Exam 3 ID

if a drug is renally dosed, it does not mean it is nephrotoxic (t/f)

true

if a drug is renally dosed, it does not mean It is not preferred in a patient with renal dysfunction (t/f)

true

the 3 steps in approach to ID are what

1. assessment

2. plan

3. monitoring

what is the likelihood of true infection is what part of the approach

assessment

do we need to start antibiotics right away? how long should we treat for?

plan

what do I need to monitor for my antibiotics is what part of the approach

monitoring

need to assess probability of the infection based on what categories?

symptoms

signs

cultures

rapid diagnostics

what are the symptoms to asses

cough

urinary frequency

chills

what are the things to look for in signs

fever

WBC

procalcitonin

what cultures to look for in assessing

blood

urine

sputum

what is the rapid diagnostic in assessing probability

respiratory PCR panel

how to identify if SIRS (systemic inflammatory response syndrome)

must have 2 of the following

• temperature >38C or < 36

• HR > 90

• RR >20

• WBC >12

what is the best treatment possible

source control

antibiotics without source control can often lead to failure (t/f)

true

the study showed that in the end, it didn’t matter if the patient recieved antibiotics or not → draining the abscess (source control) was the best treatment (t/f)

true

what are the types of reactions in allergies?

anaphylaxis

hives

rash

anaphylaxis has what reaction ?

high

hives has what reaction

medium

rash has what reaction?

low

cross reactivity (if PCN allergic) is low

there are many beta lactase safe to take

cross reactivity if PCN allergy what is cephalosporin

<2%

what are the management options for penicillin allergy management

• penicillin skin test

• single dose ingestion challenge

• graded dose challenge

  • desensitization

optimization of antimicrobial dosing to maximize efficacy and minimized harm (t/f)

true

which antibiotics are

peak/MIC

concentration dependent

ahminoglycosides

fluoroquinolones

daptomycin

which antibiotics are

time above MIC

time dependent

beta lactam

which antibiotics are

AUC/MIC

exposure dependent

vancomycin

when to consider oral options which would benefit

• cheaper

• faster discharge

• avoid risk of infection

when else can oral option be consider

• patient is not NPO

• oral option available that bug is susceptible to

• good GI absorption

• options with good bioavailability

• no sig diet interactions

durations of therapies getting shorter with emerging evidence challenging historical practices (t/f)

true

platelets and neuropathies are adverse effects of what

linezolid

QTc and renal function is adverse effect of?

FQs

CK is adverse effect of what?

daptomycin

K+ and renal function are adverse effect of what

bactrim

narrowing differential and antibiotic therapy as more data come in to confirm diagnosis of infection (t/f)

true

Cephalexin is a renally adjusted antibiotic. Which means it’s also nephrotoxic (t/f)

false

While reviewing a patient's chart during your rotation, you notice that a

penicillin allergy is documented as a family history of a penicillin allergy.

How would you classify this patient's allergy risk?

A) Low

B) Medium

C) High

A

While working up another patient during your rotations, you notice a

documented penicillin allergy, described as a rash that occurred 15 years

ago. Upon further review, you see an order for ceftriaxone. What would be

your next course of action?

A) Discontinue the order immediately and notify the doctor

B) Continue the medication, and monitor the patient’s response

C) Notify the doctor regarding contraindication between cephalosporins

and penicillin allergy

B

The dosing strategy for beta-lactams is typically based on a specific

pharmacokinetic parameter. Given this, which PK/PD indices is most

appropriate for beta-lactams?

A) Time above MIC

B) AUC/MIC

C) Peak/MIC

A

what are the 2 main types of resistance

1. enzymatic inactivation

2. non-enzymatic mechanism

beta lactamases

aminoglycoside modifying enzymes

What resistance?

enzymatic inactivation

decreased permeability

efflux pumps

alteration of target site

what type of resistance?

non-enzymatic mechanism

CDC typically uses this term to refer to an isolate that is resistant to at least one antibiotic in > 3 drug classes is def of what?

multidrug resistant isolate

gram + MDR organisms

VRE

MRSA

what is the drug of choice for MRSA

vancomycin

what are new antibiotic agents for MRSA

Dalbavancin

Oritavancin

enterobacterales consists of what

E.coli

klebsiella spp

proteus spp

what does ESBL stand for

extended spectrum beta lactamases

what is the drug of choice for ESBL

carbapenems

what is the drug of choice for CRE in KPC

meropenem-vaborbactam

what is the drug of choice of resistance for class B

aztreonam-avibactam

what is the drug of choice for pseudomonas

ceftolozane-tazobactam

acinetobacter baumannii is covered by 2 drugs which are

sulbactam-durlobactam & cefiderocol

which of the following ABX cover pseudomonas ? SATA

A. Cefiderocol

B.Sulbactam-durlobactam

C. Ceftazidime-avibactam

D. Ceftolozame-tazobactam

A,C,D

which ABX would you choose as first line to cover ESBL ?

A. Cefiderocol

B. polymyxin B

C. Meropenem-vaborbactam

D. Meropenem

E. Aztreonam-avibactam

D

the physicians orders meropenem-vaborbactam for pseudomonas ? do you verify this order?

