Term
|
Definition
Staphylococci (coagulase-negative)
Streptococci
Diptheroids |
|
|
Term
| Normal Flora of Mouth/Oropharynx |
|
Definition
Streptococci
Neisseria sp.
Haemophilus sp.
Bacteroides sp. |
|
|
Term
| Normal Flora of Genitourinary Tract |
|
Definition
Enterobacteriaceae
Lactobacillus sp.
Staphylococci |
|
|
Term
|
Definition
Enterobacteriaceae
Bacteroides sp.
Clostridium sp.
Streptococci (anaerobic)
Enterococci |
|
|
Term
| Gram stain characteristics of gram positive organisms vs. gram negative |
|
Definition
positive (deep violet or blue)
negative (pink or red) |
|
|
Term
morphology of organisms
rod-like
round/oval
intermediate |
|
Definition
rod-like (bacilli)
round/oval (cocci)
intermediate (coccobacilli) |
|
|
Term
spatial relationships of organisms (clusters, chains, pairs etc.)
-staphylococi
-streptococci
-diplococci |
|
Definition
staph-clusters
streptococci-chains
diplococci-pairs |
|
|
Term
| acid-fast stain associated with: |
|
Definition
|
|
Term
|
Definition
| enhance observation of capsule, exclusionary stain for visualizing organism |
|
|
Term
| KOH fungal microscopic exam for |
|
Definition
| dissolving epithelial cells of skin scrapings |
|
|
Term
| giemsa stain (microscopic exam) use |
|
Definition
| staining cell contents directly (special stain for visibility) |
|
|
Term
| GMS (gomori methenamine silver stain) used for what in microscopic exam |
|
Definition
| staining cell wall (special stain for visibility of organism) |
|
|
Term
immunologic/serology method uses
-latex agglutination
-direct and indirect immunofluorescence
-enzyme immunoassay
-molecular assay |
|
Definition
all are for antigen/antibody detection
latex agglutination: positive indicated by clumping (CSF specimens)
immunofluorescence (good for low amt. of organisms)
EIA - detecting antigen, toxin, antibody
molecluar assay - high conserved DNA sequences in bacteria |
|
|
Term
|
Definition
| for culturing viruses, centrifugation, CMV (owl's eye) |
|
|
Term
types of macroscopic identification (uses):
1.selective media
2.enhanced media
3.selective environments
4.quantiation |
|
Definition
1. sel. media - inhibits growth of undesired organisms allows pathogen to grow
2. enhanced media - contains nutrients to promote growth of selective organisms
3. selective environment - aerobic, anaerobic, CO2
4. quantitation - # colony forming units/ml (urine) |
|
|
Term
|
Definition
|
|
Term
| coagulase negative (usually contaminant) |
|
Definition
|
|
Term
| alpha hemolytic, usually causes RTIs, high mortality |
|
Definition
|
|
Term
| beta-hemolytic, strep throat cause, group A |
|
Definition
|
|
Term
| gamma-hemolytic, salt-tolerant |
|
Definition
|
|
Term
| strict streptococcal anaerobe |
|
Definition
|
|
Term
|
Definition
gram positive bacilli
lactobacillus
diptheroids - corynebacterium |
|
|
Term
|
Definition
|
|
Term
| facultative, often in UTI and GI infections |
|
Definition
enterobacteriaceae:
e. coli
klebsiella sp.
proteus sp.
enterobacter sp. |
|
|
Term
|
Definition
| enterobacteriaceae: e coli, kleb, proteus, enterobacter |
|
|
Term
| oxidase positive, highly pathogenic, highly resistant |
|
Definition
|
|
Term
| oxidase negative, opportunistic, gut flora, ventilator tubes |
|
Definition
|
|
Term
| strict anaerobe, makes b lactamase, difficult |
|
Definition
|
|
Term
|
Definition
moraxella,
neiserria gonorrhoeae/meningitidis |
|
|
Term
| Peak/MIC (concentration dependent) drugs, long post-abx effect |
|
Definition
aminoglycosides
fluoroquinolones |
|
|
Term
|
Definition
| azithromycin, clindamycin, streptogramins |
|
|
Term
| Time > MIC drugs (concentration independent), short post abx effect |
|
Definition
| B-lactams, erythromycin, linezolid |
|
|
Term
| what do you need for dosing vancomycin (PK parameters) |
|
Definition
|
|
Term
| Vd around any dose does not require |
|
Definition
| Steady state concentration |
|
|
Term
| time to steady state is based on number of |
|
Definition
| half lives (usually about 3-4 t1/2) |
|
|
Term
| find kel, extrapolate back up (negative in the equation) to find Cmax, then delta T from predose trough to get change in concentration (not Vd) |
|
Definition
|
|
Term
| can use first dose random sampling for pts who have renal issues |
|
Definition
|
|
Term
| WBC count (increased, decreased, normal?) in immunocompromised pts. |
|
Definition
|
|
Term
| WBC count (increased, decreased, normal?) during sepsis? |
|
Definition
|
|
Term
| acid/base changes in infection |
|
Definition
| lactic acidosis (metabolic) and respiratory alkalosis from tachypnea |
|
|
Term
| should you obtain cultures before or after antibiotics are started? |
|
Definition
| before antibiotics are started |
|
|
Term
| mnemonic for abx that do NOT require renal adjustment: Oh No! Dad Caught Everyone At My Mansion Sledding Clothes-less Down The Lawn |
|
Definition
| (oxacillin, nafcillin, dicloxacillin, ceftriaxone, erythromycin, azithroycin, moxifloxacin, metronidazole, synercid, clindamycin, doxycycline, tigecycline, linezolid) |
|
|
Term
| examples of bactericidal drugs |
|
Definition
| B-lactams, vanc, aminoglycosides, fluoroquinolones |
|
|
Term
| examples of bacteriostatic drugs |
|
Definition
| clindamycin, macrolides, tetracyclines, linezolid, TMP/SM |
|
|
Term
| dosing for concentration dependent killing drugs: |
|
Definition
|
|
Term
| dosing for concentration independent (time-dependent) drugs |
|
Definition
| multiple daily doses or continuous infusion, usually lower dose |
|
|
Term
| use of antimicrobial synergy |
|
Definition
| limited clinical situatinos, maybe enterococcal endocarditis (PCN + AG), pseudomonas infections? |
|
|
Term
| indications for combo therapy (principles of ID lecture) |
|
Definition
broaden antimicrobial spectrum (mixed infections - multiple likely organisms, nosocomial infections, - empiric therapy, severely immunocompromised patients)
antimicrobial synergy (enterococcal endocarditis, Bactrim, pseudomonas infections?)
prevent resistance (TB, H pylori) |
|
|
Term
| IV to PO switch requirements |
|
Definition
Afebrile 24-48 hours
decreased WBC count
Functioning GI tract |
|
|
Term
| linear genetic sequences incapable of self-replication, associated with one or several specific resistance phenotypes, flanked by insertion sequences, allows transfer from chromosome to plasmids |
|
Definition
|
|
Term
| autonomous, self-replicating extrachromosomal DNA elements, may encode for multiple resistance factors, commonly shared through transduction or conjugation |
|
Definition
|
|
Term
| conserved region on DNA allows development in step wish fashion, genetic code reamins intact, MDR occurs, genetic unit enables site-specific recombination, responsible for development of multidrug-resistant plasmids and transposons |
|
Definition
|
|
Term
| define: resistance that is expressed continuously |
|
Definition
|
|
Term
| define: resistance only expressed when inducing agent (antibiotic) is present (difficult for micro lab to find) |
|
Definition
|
|
Term
| nonspecific resistance mechanism, associated more with gram negative, usually not associated with high-level resistance to abx, loss of a channel can delay entry of abx, can contribute to resistance for multiple abx |
|
Definition
|
|
Term
-exist in both gram + and gram _ bacteria
-can confer low to high level resistance to multiple abx
-largely responsible for intrinsic resistance of P. aeruginoa to many abx |
|
Definition
|
|
Term
-preferentially hydrolyze PCNs
-primarily produced in staphylococci
-enterococci are occasional producers
-fairly homogenous |
|
Definition
| gram-positive beta-lactamases |
|
|
Term
-hydrolyze both cephalosporins and PCNs
-found in enterobacteriaceae, p aeruginosa, h influenzae, n gonorrhoeae |
|
Definition
| gram negative beta-lactamases |
|
|
Term
-resistant to all beta lactams (except carbapenems and cefepime)
-not inhibited by beta-lactamase inhibitors
-harbor resistance to multiple drug classes
-can be difficult to detect
-found in enterobacteria and pseudomonas |
|
Definition
|
|
Term
-resistant to all penicillins, cephalosporins, monobactams
-inhibited by b-lactamase inhibitors (aid in detection but not treatment)
-harbor multi drug resistance
-commonly observed in ICU or LTC pts.
-found in nosocomial strains of e coli and klebsiella |
|
Definition
| extended-spectrum beta-lactamases |
|
|
Term
-primarily found in klebsiella pneumoniae isolates
-should be considered resistant to ALL beta-lactams
-susceptibility may only exist to tigecycline or polymixin |
|
Definition
| carbapenemases (KPC, NDM-1) |
|
|
Term
exist in both gram + and gram - bacteria
-inactivate AGs by adding functional groups to molecule to impede binding
-responsible for high level AG resistance in enterococci |
|
Definition
| aminoglycoside modifying enzymes (AME) |
|
|
Term
-acquisition of new gene cassette that encodes for altered PBP
-results in resistance to ALL beta lactam agents |
|
Definition
|
|
Term
| PCN resistant s. pneumoniae MOA |
|
Definition
| altered PBP due to exogenous modification with low affinity gene |
|
|
Term
principle MOA of resistance for s pneumoniae in US
confers resistance to agents that inhibit protein synthesis
principal method of resistance among G+ organisms to erythromycin and clindamycin |
|
Definition
ribosomal methylation
{rRNA methylase: MLSB resistance (macrolide lincosamide streptogramin B)} |
|
|
Term
| DNA gyrase (topoisomerase) resistance is primary target for what drug resistance |
|
Definition
|
|
Term
| what drug has a SSRI interaction |
|
Definition
|
|
Term
|
Definition
|
|
Term
| D-Ala mutation drug resistance |
|
Definition
| for vancomycin in enterococci and staph aureus |
|
|
Term
| Acetylation &/or adenylation of aminoglycoside yields resistance for what drugs |
|
Definition
|
|
Term
| phosphorylation of AG leads to resistance to what AG drug |
|
Definition
|
|
Term
| 3 primary mechanisms of resistance: |
|
Definition
| altered permeability, enzyme inactivation, altered target |
|
|
Term
| primary risk factors for resistance are (2): |
|
Definition
1. recent exposure to abx therapy
2. residence in a health care facility |
|
|
Term
|
Definition
| PCN, Streptomycin, MLSb, high level AG, Vancomycin |
|
|
Term
|
Definition
PCN (b-lactamases are good at overcoming),
MRSA {MLSb & fluoroquinolone resistance)
VISA (reduced vanco susceptiblity)
VRSA resistant to vanco
CA-MRSA - endo/exotoxins --> cause pneumonia |
|
|
Term
| strep pneumonia resistance factors |
|
Definition
| PCN resistance (b-lactamase inhibitors no benefit), macrolide resistance |
|
|
Term
|
Definition
| B-lactamase (augmentin resistance through altered PBP) |
|
|
Term
| Enterobacter cloacae resistance |
|
Definition
| B-lactamases (AmpC, porins, efflux pumps, heteroresistance w/ 3gen cephs) |
|
|
Term
| p. aeruginosa resistances |
|
Definition
| Carbapenems (porin), efflux pumps, ESBL, AmpC, AGMEs, DNA gyrase (50% resistant to quinolones) |
|
|
Term
| n. gonorrhoeae resistances |
|
Definition
| PCNs (no longer rec'd for empiric), TCNs, Quinolones (small %) |
|
|
Term
| production of extended spectrum b-lactamases (carbapenemases) can be found in what two organisms |
|
Definition
| p. aeruginosa, klebsiella pneumonia |
|
|
Term
| (class example) e. coli resistant to ampicillin through: |
|
Definition
|
|
Term
| (class example): e. coli resistant to levofloxacin through |
|
Definition
|
|
Term
| (class example): e coli resistant to tetracycline through |
|
Definition
|
|
Term
| (class example):MRSA resistant to clindamycin through |
|
Definition
|
|
Term
| (class example): s pneumonia resistant to erythryomycin through |
|
Definition
| ribosomal binding/efflux pump |
|
|
Term
| (class example): s pneumonia resistant to PCN through |
|
Definition
|
|
Term
| majority of SSTI caused by what two gram + organisms |
|
Definition
|
|
Term
| CA-MRSA in SSTI's usually have unique features |
|
Definition
| furuncles/carbuncles, folliculitis mistaken for spider bites |
|
|
Term
| cellulitis often occurs from what in the hospital |
|
Definition
| IV lines - lead to CAMRSA or MSSA may be polymicrobial |
|
|
Term
|
Definition
1. hospitalized last 24 mos
2. out pt. visit past 12 mos.
3. nursing home admin. past 12 mos.
4. abx exposure in past 12 mos.
