Professional Documents
Culture Documents
Gram
positive
Rods
Staph
Species
Coagulas
e
positive
Coagulas
e
Negative
S.
epidermi
dis
Staph
Aureus
MSSA
Cocci
Catalase
Positive/
GPC
Clusters
MRSA
CAMRSA
HAMRSA
S
saproph
yticus
Alpha
Hemolys
is
Catalase
Negative
/GPC
pairs and
chains
Optochin
sens Strep
Pneumo
not sens
- Strep
Viridans
Gamma
Hemolys
is
Peptostr
Enteroco
eptococc
ccus
us
Vre
Rods
Spore
Formers
Beta
Hemolys
is
Bacitraci
n
not sens
sens - S,
-S
pyogene
Agalactia
s
e
Bacillus
Anthraci
s
Cereus
Clostriidi
um
Difficile
Botulinu
m
Tetani
Perfringe
ns
Non
Spore
Formers
Cornyeb
Listeria
acterium
Rhodocc
us
non-VRE
Staphylococcus
- gram positive cocci in clusters
Staph Aureus
- General Syndromes
o Toxic Shock
o Scalded Skin
o Food Poisoning
o Post-Viral Pneumonia
o Skin Infections/Abscesses
o Acute Bacterial Endocarditis
- MSSA
o Methicillin/Nafcillin Sensitivity
o Treatment: Oxacillin
- MRSA
o HA-MRSA: vancomycin linezolid, daptomycin
o CA-MRSA: clindamycin, Bactrim, tetracyclines (in addition to the above)
Coagulase-Negative Staph
- Prosthesis Infections
- Frequent Culture Contaminant
- Particular Species to Know
o Staph Saprophyticus: UTIs in sexually active women
o Staph Lugdunensis: can act like Staph Aureus
Sidenote: What are other causes of UTI?
SEEKS PP
- Staph saprophyticus
- E coli
Nocardia
Enterococcus
Klebsiella
Serratia
Proteus
Pseudomonas
Catalase Negative
Streptococcus/Enterococcus
- gram positive cocci in pairs and chains
Strep Pneumoniae
- Micro: encapsulated
- Clinical Syndromes: (mnemonic Most OPtochin Sensitive)
o Meningitis
o Otitis Media
o Pneumonia
o Sinusitis
SIdenote: other encapsulated organisms, why are these important?
Strep pneumo
H Flu
N Meningitidis
Answer: asplenic patients at increased risk for infection from these bugs 2/2 impaired
clearance of opsonized bacteria need to immunize against these at least 14 days prior to
a planned splenectomy or 14 days post-splenectomy
Strep Pyogenes
- Micro: Group A Strep
- Clinical Syndromes
o Pharyngitis
Scarlet Fever
Rheumatic Heart DIsease
o Skin/Soft Tissue Infections
o Post-Strep GN
Strep Agalactiae
- Micro: Group B strep
- Clinical Syndromes
o Meningitis/Sepsis in newborns
Enterococcus
- Micro
o E Faecalis
o E Faecium: more likely to be vancomycin-resistant
- Clinical Syndromes
o UTI
- Preferred Treatments
o Enterococcus: ampicillin/amoxicillin
o VRE: linezolid, daptomycin, quinupristin/dalfopristin can be used to treat E
faecalis but not e faecium
- Notable Resistances:
o Cephalosporins, aminoglycosides
Sidenote:
What other bugs can be treated with Amp/Amox?
HELPS organisms
o Haemophilus
o Enterococcus
o E Coli
o Listeria
o Proteus
o Salmonella
Cocci
Maltose
Fermentation
Neisseria
Meningitidis
Rods
Non-Maltose
Fermentation
Neisseria
Gonorrhea
Lactose
Fermentation
Klebsiella
Enterobacter
Non-Lactose
Fermentation
E Coli
Oxidase Positive
Pseudomonas
Oxidase Negative
Others
Gram Negatives
Gram Negative Cocci
Neisseria
- Micro:
o Meningitidis ferments both glucose and maltose while gonorrhea only ferments
maltose (Meningitidis with M and G, Glucose with G)
- Meningitidis
o Clinical Syndromes
Meningitis
Waterhouse-Friedrichsen
o Treatment
Cephalosporins with CNS penetration: CTX
o Vaccine
- Gonorrhea
o Clinical Syndromes:
Urethritis
Reiters Syndrome
o Diagnosis: Urine/Urethral Swab Testing
o Treatment
Cephalosporins: CTX IM X 1 dose
Gram Negative Rods
- Lactose Fermenters
o KEE organisms
Klebsiella
Enterobacter
E Coli
o Non-Fermenters: distinguish based on oxidase
Oxidase Positive: Pseudomonas
Oxidase Negative: Shigella, Salmonella, Proteus
Cellulitis
- Community
o Bugs: strep, staph
o Treatment:
First Generation Cephalosporins
Dicloxacillin
Drugs
Cell Wall Inhibitors
Pencillins
- Pen G
o Strep species, syphilis
- Amp/Amox
o Enteric Gram negatives, enterococci, strep
- Amox/Clavulanic Acid
o Improved anaerobic coverage (particularly bacteroides)
- Methicillin/Naficillin/Oxacillin PO Form Dicloxacillin
o MSSA
o Strep Skin infections
- Ticaricilin/clavulanic acid or Piperacillin/tazobactam
o Gram negatives, anaerobes, most notably Pseudomonas
o Ticaricillin treats stenotrophomonas (CF patients)
Cephalosporins
s
rd
- 1 3 : Gram Positives > Gram Negatives
rd
- 3
o CTX: no pseudomonas coverage, CNS penetration
PO form: cefpodoxime
o Ceftazidime: pseudomonas coverage
th
- 4 Cefepime: pseudomonas coverage
th
- 5 Ceftobirole: anti-pseudomonal activity
Carbapenems
- Examples: Meropenem, Imipenem/Cilastatin, ertapenem
- Broad-Coverage including pseudomonas
Aztreonam
- Gram negatives only
- Used in patients with penicillin allergies
Vancomycin
- MOA: prevents d-ala d-ala cross-linking in the peptidoglycan cell wall
- Bugs: gram positives
- Side Effects:
o Red Man syndrome: mast cell degranulation with rapid infusion
Protein Synthesis Inhibitors
- Clindamycin: anaerobes, classically assoc with pseudomembranous colitis
- Chloramphenicol
- Linezolid
o Bugs: MRSA, gram positives more generally as well
o Side Effects: thrombocytopenia, rarely can interact with MAO inihibitors and
SSRIs to inc risk of a serotonin-syndrome
Erythromycin/Macrolides
o Bugs: atypical coverage, strep species
o Side effects: prolonged QT, erythro has pro-motility properties
Tetracycline
o Bugs: chlamydia, rickettsia, mycoplasma, brucella
o Side Effects: photosensitivity
Aminoglycosides
o Examples: gentamicin, tobramycin, amikacin, neomycin
o Bugs: only aerobic organisms
o Side Effects
Nephrotoxicity, ototoxicity, neuromuscular blockade (inc risk when used
with paralytics in the ICU)
Others
- Fluoroquinolones
o Examples: moxifloxacin, levofloxacin, ciprofloxacin
o MOA: DNA gyrase (topoisomerase 2) inhibitor
o Bugs: enteric gram negatives, intracellular organisms, gram positives
o Side Effects:
Prolonged QT
Tendon rupture
- Daptomycin
o Bugs: gram positives
o MOA: alters membrane form and then permeability
o Side Effects
Rhabdomyolysis: trend CPK
- TMP/SMX
o MOA: competitive inhibitors of folate synthesis
o Bugs: gram positives and gram negatives
o Side Effects: (Treats Marrow Poorly)
Leukopenia, neutropenia, anemia
Increased creatinine without AKI (competes with creatinine in proximal
tubule secretion)