A. Yes

B. No

no

Which of the following has reliable coverage against is the

MDR Pseudomonas (SATA)

a) Ceftazidime-avibactam

b) Cefiderocol

c) Ceftolozane-tazobactam

d) Meropenem Vaborbactam

A,B,C

Which of the following has reliable coverage against MDR CRE (Class B)

a) Ceftazidime-avibactam

b) Cefiderocol

c) Imipenem-relebactam

d) Meropenem Vaborbactam

B

Which of the following has reliable coverage against MDR Acinetobacter(SATA)

a) Ceftazidime-avibactam

b) Cefiderocol

c) Sulbactam-durlobactam

d) Meropenem Vaborbactam

B,C

URTI mostly caused by what?

Viruses

H.influenza, Moraxella are the most common type of bacterial infection (t/f)

true

when to treat with ABX for rhinosinusitis ?

• persistent sign lasting >10 days

• worsening signs by onset fever lasted 7 days

  • severe signs, high fever, 3-4 consecutive days at the beginning of illness

what is the first line for sinusitis

amox/clav

or

doxycycline if beta lactam allergy

what is the second line for sinusitis if first failed?

high dose amox/clav

“respiratory” FQ (levo, moxi)

in pneumonia inflammation occurs within the lung tissue, bronchioles, and what?

alveoli

pathogens are acquired by what?

via aspiration (salive, oral colonizers)

via inhalation of aerosolized particles

seeding from bloodstream

lung defenses protect from pneumonia but can still occur if what?

patient is immunocompressed

Celia defense mechanisms not working

inoculum of bacteria is too high

viral infection

what are the risk factors of pneumonia ?

smoking

PPI use

structural lung disease

prolonged hospitalization/ ventilator use

contaminated water supply

Immunosupprresion

what are signs/symptoms for pneumonia ?

dyspnea

productive cough

fever

chest pain

what physical exam for pneumonia?

tachypnea, tachycardia

inspiratory crackles, rales, wheezing, rhonchi

what labs for pneumonia?

WBC with differential

• PMNs

• elevated bands

low oxygen

pro-calcitonin

C-reactive protein

diagnostics of Pneumonia

chest xray

sputum gram stain

blood cultures

CBC, BMP, LFTs, procalcitonin, CRP

pulse oximetry

optimal specimen for sputum culture

• <10 epithelial cells

• >25 WBCs

• heavy growth of a single species on culture

pro-calcitonin is unregulated in sepsis, systemic bacterial infections. studies have found in bacterial pneumonia ( including CAP ) PCT is usually elevated

true PC

PCT levels can be low due to viral co-infection

true

PCT levels decrease as infection is treated

true

HAP & VAP are considered what?

nosocomial

pneumonia symptoms present <48 hours after admission is what type of pneumonia

CAP

Step 1: clinical presentation

Step 2: location to treat decision

Step 3: selecting empiric therapy

Step 4: definitive therapy

approach to CAP

class of severity will be defined as what in CAP?

• hemodynamic instability

• respiratory failure requiring intubation

• stated otherwise

major criteria for severe CAP one of these

invasive mechanical ventilation

septic shop

what is the most common outpatient etiology

streptococcus pneumonia

what is the Drug of choice for inpatient CAP

ceftriaxone

which antibiotics cover atypical bacteria ?

macrolifes, FQs, tetracyclines (Doxy,mino)

what ABX do CAP guidelines recommend depends on?

risk factors

outpatient vs inpatient

inpatient (non-ICU/ ICU)

what is the therapy for outpatient CAP who are healthy

amoxicillin

doxycycline

what is the therapy for outpatient CAP who have comobirdities, immunosuppression, DM, CKD, alcoholicm

Beta-lactam plus macrolide (augmentin + azithromycin)

or

Beta0lactam plus doxycycline (augmentin + doxycycline)

what is the therapy for inpatient (non-icu) CAP

ceftriaxone

ampicillin-sulbactam

what is the therapy for inpatient (non-icu) CAP with no penicillin allergy

beta lactam IV + macrolide IV/PO (ceftriaxone + azithromycin)

or

beta lactam IV + doxycycline IV/PO (ceftrixone + doxycycline)

what is the therapy for inpatient (non-icu) CAP with penicillin allergy

respiratory FQ IV/PO

• levo, moxi

what is the therapy for inpatient (icu) CAP with no concern for pseudomonas

Beta lactam IV plus azithromycin IV (ceftriaxone + azithromycin)

or

Beta lactam IV plus Respiratory FQ IV (levo or moxi)

what is the therapy for inpatient (icu) CAP with risk factors for pseudomonas

ceftazidime/aztreonam IV + azithromycin IV or levofloxacin IV

if MRSA risk factors which should be added

vancomycin

linezolid

cultures recommended for who?

severely ill patients

patients started on anti-MRSA or anti-PSA

patients with weak MRSA/PSA risk factors

Legionella & pneumococcal urinary antigen tests only recommended for?

patients with severe CAP

strong suspicion

If Nares is - for MRSA, >95% chance pneumonia will NOT be caused by MRSA

true

what is the duration of therapy

5 days

what are the vaccinations for prevention pneumonia

• pneumonia

  • h.influenza

true aspiration pneumonia typically associated with lung abscess or empyema

true

most “aspiration pneumonia” is aspiration pneumonitis

true

HAP & VAP are considered as what?

nosocomial