5. chronic medical illness
6. injection drug use (ACTIVE (not previous) drug users - MRSA needs to be at top of concern list)
7. close contact with infected person |
|
|
Term
| if pt. allergic to sulfa use what drug |
|
Definition
|
|
Term
| clinical features of MSSA |
|
Definition
rapidly developing lesion
localized pain, tenderness, redness, inflamm
constitutional symptoms
possible elevated WBC and lymphadenopathy |
|
|
Term
| first line for MSSA or b-hemolytic strep out patient (one drug used PO and another is used IV) |
|
Definition
| dicloxacillin PO, Nafcillin IV |
|
|
Term
| MSSA & b-hemolytic strep treatment if pt. has PCN allergy but not a true allergy (one drug PO and another is used IV) |
|
Definition
| cephalexin PO, cefazolin IV |
|
|
Term
| MSSA or B-hemolytic strep treatment if pt. has true anaphylactic rxn to PCN |
|
Definition
|
|
Term
| this type of SSTI is often seen in diabetics |
|
Definition
|
|
Term
| PO therapies for polymicrobial SSTI |
|
Definition
Augmentin
Levofloxacin + metronidazole or clindamycin |
|
|
Term
| IV therapies for polymicrobial SSTI |
|
Definition
1. pip/tazo +/- vanc
2. imipenem +/- vanc
3. levofloxacin +/- metronidazole or clindamycin +/-vanc |
|
|
Term
| honey colored lesions, pustules, more in summer |
|
Definition
|
|
Term
|
Definition
| b-hemolytic strep, MSSA and MRSA |
|
|
Term
| treatment of nonbullous impetigo |
|
Definition
| PO meds (dicloxacillin, cephalexin, bactrim, clindamycin) |
|
|
Term
| bullous impetigo treatment |
|
Definition
| IV meds, may be able to use PO |
|
|
Term
|
Definition
use warm soapy water to soak and remove crusts
do not allow drainage to contaminate common surfaces
peeling scabs can cause permanent scars |
|
|
Term
| risk factors for polymicrobial necrotizing fascitis |
|
Definition
| surery/trauma, PVD/DM, ulcers, IVDU, perianal abscess |
|
|
Term
| risk factors for monomicrobial necrotizing fascitis |
|
Definition
| health people, strep pyogenes |
|
|
Term
| chronic diabetic foot ulcers are usually mono or polymicrobial? |
|
Definition
|
|
Term
| acute diabetic foot ulcers are caused by mono or polymicrobial? |
|
Definition
|
|
Term
| gram negative chronic diabetic foot ulcer cause |
|
Definition
|
|
Term
| if pt. has diabetic foot ulcer and systemic inflammatory response signs (SIRS) how should they be treateed |
|
Definition
|
|
Term
| if diabetic foot ulcer has erythema >2cm around ulcer or involves structures deeper than SQ tissue pt. should be treated in or out pt? |
|
Definition
|
|
Term
| treatment of diabetic foot ulcers must always include what? |
|
Definition
|
|
Term
| since no out patient treatment for diabetic foot ulcers covers pseudomonas, what should you use if that is a concern? |
|
Definition
cipro, first line is augmentin but doesn't cover pseudomonas
duration 1-2 weeks |
|
|
Term
| treatment for moderate to severe diabetic foot ulcer inpatient |
|
Definition
ampicillin sulbactam (if no pseudomonas concern), can use vanc or linezolid if concern, start with pip/tazo empiric if pseudomonas concern
duration of therapy 2-3 weeks |
|
|
Term
|
Definition
|
|
Term
classify route of bone/joint infection:
source spread through bloodstream
metaphyses of long bones most frequently involved
most often seen in children
staph aureus almost always recovered |
|
Definition
|
|
Term
classify route of infection of bone/joint infection:
hematogenous spread is most likely route of infection
two adjacent vertebrae
most often in adults >50 yo |
|
Definition
|
|
Term
classify route of bone/joint infection:
most commonly involves multiple organisms, chronic process, often in adults |
|
Definition
|
|
Term
| duration of treatment for bone/joint infection |
|
Definition
| 4-6 weeks of bactericidal agent |
|
|
Term
| empiric therapy of neonate for bone/joint infection |
|
Definition
| oxacillin/nafcillin +/- cefotaxime |
|
|
Term
| empiric therapy of child < 5 for bone/joint infection |
|
Definition
| oxcallin/nafcillin or cefazolin or cefuroxime |
|
|
Term
| empiric therapy of child > 5 for bone/joint infection |
|
Definition
| oxacillin/nafcillin or cefazolin |
|
|
Term
| empiric therapy for IVDU for bone/joint infection |
|
Definition
| anti-pseudomonal b-lactam (pip/tazo, ticar/clav) + vancomycin |
|
|
Term
| monitoring parameters for bone/joint infection: |
|
Definition
CBC - 1-2x/weekly until normal
ESR &/or CRP- weekly or qow
MRI - repeat at end of therapy and one month after
Chem panel - follow BUN/Scr
Serum DRug levels - vanc
adherence |
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|
