Term
|
Definition
Inhibit cell wall synthesis
š Effectively punching a hole through the cell wall causing the cell to fill
with water and explode (cidal) |
|
|
Term
| Amoxicillin (oral) and ampicillin (oral but used almost exclusively IV) |
|
Definition
š Excellent against Strep species and anaerobes (except C. difficile)
š Ineffective for staph and gram(-‐‑) |
|
|
Term
| Dicloxacillin (oral), oxacillin (IV), nafcillin (IV) |
|
Definition
š Excellent against strep species and methicillin susceptible staph aureus (MSSA)
š Ineffective against gram(-‐‑) and anaerobes |
|
|
Term
| Cephalexin (oral) and cefazolin (IV) are first generation |
|
Definition
| Excellent against strep species, MSSA, E. coli, Klebsiella, proteus miribilis |
|
|
Term
Cefotetan, cefoxitin, and cefuroxime are 2nd gen; cefotaxime/ceftriaxone
are 3rd gen (all IV) |
|
Definition
š Less effective for MSSA but very effective for gram (-‐‑) and anaerobes
š Excludes pseudomonas (PsA) and c. difficile |
|
|
Term
| Cefepime is 4th generation (IV) |
|
Definition
| Excellent across gram (+) and gram (-‐‑) including PsA but no anaerobes |
|
|
Term
| Ceftaroline is 5th generation (IV) |
|
Definition
Excellent strep species, MSSA, methicillin resistant staph aureus (MRSA), E.
coli, Klebsiella |
|
|
Term
Ampicillin/clavulanate (Augmentin/oral), amoxicillin/sulbactam
(Unasyn/IV), piperacillin/tazobactam (Zosyn/IV) |
|
Definition
š Excellent against most gram (+) (except MRSA), gram (-‐‑), and anaerobes
(except c. difficile)
š Piperacillin/tazobactam has the least resistance and only one active against PsA |
|
|
Term
| Sulfamethoxazole/trimethoprim (SMX/TMP) (Bactrim/Septra) (oral/IV) |
|
Definition
š Both inhibit folic acid synthesis at two different pathway points stopping
DNA synthesis (cidal)
š Effectively giving the cell a heart a[ack
š Moderately effective against gram (+) strep and staph including
community acquired MRSA (CA MRSA)
š Moderately effective against gram (-‐‑) excluding PsA
š No anaerobic activity
š Contains sulfa moiety which can lead to serious skin reactions
š Most notably Stevens Johnson Syndrome
š Life-‐‑threatening interaction with warfarin causing increased bleeding
š Contraindicated at the James A. Haley VA |
|
|
Term
|
Definition
š Tetracycline (oral), doxycycline (oral /IV), minocycline (oral /IV)
š Inhibits protein synthesis through 30S subunit of microbial
ribosomes
š Effectively causing the bacteria to waste away over time (static)
š Moderately effective against gram (+) strep and staph including CA
MRSA
š Sporadically effective for gram(-‐‑) and anaerobes due to resistance
š Excellent for atypical bacteria including Lyme disease
š Counsel patients on the harsh GI effects, drug chelation, and should
be avoided in children and pregnant mothers. |
|
|
Term
| Clindamycin (oral/IV/topical) |
|
Definition
š Protein synthesis inhibitor acting on 50S subunit of the bacterial
ribosome
š Effectively causing the bacteria to waste away over time (static)
š Excellent against anaerobes (except d. difficile)
š Moderately effective against gram (+) strep and staph including CA
MRSA
š Ineffective against gram(-‐‑)
š Must counsel patient for c. difficile infection
š Can suppress toxins secreted by bacteria |
|
|
Term
|
Definition
š Ciprofloxacin, levofloxacin, and moxifloxacin (all oral/IV)
š Inhibit DNA-‐‑gyrase which breaks the double-‐‑stranded DNA (cidal)
š Effectively they smash the DNA into bits
š Moderately effective gram (+) coverage with some activity against
CA MRSA
š Moderately effective against gram (-‐‑) including PsA (except
moxifloxacin)
š Good anaerobic activity except for c. difficile
š Many bacterial species are becoming resistant to this group
š Counsel patient on c. difficile infection and chelation |
|
|
Term
|
Definition
š Prevents cell wall synthesis through disruption in cross link binding
š Think of a bacterial wall like Legos—vancomycin stops them from
connecting (cidal)
š Excellent gram (+) coverage including health care associated MRSA
(HA MRSA)
š No gram (-‐‑) coverage
š Excellent anaerobic coverage including c. difficile for oral only
š Dose based on renal function and weight
