
alpha hemolytic Strep = Streptococcus pneumoniae and Viridans
enterics = E. coli and Klebsiella
non-enteric = Pseudomonas aeruginosa
atypicals = Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumoniae |
|
Definition
spectrum of activity of levofloxacin IV/PO
classification |
|
|
Term
fluoroquinolone
alpha hemolytic Strep = Streptococcus pneumoniae and Viridans
enterics = E. coli and Klebsiella
anaerobes = Bacteroides, Clostridium (non-difficile), and Peptostreptococcus
atypicals = Mycoplasma pneumoniae, Chlamydiophila pneumoniae, and Legionella pneumoniae |
|
Definition
spectrum of activity of moxifloxacin IV/PO
classification |
|
|
Term
Lincosamide
MRSA
Group A Strep = beta hemolytic = Streptococcus pyogenes
Group B Strep = beta hemolytic = Streptococcus agalactiae
alpha hemolytic Strep = Streptococcus pneumoniae and Viridans
anaerobes = Bacteroides, Clostridium (non-difficile), and Peptostreptococcus |
|
Definition
spectrum of activity of Clindamycin IV/PO
classification |
|
|
Term
| DOC for most anaerobic infections = Bacteroides, Clostridium (non-difficile), and Peptostreptococcus |
|
Definition
| spectrum of activity of Metronidazole IV/PO |
|
|
Term
Pneumonia - lung concentration
bacteremia - endocarditis
MRSA
gold standard for resistant gram (+) |
|
Definition
| spectrum of activity for Vancomycin IV |
|
|
Term
VRE - faecium
Pneumonia - lung concentration
MRSA
use caution long term and with SSRIs |
|
Definition
| spectrum of activity of Linezolid IV/PO |
|
|
Term
|
Definition
| spectrum of activity of Quinupristin/Dalfopristin IV |
|
|
Term
bacteremia - endocarditis
MRSA |
|
Definition
| spectrum of activity of Daptomycin IV |
|
|
Term
intra-abdominal infections
also covers anaerobes and all gram (-) other than Pseudomonas aeruginosa and Proteus
MRSA |
|
Definition
| spectrum of activity of Tigecycline IV |
|
|
