Term
|
Definition
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|
Term
| leukopenia (immune exhaustion) |
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Definition
|
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Term
|
Definition
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Term
|
Definition
| presence of bacteria in blood culture |
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Term
|
Definition
| presence of fungus in blood culture |
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
| elderly, open abdominal wounds, large burs, antipyretic or anti-inflam drugs, immuno suppressed |
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Term
|
Definition
| stroke, intracranial bleed, severe head trauma |
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Term
|
Definition
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Term
|
Definition
| malignant hyperthermia, neuroleptic malignant syndrome, immune/ inflammatory reactions |
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Term
| antimicrobial related fevers |
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Definition
| b-lactams, sulfonamides, abacavir, amphotericin B |
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|
Term
| antiepileptic related fevers |
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Definition
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|
Term
| antiarrhythmic related fevers |
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Definition
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Term
|
Definition
| temporaty: peripheral venous catheter, midline catheter, higher risk of infection |
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Term
|
Definition
| non-tunneled lines, PICC, tunneled lines and totally implanted lines (less infection) |
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Term
|
Definition
| high infection rates, used for cardiac monitoring |
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|
Term
| localized infections of catheter |
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Definition
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Term
|
Definition
| larger infection within 2cm of the catheter exit site |
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Term
|
Definition
| along the subcutaneous tract |
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|
Term
|
Definition
| subcutaneous pocket of an implanted device |
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Term
|
Definition
| can be with or without a local infection or visible manifestations |
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Term
|
Definition
| bacteria is living on the inside of the line |
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Term
|
Definition
| uncommon pharmacy specific problem: either contamination at compounding or contaminated stock solution |
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|
Term
| pathogen of suspected infusate-related infections |
|
Definition
| cultures from both infusate and blood cultures to verify with sudden onset of symptoms soon after start of an infusion |
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Term
|
Definition
| blood culture contamination, low ratio of pos/neg blood cultures |
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|
Term
| bacterial species of pseudobacteremia |
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Definition
| coagulase-neg staph spp., bacillus spp., diphtheroids (corynebacteria) |
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|
Term
|
Definition
| most likely not pseudobacteremia, should consider that it's a true infection |
|
|
Term
| how do you know if it's a line infection |
|
Definition
| pull the line and culture the line |
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|
Term
| "plate roll" line tip section rolled on agar plate |
|
Definition
| > or = to 15 colony forming units (CFU), sensitivity is 60% |
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|
Term
| flushing, vortexing or sonicating in broth |
|
Definition
| sensitivity of this method is 80% but it's much more expensive, must have > or = to 100 CFU's |
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|
Term
| pathogens of the line infection |
|
Definition
| gram pos cocci (staph aureus, coag neg staphylococcus), gram neg bacilli (pseudomonas, enterobacter) and candida spp (rare and more common with TPN) |
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|
Term
|
Definition
| staphylococcus aureus, Streptococcus |
|
|
Term
|
Definition
| pseudomonas, enterobacter |
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|
Term
| empiric treatment of line infections |
|
Definition
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|
Term
| alternative empiric treatment for line infections |
|
Definition
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|
Term
| vanco, daptomycin, linezolid |
|
Definition
| active against MRSA, coag-neg staph; choice depends on complications |
|
|
Term
|
Definition
| good for endocarditis scenarios, not good for pulmonary |
|
|
Term
|
Definition
| very good for osteomylitis, not good for endocarditis |
|
|
Term
| use Nafcillin or alternatively cefazolin for empiric line infection |
|
Definition
| local rate of MRSA low ***doesn't know where this is not high rates of MRSA |
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|
