Infectious Disease

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63 Terms

1
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Cell-wall synthesis Inhibitors

  • Beta-lactams

  • Vancomycin

  • Daptomycin

  • Fosfomycin


2
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Protein Synthesis Inhibitors

  • tetracyclines

  • macrolides

  • clindamycin

  • Amino-glycosides

  • Linezolid


3
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DNA Synthesis Inhibitors

  • FQs

  • Septra


4
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Good Tasting Suspensions

  • amox ± clav

  • Cephalexin

  • Cefprozil

  • Cefixime

  • Azithromycin


5
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Known safe Abx in pregnancy

  • Penicillins (including BLIs)

  • Cephs (except ceftriaxone at term)

  • Carbapenems

  • Vancomycin

  • Daptomycin

  • Fosfomycin

  • Clindamycin


6
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Abx needing renal dosing

  • all beta-lactams (except cloxacillin and ceftriaxone)

  • Vancomycin

  • Daptomycin

  • Clarithromycin

  • Amino-glycosides

  • FQs (except moxifloxacin)

  • Septra

  • Nitrofurantoin


Note: vanco and amino-glycosides should be avoided in renal dysf. b/c nephrotoxic

7
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Risk factors for PRSP (penicllin-resistant Strep pneumo)

  • <2 or >65

  • daycare attendance (or close contact for adults)

  • recent institutionalization (shelter, LTC, hospitalization)

  • recent antimicrobial use (3 months) - especially for FQs and macrolides

  • smoking

  • DM

  • malignancy

  • alcohol misuse

  • immunosuppression

  • chronic disease (heart, liver, renal, lung)


Overcome by using high-dose beta-lactams

8
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1st gen Cephalosporins


  • Cephalexin (PO)

  • Cefadroxil (PO)

  • Cefazolin (IV)


9
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2nd gen cephalosporins

  • Cefuroxime (IV and PO)

  • Cefprozil (PO)


10
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3rd gen cephalosporins

  • Cefixime (PO)

  • Ceftriaxone (IV) and Cefotaxime (IV) - both have same spectra

  • Ceftazidime (IV)


11
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Most narrow carbapenem

Ertapenem

12
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ESBL Risk Factors (Extended Spectrum Beta-Lactamase)

  • Recent hospitalization (>12 hrs in the past year)

  • Travel to endemic countries (especially if for healthcare or staying with family/friends)

    • especially India and Vietnam

  • Prolonged use of broad-spectrum Abx (FQs, 3rd gen cephs)

  • Previous infection or colonization


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Which bugs do you need to worry about ESBL in?

Enterobacterales

  • E. coli

  • K. pneumoniea

  • P. mirabilis


14
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Drug of choice to treat ESBL

Carbapenems

15
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MRSA risk factors

  • IV drug use

  • crowded living conditions (homelessness, incarceration, indigenous on reserve)

  • recent hospitalization or LTC (>12 hrs in the past year)

  • recent travel to an endemic region (USA has 45% colonization) - Canada only 18%

    • especially if received healthcare there

  • prior MRSA or household contact


16
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PsA risk factors

  • recent hospitalization with IV Abx

  • bronchiectasis, COPD, or other structural lung disease

  • immunocompromise

  • invasive medical devices


17
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Penicillin Spectra

Gram Pos:

  • GAS

  • S. pneumo

  • E. faecalis


Gram Neg:

  • H influenzae


Atypicals:


Anaerobic:

  • oral anaerobes


18
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Cloxacillin Spectra

Gram Pos:

  • GAS

  • MSSA

  • S pneumo


Gram Neg:


Atypicals:


Anaerobes:


19
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Ampicillin / Amoxicillin Spectra

Gram Pos:

  • GAS

  • S. pneumo

  • E. faecalis


Gram Neg:

  • H influenzae

  • E. coli

  • P. mirabilis


Atypicals:


Anaerobes:

  • oral anaerobes


20
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Amox-Clav Spectra

Gram Pos:

  • GAS

  • MSSA

  • S. pneumo

  • E. faecalis


Gram Neg:

  • H influenzae

  • E. coli

  • P. mirabilis

  • K. pneumoniae


Atypicals:


Anaerobes:

  • oral anaerobes

  • B. fragilis


21
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Pip-Taz Spectra

Gram Pos:

  • GAS

  • MSSA

  • S. pneumo

  • E. faecalis


Gram Neg:

  • H influenzae

  • E coli

  • P mirabilis

  • K pneumoniae

  • PsA


Atypicals:


Anaerobes:

  • oral anaerobes

  • B. fragilis


22
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Cefazolin / Cephalexin / Cefadroxil Spectra

Gram Pos:

  • GAS

  • MSSA

  • S. pneumo


Gram Neg:

  • H influenzae

  • E. coli

  • P mirabilis

  • K pneumoniae


Atypicals:


Anaerobes:

  • oral anaerobes


23
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Relative potency of beta-lactams against S. pneumo

Amoxicillin > Cefuroxime = Cefprozil > > Cefixime > Cephalexin

24
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M catarrhalis susceptibility pattern

Follows H. influenzae but 100% produce beta-lactamases

25
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Cefuroxime / Cefprozil Spectra

Gram Pos:

  • GAS

  • MSSA

  • S. pneumo


Gram Neg:

  • H influenzae

  • E. coli

  • P. mirabilis

  • K. pneumoniae


Atypicals:


Anaerobes:

  • Oral anaerobes


26
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Cefixime Spectra

Gram Pos:

  • GAS

  • S. pneumo


Gram Neg:

  • H influenzae

  • E. coli

  • P. mirabilis

  • K. pneumoniae


Atypicals:


Anaerobes:

  • oral anaerobes


27
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Ceftriaxone / Cefotaxime Spectra

Gram Pos:

  • GAS

  • MSSA

  • S. pneumo


Gram Neg:

  • H influenzae

  • E coli

  • P mirabilis

  • K pneumoniae


Atypicals:


Anaerobes:

  • oral anaerobes


28
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Ceftazidime Spectra

Gram Pos:


Gram Neg:

  • H influenzae

  • E coli

  • P mirabilis

  • K pneumoniae

  • PsA


Atypicals:


Anaerobes:

  • oral anaerobes


29
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Meropenem / Imipenem Spectra

Gram Pos:

  • GAS

  • MSSA

  • S. pneumo

  • E. faecalis


Gram Neg:

  • H influenzae

  • E coli

  • P mirabilis

  • K pneumoniae

  • PsA


Atypicals:


Anaerobes:

  • oral anaerobes

  • B. fragilis


30
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Ertapenem Spectra

Gram Pos:

  • GAS

  • MSSA

  • S. pneumo


Gram Neg:

  • H influenzae

  • E coli

  • P mirabilis

  • K pneumoniae


Atypicals:


Anaerobes:

  • oral anaerobes

  • B. fragilis


31
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Vancomycin Spectra

Gram Pos:

  • GAS

  • MSSA and MRSA

  • S pneumo

  • E faecalis

  • E faecium


Gram Neg:


Atypicals:


Anaerobes:


32
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Doxycycline Spectra

Gram Pos:

  • GAS

  • MSSA and MRSA

  • S pneumo

  • E faecalis (UTI only)

  • E faecium (UTI only)


Gram Neg:

  • H influenzae

  • E coli


Atypicals:

  • C pneumoniae

  • M pneumoniae

  • Legionella spp


Anaerobes:

  • oral anaerobes


33
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Azithromycin / Clarithromycin Spectra

Gram Pos:

  • GAS

  • MSSA

  • S pneumo


Gram Neg:

  • H influenzae


Atypicals:

  • C pneumoniae

  • M pneumoniae

  • Legionella spp


Anaerobes:

  • oral anaerobes


34
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Clindamycin Spectra

Gram Pos:

  • GAS

  • MSSA and MRSA

  • S pneumo


Gram Neg:


Atypicals:


Anaerobes:

  • oral anaerobes

  • B. fragilis


35
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Norfloxacin Spectra

Gram Pos:

  • E. faecalis


Gram Neg:

  • E coli

  • P mirabilis

  • K pneumoniae

  • PsA


Atypicals:


Anaerobes:


36
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Ciprofloxacin Spectra

Gram Pos:

  • GAS

  • MSSA

  • E. faecalis (UTI only)


Gram Neg:

  • E coli

  • P mirabilis

  • K pneumoniae

  • PsA


Atypicals:

  • C pneumoniae

  • M pneumoniae

  • Legionella spp


Anaerobes:


37
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Levofloxacin Spectra

Gram Pos:

  • GAS

  • MSSA

  • S pneumo

  • E faecalis (UTI only)


Gram Neg:

  • H influenzae

  • E coli

  • P mirabilis

  • K pneumoniae

  • PsA


Atypicals:

  • C pneumoniae

  • M pneumonia

  • Legionella spp


Anaerobes:

  • Oral anaerobes


38
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Moxifloxacin Spectra

Gram Pos:

  • GAS

  • MSSA

  • S pneumo


Gram Neg:

  • H influenzae

  • E coli

  • P mirabilis

  • K pneumoniae


Atypicals:

  • C pneumoniae

  • M pneumoniae

  • Legionella spp


Anaerobes:

  • Oral anaerobes

  • B fragilis


39
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Metronidazole Spectra

Gram Pos:


Gram Neg:


Atypicals:


Anaerobes:

  • Oral anaerobes

  • B fragilis


40
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Fosfomycin Spectra (Uropathogens Only)

Gram Pos:

  • E faecalis

  • E faecium


Gram Neg:

  • E coli


Atypicals:


Anaerobes:


41
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Daptomycin Spectra

Gram Pos:

  • GAS

  • MSSA and MRSA

  • S pneumo

  • E faecalis

  • E faecium


Gram Neg:


Atypicals:


Anaerobes:


42
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Gentamicin / Tobramycin / Amikacin Spectra

Gram Pos (Synergy Only):

  • MSSA and MRSA

  • E faecalis

  • E faecium


Gram Neg:

  • E coli

  • P mirabilis

  • K pneumoniae

  • PsA

    • Systemic Infection: tobramycin only

    • UTI: tobramycin, amikacin


Atypicals:


Anaerobes:


43
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Linezolid Spectra

Gram Pos:

  • GAS

  • MSSA and MRSA

  • S pneumo

  • E faecalis

  • E faecium


Gram Neg:


Atypicals:


Anaerobes:


44
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Septra Spectra

Gram Pos:

  • GAS

  • MSSA and MRSA

  • S pneumo


Gram Neg:

  • H influenzae

  • E coli

  • P mirabilis

  • K pneumoniae


Atypicals:


Anaerobes:

  • Oral anaerobes


45
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Nitrofurantoin Spectra (Uropathogens Only)

Gram Pos:

  • E faecalis


Gram Neg:

  • E coli


Atypicals:


Anaerobes:


46
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E. faecalis is resistant to all ___.

Cephalosporins

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E. Faecium is resistant to all ____.

Beta-lactams (modified PBP)

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Which bugs do we need to worry about VRE in?

E. faecalis and E faecium

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VRE risk factors

  • previous infection or colonization

  • inpatient >12 hrs in past year

  • healthcare in another country

  • recent Abx (esp vanco, 2nd and 3rd gen cephs and concurrent or sequential use of multiple broad-spectrum agents)


50
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Which bugs have greatest risk for ampC beta-lactamase production?

  • E. cloacae

  • K. aerogenes

  • C. freundii

  • Hafnia alvei


51
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Which bugs do we have to worry about CPE (carbepenemase producing enterobacterales) in?

  • E. coli

  • K. pneumoniae


52
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CPE risk factors

  • previous CPE infection or colonization

  • inpatient admission >12 hrs in past year

  • travel to high-prevalence country for medical care (esp. Brazil and India)


53
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4th Generation cephalosporin

Cefipime

54
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Cefepime spectra

Gram Pos:

  • GAS

  • MSSA

  • S. pneumo


Gram Neg:

  • H influenzae

  • E coli

  • P mirabilis

  • K pneumoniae

  • PsA?


Atypicals:


Anaerobes:

  • oral anaerobes


55
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Cephamycin (subgroup of 2nd gen cephs)

Cefoxitin

56
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Cefoxitin spectra

Gram Pos:


Gram Neg:


Atypicals:


Anaerobes:

  • oral anaerobes

  • B. fragilis


57
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5th Generation Cephs

  • Ceftobritole

  • Ceftolozane


58
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Ceftolozane Spectra

Gram Pos:


Gram Neg:

  • H influenzae

  • E coli

  • P mirabilis

  • K pneumoniae

  • PsA


Atypicals:


Anaerobes:

  • oral anaerobes


59
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Anionic Fluoroquinolone

Delafloxacin

60
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Delafloxacin Spectra

Gram Pos:

  • GAS

  • MSSA and MRSA

  • S. pneumo

  • E. faecalis


Gram Neg:

  • H influenzae

  • E coli

  • P mirabilis

  • K pneumoniae

  • PsA?


Atypicals:

  • C. pneumoniae

  • M. pneumoniae

  • Legionella spp.


Anaerobes:

  • oral anaerobes

  • B fragilis


61
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Parenteral fosfomycin spectra

Gram Pos:

  • MSSA and MRSA

  • S. pneumo

  • E faecalis

  • E faecium


Gram Neg:

  • E coli

  • P mirabilis?

  • K pneumoniae


Atypicals:


Anaerobes:

  • oral anaerobes?


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Tigecycline spectra

Gram Pos:

  • MSSA and MRSA

  • S. pneumo

  • E. faecalis

  • E faecium


Gram Neg:

  • E coli

  • P mirabilis

  • K pneumoniae


Atypicals:

  • C pneumoniae

  • M pneumoniae

  • Legionella spp.


Anaerobes:

  • oral anaerobes

  • B fragilis


63
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Glycylcycline example

Tigecycline