š Drug levels drawn for kinetic monitoring
š Infusion related red-‐‑man syndrome |
|
|
Term
|
Definition
š Cell membrane disruption causing depolarization into the cell (cidal)
š Effectively using a jackhammer to split open the cell wall
š Excellent gram (+) coverage including HA MRSA
š No gram (-‐‑) or anaerobic activity
š Deactivated in the lungs by surfactant
š Can lead to myalgia and rhabdomyolysis
š Monitor CPK baseline then 5 days later |
|
|
Term
What other class of drugs (not antibiotics) can cause myalgia and
rhabdomyolysis? |
|
Definition
|
|
Term
|
Definition
š Protein synthesis inhibition by preventing 50S and 30S combination
š Effectively causing the bacteria to waste away over time (static
except cidal for staph)
š Excellent for gram (+) including HA MRSA
š Excellent anaerobic activity (possible c. difficile)
š No gram(-‐‑) activity
š Very expensive
š Many drug-‐‑drug interactions due to its MAO inhibition properties |
|
|
Term
| Group A Streptococcus (GAS) |
|
Definition
š Gram (+)
š GAS is most predominant strep in SSTI and more difficult to
treat than Group B due to growing resistance
š Responsible for bites, cellulitis, necrotizing fasciitis, diabetic foot
ulcers, and pressure ulcers
š Can become deadly if it invades the blood and organs
š Streptococcus toxic shock
š Necrotizing fasciitis (flesh eating bacteria) |
|
|
Term
| Group A Streptococcus (GAS) Treatment |
|
Definition
š Antibiotics
š Excellent coverage
š Amoxicillin or cephalexin for PO
š Nafcillin, oxacillin, ampicillin, cefazolin for IV
š Alternative coverage
š Clindamycin
š Fluoroquinolones
š SMX/TMP
š Vancomycin, linezolid, and daptomycin |
|
|
Term
|
Definition
š Gram (+)
š Responsible for furuncles,carbuncles, bites, cellulitis, necrotizing fasciitis, diabetic foot ulcers, and pressure ulcers
MSSA
MRSA (CA MRSA, HA MRSA) |
|
|
Term
|
Definition
š Antibiotics active against MSSA
š Nafcillin, oxacillin, and dicloxacillin
š Penicillins with beta lactamase inhibitors
š Amoxicillin-‐‑clavulanate and piperacillin-‐‑tazobactam
š Cephalosporins (1st generation>3rd)
š Any agent that is active against MRSA |
|
|
Term
|
Definition
š CA-‐‑MRSA activity
š Doxycycline, minocycline, SMX/TMP, or clindamycin
š Fluoroquinolones may be used depending on culture results
š HA-‐‑MRSA (or SSTI involving hospitalization) activity
š Vancomycin, daptomycin, linezolid, ceftaroline
š Resistance
š Consider if your area or hospital has a high MRSA rate
š All penicillin based antibiotics despite beta lactamase inhibitors
š Cephalosporins (except the new 5th generation) |
|
|
Term
|
Definition
š Doxycycline, minocycline, SMX/TMP, or clindamycin
š Fluoroquinolones may be used depending on culture results |
|
|
Term
|
Definition
| š Vancomycin, daptomycin, linezolid, ceftaroline |
|
|
Term
|
Definition
š Gram (-‐‑)
š Highly resistant and very virulent
š Most antibiotics are not active against this bacteria
š Serious infections especially in diabetic and pressure ulcers
š Active antibiotics
š Piperacillin/tazobactam
š Cefepime
š Fluoroquinolones (except moxifloxacin)
š Aminoglycosides, carbapenems (except ertapenem), aztreonam |
|
|
Term
|
Definition
š Collection of pus within the dermis and deeper skin tissues
š Polymicrobial: skin flora +/-‐‑ organisms from mucus membrane
š Treatment
š Thorough evacuation of pus via incision |
|
|
Term
|
Definition
š Infection of the hair follicle that extends into the subcutaneous tissue
forming a small abscess
š Inflammatory nodule with overlying pustule where the hair emerges |
|
|
Term
|
Definition
| Infection extends to multiple hair follicles producing a pus mass |
|
|
Term
| Abscesses, Furuncles, and Carbuncles Treatment |
|
Definition
š Treatment (7-‐‑10 days)
š Heat
š Incision and drainage
š MSSA and MRSA coverage |
|
|
Term
|
Definition
š Half the population will be bi[en at one point in their life
š Average wound yields 5 types of bacterial isolates
š Pasteurella are isolated from 50% of dogs and 75% cats
š Staph and strep species are found in ~40% from both animals
š Anaerobes are common
š Treatment (10-‐‑14 days)
š Amoxicillin-‐‑clavulanate
š Doxycycline
š Penicillin G + dicloxacillin
š Fluoroquinolones
š Piperacillin/tazobactam and 2nd gen cephalosporin if IV needed |
|
|
Term
|
Definition
š Oral flora of the mouth
š Streptococcus in 80%, staph, few gram (-‐‑), and >60% anaerobes
š Many of the anaerobes produce beta lactamases (heat seeking missiles)
š Treatment (7-‐‑14 days)
š Cleanse the wound and treat immediately with antibiotics
š Amoxicillin-‐‑clavulanate
š Ampicillin-‐‑sulbactam
š Cefoxitin
š Carbapenems
š Doxycycline
š Fluoroquinolones |
|
|
Term
|
Definition
Diffuse, spreading skin infection
š Erysipelas is a more superficial cellulitis affecting upper dermis and
superficial lymphatics
š Associated with raised lesions and clear demarcation
š Cellulitis is a deeper dermal infection involving subcutaneous fat
š Lacks raised lesions and demarcation which make diagnosis difficult |
|
|
Term
|
Definition
š Mild cellulitis remains within the dermis and causes inflammation
š Moderate to severe penetrates into the lymph and circulatory system
š May result in sepsis, osteomyelitis, and gangrene if untreated |
|
|
Term
|
Definition
š Breaches in skin especially in frail skin due to obesity, diabetes, PVD
š Trauma to skin
š Surgery |
|
|
Term
| Cellulitis Signs and symptoms of cellulitis |
|
Definition
š Edema, redness, and heat on the skin
š May have petechiae or bruising |
|
|
Term
|
Definition
š Predominant species is GAS
š Second most common is S. aureus
š Usually associated with trauma or abscess
š Obtaining cultures is very difficult and are positive <5% of time |
|
|
Term
| Cellulitis Therapy not requiring hospitalization (7-‐‑10 days) |
|
Definition
š Gram (+) active against both GAS and MSSA or CA-‐‑MRSA
š SMX/TMP, doxycycline or minocycline, clindamycin, cephalexin,
dicloxacillin |
|
|
Term
| Cellulitis Empiric therapy requiring hospitalization (10-‐‑14 days) |
|
Definition
š Gram (+) active against both GAS and HA-‐‑MRSA
š IV therapy is recommended
š Vancomycin is first line due to cost and proven efficacy
š Daptomycin and linezolid may be used if allergic to vancomycin |
|
|
Term
| Necrotizing Soft Tissue Infections |
|
Definition
š Rare but highly lethal infections usually consisting of more than
one organism
š Most of these infections are due to some trauma
š May be as trivial as an insect bite or injection site
š Progressive destruction of the superficial fascia (connective
tissue) and subcutaneous fat
š Onset may be slow or extremely rapid
š Has a “wooden hard” feel
š Initial presentation similar to cellulitis but progresses to systemic
toxicity and high fevers
š Two-‐‑thirds of cases involve the extremities
š Up to 70% mortality rate |
|
|
Term
|
Definition
š Most common of the necrotizing infections
š Type Iàdestruction of fat and fascia with polymicrobials
š Type IIà”flesh eating” GAS and acts much quicker |
|
|
Term
|
Definition
š Type I necrotizing fasciitis specifically affects the male or female
genitalia
š Rapid onset without warning |
|
|
Term
| Clostridial myonecrosis (gas gangrene) |
|
Definition
š Involves skeletal muscles and gas production
š Usually due to surgery and advances over hours |
|
|
Term
| Necrotizing Soft Tissue Infections Clinical course for all types |
|
Definition
š Above all, this is a surgical emergency
š Multiple incision and debridements are needed on a daily basis
š Good cultures can be obtained through needle aspiration |
|
|
Term
| Necrotizing Soft Tissue Infections Bacterial organisms |
|
Definition
š Various types of streptococcus, especially GAS
š Gram (-‐‑) such as E. coli and PsA
š Anaerobes including clostridium species |
|
|
Term
Antibiotic treatment for both necrotizing fasciitis and gas
gangrene (treat until resolved) |
|
Definition
š IV over oral
š Broad spectrum including anaerobic coverage
š Clindamycin is drug of choice due to toxin suppression and
unaffected by large bacteria colony forming units
š Piperacillin/tazobactam+clindamycin+ciprofloxacin
š Penicillin G+clindamycin+aminoglyoside
š Cefepime+clindamycin (or metronidazole)
š Add vancomycin if suspected MRSA infection |
|
|
Term
|
Definition
š Pathophysiology
š Neuropathy
š Ischemia due to breakdown in microvasculature
š Diminished immune a[ack
š How do these ulcers form?
š Loss of pain reception -> breakdown of skin -> bacteria invade
š Why do they get so bad?
š Poor hygiene and lack of awareness |
|
|
Term
| What part of the body does the diabetic foot infection usually progress towards and ultimately infects? |
|
Definition
|
|
Term
| Diabetic Foot Infections Bacterial species |
|
Definition
Bacterial species
š Mild infection: MSSA, MRSA, and strep species
š Moderate to severe: gram(+), gram(-‐‑), and anaerobes
š Think about an open wound in stinky, sweaty, unwashed feet for days
š Pseudomonas is found around 10% of the time
š This number increases in warmer climates
š Should be covered in moderate to severe infections |
|
|
Term
| Diabetic Foot Infections Treatment |
|
Definition
š Intraoperative incision and debridement for moderate to severe wounds
š Retrieve intraoperative cultures if possible by scraping or aspiration
š Antibiotics
š Mild: treat like a cellulitis (10-‐‑14 days)
š SMX/TMP, doxycycline, clindamycin, cephalexin, dicloxacillin, amoxicillin-‐‑
clavulanate
š Moderate to severe: cover everything (up to 21 days)
š Fluoroquinolones
š 2nd, 3rd, 4th cephalosporins
š Penicillin with beta lactamase inhibitor
š Vancomycin, daptomycin, linezolid for MRSA
š Amputation |
|
|
Term
| Why is vancomycin + piperacillin/tazobactam the most frequently used combination for empiric therapy? |
|
Definition
|
|
Term
|
Definition
š Patients mostly effected
š Quadriplegics
š Sacral ulcers
š Paraplegics
š Ischial ulcers
š Elderly and immobile
š Miscellaneous areas depending on position
š Pathophysiology
š Similar to diabetic foot ulcers
š The bacteria can “track” up into the fat, muscle, and tissue
š Lead to sepsis, necrosis, and osteomyelitis |
|
|
Term
|
Definition
š Prevention is key
š Specific pressure beds, physically being moved, hygiene, pressure relief
š Surgical debridement, wound vac, and flap surgery
š May heal on their own with proper a[ention if not infected
š Antibiotics (treat until resolved)
š Topical creams and cleansers (silver sulfadiazine, Datkins, peroxide)
š Get intraoperative cultures, bedside biopsy, or needle aspiration
š Gram (+), gram (-‐‑), anaerobes
š Treat like diabetic foot ulcers
š Additional poop bacteria if quadriplegic or incontinent |
|
|
Term
A quadriplegic has an infected sacral pressure ulcer. The a[ending
suspects MRSA so vancomycin is ordered. As the pharmacist on the
SCI team, you suggest adding an additional antibiotic. What would
you add? |
|
Definition
|
|
Term
| Case What type of SSTI does John have? |
|
Definition
|
|
Term
This patient is in the emergency room, what antibiotics do we
start him on if MRSA is suspected and…..
A. He does not have a penicillin allergy |
|
Definition
|
|
Term
This patient is in the emergency room, what antibiotics do we
start him on if MRSA is suspected and…..
He does have a true penicillin allergy |
|
Definition
1. Vancomycin+levofloxacin
Moxiflox dos not cover pseudomonis |
|
|
Term
After his below the knee amputation, the patient quickly
developed a foul smelling greenish infection at the incision
site. What type of SSTI infection is it (besides being a surgical
site infection)? What antibiotic do you want to make sure is
on board for this patient? |
|
Definition
| 3. Gas gangrene add clindamycin |
|
|