Term
|
Definition
| antipseudomonal b-lactam, antipseudomonal cabapenems and aminoglycosides |
|
|
Term
|
Definition
| Ceftazidime, piperacillin-tazobactam, cefipime |
|
|
Term
| antipseudomonal cabapenems |
|
Definition
| Imipenem, meropenem, doripenem |
|
|
Term
| aminoglycosides (active agains psuedomonas) |
|
Definition
| gentamycin, tobramycin, amikacin |
|
|
Term
|
Definition
| no pseudomonal activity, not appropriate for line infection suspected for pseudomonal |
|
|
Term
| amphoteracin B (lipasomal/ non-lip) |
|
Definition
| highly active against candida |
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|
Term
|
Definition
| more spendy but less toxicity |
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|
Term
|
Definition
| fluconazole and voriconazole, cost resistance common (can't switch) |
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|
Term
|
Definition
| when patient is trying to die |
|
|
Term
|
Definition
| caspofungin, MICAfungin :), anidulafungin |
|
|
Term
| clinically stable candida spp line infection |
|
Definition
|
|
Term
| clinically UNstable candida spp line infection |
|
Definition
|
|
Term
|
Definition
| mixed with normal saline or heparin, used to penetrate biofil and get good antibiotic circulation systemically |
|
|
Term
| heparin + vanco for Antibiotic lock therapy |
|
Definition
| must have high doses of heparin to prevent precipitation |
|
|
Term
| antibiotics used for antibiotic lock therapy |
|
Definition
| vanco, gent/amikacin, or cipro |
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|
Term
| best outcomes for ALT(lck therapy) |
|
Definition
| coag neg staph spp and 10-14 days in addition to systemic Abx |
|
|
Term
| coag neg staph (staph epidermidis); UNcomplicated |
|
Definition
| many lines salvaged with systemic Abx + ALT for 10-14 days; line not retained shorten duration to 5-7 days |
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|
Term
|
Definition
| shorter duration only if catheter REMOVED, resolution of infection within 3 days, no prosthetic intravascular device, no metastatic infection, not diabetic and not immunosuppressed |
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|
Term
| staph aureus abx duration |
|
Definition
| 4-6 wks therapy because of metastatic infections (osteomylitis); line not salvageable most cases |
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|
Term
| gram-neg bacilli (e. coli, klebsiella) |
|
Definition
| recommended to remove line, systemic abx 7-14 days; salvage with systemic + ALT for 10-14 days (no response remove line) |
|
|
Term
|
Definition
| remove line and treat 14 days (14 days start once blood cultures are CLEAR of candida) |
|
|
Term
| febrile after day 3 or persistent bacteremia (2-4 days on abx) |
|
Definition
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|
Term
|
Definition
| high bioavailability, clinically stable pt, NOT ok for endocarditis |
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|
Term
| ventilator associated pneumonia |
|
Definition
| > 48-72 hours after intubations |
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|
Term
|
Definition
| chest radiograph with progressive infiltrate + two of the following: fever, leukocytosis or leukopenia, purulent sections |
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|
Term
|
Definition
| abx sesitive pathogens more likely <4 days of hospitalization better prognosis |
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|
Term
| if at risk for multi-drug resistant pathogens (MDRP) |
|
Definition
| treat as if late onset VAP |
|
|
Term
|
Definition
| strep pneumoniae, H. influ, staph aureaus, enteric gram neg bacilli |
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|
Term
|
Definition
| E. coli, klepsiella pneumoniae, enterobacter, proteus, serratia marcenscens |
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|
Term
|
Definition
| >/= 5 days of hospitalization, increased morbidity/ mortality and rate of multidrug resistant pathogens |
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|
Term
| ceftriaxone or cefotaxime for VAP |
|
Definition
| no multi-drug resist bags for early onset VAP (covers all bugs) |
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|
Term
| levofloxacin and moxifloxacin for VAP |
|
Definition
| anti-pneumococcal fluoroquinolones, good for strep pneumoniae |
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|
Term
|
Definition
| poor strep pneumo activity |
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|
Term
|
Definition
| check E. coli, only use if there is not suspected E. coli |
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|
Term
|
Definition
| usually restricted, used for resistant bugs |
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|
Term
| Multi-drug resistant pathogens risk factors (one of the following) |
|
Definition
| antimicrobial therapy in past 90days, current hospitalization > 5 days, high feq. of local antibiotic resistance, immune suppressed and has risk factors for HCAP |
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|
Term
|
Definition
| prior hospitalization, nursing home or extended care facility, home infusion, dialysis, long term wound care, close contact with MDR pathogen |
|
|
Term
|
Definition
| Aerobic gram-neg bacteria, resistant strains of gram pos cocci |
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