ID 2 - Bacterial Infections (copy)

What bacteria are most common to cover for in perioperative antibiotic prophylaxis?

Staphylocci and streptococci for skin flora

Gram-negative and anaerobic for select surgeries (intra-abdominal procedures)

What is the timing for perioperative antibiotic prophylaxis?

Most antibiotics (cefazolin or cefuroxime) - within 60 minutes before first incision

If a quinolone or vancomycin is used, start the infusion 120 min before first incision

When to add additional doses of antibiotic when intra-operative?

When the surgery is >4 hours or major bleed loss

What antibiotics are recommended for cardiac or vascular surgery?

Cefazolin or cefuroxime

Clindamycin or vancomycin

What antibiotics are recommended for orthopeic surgery? What about with beta-lactam allergy?

Cefazolin

Clindamycin or vancomycin

What antibiotics are recommended for GI surgery? What about with beta-lactam allergy?

Cefazolin + metronidazole, cefotetan, cefoxitin, or ampicillin/sulbactam

Clindamycin or metronidazole + aminoglycoside or quinolone

Meningitis common presentation

inflammation of the meninges (membranes) that cover the brain and spinal cord

Fever, headache, nuchal rigidity, altered mental status

Meningitis diagnosis

Lumbar puncture to get cerebrospinal fluid (CSF)

Gram stain and culture

High CSF pressure detected during LP can also help

Meningitis common causes

Bacterial: Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae for most adults

Listeria risk is higher in neonates

Fungus as well

What is the empiric treatment for CA-menigitis for each of the 3 age ranges?

AGE < 1 MONTH (NEONATES) - Ampicillin (listeria coverage) + (cefotaxime, ceftazidime or cefetime) ± gentamicin

AGE 1 MONTH TO 50 YEARS - Ceftriaxone + vancomycin

AGE > 50 YEARS OR IMMUNOCOMPROMISED - Ampicillin (listeria) + ceftriaxone + vancomycin

Avoid ceftriaxone in neonates due to biliary slugging and kernicterus

Role of dexamethasone for CA-meningitis

Dexamethasone, administered 15 - 20 minutes prior to or with the first antibiotic dose, can prevent neurological complications (e.g., hearing loss) and death from pneumococcal meningitis.

Antibiotic durations for CA-meningitis

7 days for N. meningitidis and H. influenzae

10 - 14 days for S. pneumoniae

At least 21 days for Listeria monocytogenes

Acute otitis media presentation

Bulging tympanic (eardrum) membranes, otorrhea, otalgia, fever, tugging/rubbing the ears

Acute otitis media common causes

Most AOM caused by viruses

Bacterial infection is typically caused by S. pneumoniae, H. influenzae or Moraxella catarrhalis.

Acute otitis media empiric treatment

Amoxicillin 90 mg/kg/day in 2 divided doses

Augmentin 90 mg/kg day with 6.4 mg/kg/day of clavulanate in 2 divided doses

Penicillin allergy: 2nd or 3rd gen cephalosprin

Treatment failure (not improved after 2-3 days): Augmentin or ceftriaxone 50 mg/kg IM daily for 3 days

Acute otitis media treatment duration

10 days for children < 2 years

7 days for ages 2 - 5 years

5 - 7 days for ages ≥ 6 years

Acute otitis media when to consider observation

Observation (without antibiotics) for 48-72 hours is an option for select patients age ≥ 6 months with non-severe AOM

Severe AOM is defined as ill appearance, otorrhea, otalgia >48 hours, temp >= 102.2F

Common cold: Etiology, Clinical presentation, Criteria for anti-infective treatment, treatment options

Respiratory viruses (rhinovirus, seasonal coronavirus)

Sneezing. runny nose. mild sore throat and/or cough, congestion

None; generally resolves in a few days

Symptomatic care

Influenza: Etiology, Clinical presentation, Criteria for anti-infective treatment, treatment options

Influenza virus

Sudden onset of fever, chills, fatigue, myalgia, dry cough, sore throat, headache - more severe than common cold

Suspected or confirmed infection (e.g., positive rapid influenza antigen test) and:

• Symptoms < 48 hours, or

• Severe illness (e.g, hospitalized). or

• Symptoms plus risk factors for influenza complications

Symptomatic care with or without antiviral therapy

Pharyngitis: Etiology, Clinical presentation, Criteria for anti-infective treatment, treatment options

Respiratory viruses, Group A Streptococcus (S. pyogenes); commonly referred to as "strep throat"

Sore throat, fever, swollen lymph nodes, white patches exudates) on the tonsils

There is an absence of cough, runny nose or congestion

Rapid antigen test (tonsil swab) or throat culture positive for S. pyogenes

Penicillin or amoxicillin

Acute sinusitis: Etiology, Clinical presentation, Criteria for anti-infective treatment, treatment options

Respiratory viruses, S. pneumoniae, H. influenzae, M. catarrhalis

Nasal congestion, purulent nasal discharge, facial/ear/dental pain or pressure, headache, fever

≥ 10 days of persistent symptoms OR

≥ 3 days of severe symptoms (face pain, purulent nasal discharge, temperature > 102°F) OR

Worsening symptoms after initial improvement

Amoxicillin/clavulanate or Symptomatic care for up to 7 days

Acute bronchitis: