PNN - ID - CH.1

Gram + Cocci

Streptococcus, Staphlococcus, Enterococcus

Gram + Rod

Diphtheriae, Listeria, Anthrax, Clostridium species*

*anaerobic

Gram - cocci

Neisseriae, Moraxella

Gram - Rods

E. coli, Pseudomonas, Klebsiella, H. Influenzae, Helicobacter pylori, Shigella, Salmonella, Campylobacter, B. fragilis

Staphylocci

Grape looking

MSSA, MRSA, epidermidis, saprophyticus

Streptococci

Looks like purple snake chains. GAS (pyrogenes), GBS (agalactiae), pneumococcus (pneumoniae), viridans

Entercocci

Blue and not really in chains. E. faecalis and faecium

Streptococcus: Gram (+) cocci

1ST LINE CHOICE: PENICILLIN FAMILY

A woman is on the labor and delivery floor about to give birth. Her cultures come back as Group B Strep + (GBS+). Her past medical hx shows an mild PCN allergy. What do you give her?

IV cefazolin, if it was severe is would be IV clindamycin

What is 1st line for GBS+ in pregnant women prior to delivery?

PEN G or ampicillin

What is one of the most common causes of bacterial otitis media, sinusitis and respiratory infections in COPD?

Moraxella catarrhalis

Bacterial OM causes (PMH)

• pneumococcus

• haemophilus

• moraxella

Most common bacterial cause of UTIs, Pyelonephritis, Urosepsis, Neonatal meningitis

E. coli

Most common contamination of respiratory/medical equipment causing UTI/pyelonephritis, sepsis, pneumonia (Cystic fibrosis), osteomyelitis, external ear infec., and wounds (burns)

pseudomonas - THINK WET AREAS

Anti-pseudomonal penicillins

Pipercacillin + tazobactam (Zosyn)

Anti-pseudomonal cephalosporins

• ceftazidime (Fortaz, Tazicef)

• Cefepime (maxipime)

• ceftazidime-avibactam (Avycaz) for MDR

• ceftolozane-tazobactam (Zerbaxa) for MDR

Carbapenems for pseudomonas aeruginoa

• doripenem

• meropenem

• imipenem

Fluoroquinolones for pseudomonas

• ciprofloxacin

• levofloxacin

aminoglycosides for pseudomonas

NOT USED AS A SINGLE AGENT

monobactam for pseudomonas

Aztreonam

What does H. pylori usually cause?

Peptic Ulcer disease

What are three treatment therapies for H. pylori

1. triple therapy

2. bismuth quadruple therapy

3. Concomitant therapy

2nd line therapies for H. pylori

• Sequential

• hybrid

• levoquin sequential

H. Influenzae can cause

• meningitis

• epiglottis

• OM/sinusitis

• pneumonia

meningitis H. influenzae tx: same as meningitis as previous (Ceftriaxone)

Legionella pneumophila tx

• macrolides or respiratory quinolones in adults

• azithromycin in children

Bordetella Pertussis causes

whopping cough

part of the Tdap vaccine

Gram + anaerobic rods (purple)

• perfrigens (gas gangrene)

• difficile (pseudomembranous colitis)

• tetani (tetanus)

• botulinum (botulism)

Gram - anaerobic robs (pink)

bacteroides (B. fragilis)

Besides surgical debridement and amputation, what is the directed tx for C. perfringens?

Penicillin + Clindamycin or tetracycline

Empiric tx: Zosyn + clinda

What is the only reason why ORAL VANCO would MOST LIKELY BE USED

C. diff!!!!

Other tx options for C. diff

• PO fidaxomicin (Dificid)

• If fulminant: increase vanco to 500 QID and add IV metronidazole

If pt has ileus and has C. diff

consider rectal vanco enema

Clostrium tetani (Tetanus/lockjaw) tx

• Tetanus immune globulin to neutralize unbound toxin

• tetanus toxoid vaccine (Td or Tdap) 3 doses 2 wks apart

• Metronidazole IV or alt: PCN G IV

• Benzos (spams)

• Respiratory support

• alpha/beta blockade

What is the most common cause of anaerobic infections below the diaphragm - Intra-abdominal and pelvic infections

B. fragilis

What is the drug of choice (1ST LINE) for B. fragilis

Metronidazole

Intra-abdominal infections are generally poly-microbiral, so we should cover for both

B. fragilis and pseudomonas

Chlamydia is the most common cause of

bacterial STI in men in women

Tx of chlamydia

• Doxycycline 100 mg BID x 7D

Other tx options for chlamydia

• Azithromycin 1g x once FOR PREGNANT PTS

• Levofloxacin 500 mg QD x 7 days

One of the causes of “Atypical pneumonia” and also can cause 7-20% of CAP

Mycoplasma penumoniae

Tx of Mycoplasma pneumoniae

macrolides or doxycycline, if resistant use 3rd/4th gen quinolones