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Chap - 17


prevent infection, diagnose and treat infection effectively, use antimicrobials wisely, prevent transmission four strategies to prevent antimicrobial resistance
preventing antimicrobial resistance in healthcare settings, four strategies that clinicians can use to prevent antimicrobial resistance, tools for preventing antimicrobial resistance, action steps to prevent antimicrobial resistance, & implementation CDC's Campaign to Prevent Antimicrobial Resistance
vaccinate, catheters out, target pathogen, access experts, practice antimicrobal control, use local data, treat infection not contamination/colonization, say “no” to vanco, stop antimicrobial treatment, isolate pathogen, break chain contagion 12 Steps to Prevent Antimicrobial Resistance Among Hospitalized Adults
Give influenza/pneumococcal vaccine to at-risk patients before discharge Get influenza vaccine annually Step 1. Vaccinate
Use catheters only when essential; Use the correct catheter; Use proper insertion and catheter-care protocols; Remove catheters when they are no longer essential Step 2. Get the Catheters out
Culture the patient; Target empiric therapy to likely pathogens and local antibiogram; Target definitive therapy to known pathogens and antimicrobial susceptibility test results Step 3. Target the pathogen
Consult infectious diseases experts for patients with serious infections Step 4. Access the experts
Engage in local antimicrobial control efforts Step 5. Practice antimicrobial control
Know your antibiogram; Know your patient population Step 6. Use local data
Use proper antisepsis for blood and other cultures; Culture the blood, not the skin or catheter hub; Use proper methods to obtain and process all cultures Step 7. Treat infection, not contamination
Treat pneumonia, not the tracheal aspirate; Treat bacteremia, not the catheter tip or hub; Treat urinary tract infection, not the indwelling catheter Step 8. Treat infection, not colonization
Treat infection, not contaminants or colonization; Fever in a patient with an intravenous catheter is not a routine indication for vancomycin Step 9. Know when to say “no” to vanco
When infection is cured; When cultures are negative and infection is unlikely; When infection is not diagnosed Step 10. Stop antimicrobial treatment
Use standard infection control precautions; Contain infectious body fluids (Follow airborne, droplet, and contact precautions); When in doubt, consult infection control experts Step 11. Isolate the pathogen
Stay home when you are sick; Keep your hands clean; Set an example Step 12. Break the chain of contagion
Hospitalized adults, Dialysis patients, Surgical patients, Hospitalized children, & Long-term care patients 5 specific specific patient populations CDC campaign
serious bacterial illness, leading cause of bacterial meningitis in children 2-18, also causes blood infections, 1,000-2,600 get each yr-10-15% die & 11-19% lose arms/legs, deaf, problems with nervous systems, mental retardation/suffer seizures/strokes meningococcal disease
meningococcal disease is most common in infants __ __ one year & people w/medical conditions such as lack of __ less than; spleen
meningococcal infections can be treated with drugs such as penicillin
licensed in 2005; preferred vaccine for people 2-55 years of age; expected to give better, longer-lasting protection; better at preventing the disease from spreading from person to person meningococcal conjugate vaccine (MCV4)
available since the 1970s; only vaccine licensed for people older than 55 meningococcal polysaccharide vaccine (MPSV4)
recommended for children & adolescents 11-18 years of age; given during the routine preadolescent immunization visit (at 11-12 years) dose of MCV4
College freshmen living in dorms, microbiologists who are routinely exposed, U.S. military, traveling to, or living in, a part of the world where disease is common, damaged/removed spleen, immune system disorder, exposed to meningitis during an outbreak recommended to get meningococcal vaccine
people 2 years of age and older should get __ __ of MCV4 one dose
may be recommended for children 3 months to 2 years of age under special circumstances; should get 2 doses, 3 months apart MPSV4
those with allergic reaction to a previous dose, allergy to any vaccine component, moderately or severely ill, Guillain-Barré Syndrome, & pregnant women only if clearly needed should not get meningococcal vaccine
redness or pain where the shot was given usually last for 1 or 2 days; small percentage of people who receive the vaccine develop a fever mild side effects
Serious allergic reactions, within a few minutes to a few hours of the shot, Guillain- Barré Syndrome (or GBS) severe side effects
federal program to help pay for the care of anyone who has had a rare serious reaction to a vaccine National Vaccine Injury Compensation Program
treatment of infection depends on the medications mode of action, __ vs. __ bacteriostatic; bacteriocidal
1st step of treatment is ordering C&S
test to identify causative infectious organism & specific medicine to which it is sensitive; results available 24-48hres culture & sensitivity (C&S) test
symptoms on which C&S test is based wound, throat, urine, or blood
antibiotic effective against a large variety of organisms broad spectrum
when drugs are used too frequently & those drugs are no longer effective resistance
antibiotics should not be used for common colds because they are caused by viruses
organisms can also become resistant if infections have been treated incompletely
more than 70% of bacteria that cause __ infections are resistant to at least one of drugs most commonly used to treat those infections according to the CDC nosocomial
antimicrobial resistance is rising in __ and across all spectrum of antibiotics prevalence
organism resistant to most antibiotics is methicillin-resistant Staphylococcus aureus (MRSA)
one of the very few drugs effective against MRSA Vancomycin IV
Vancomycin IV can cause serious side effects, including ototoxicity & nephrotoxicity
some strains of __ have become resistance to most of the antibiotics, incl. vancomycin enterococci
infections such as bacteremia, endocarditis, or urinary tract infections (UTIs) are caused by vancomycin-resistant enterococci
effective strategies to combat __ __ incl. better patient/physician education on appropriate antibiotic use, accurate diagnosis, & targeted treatment of bacterial infections antimicrobial resistance
lower doses or alternative anti-infective drugs may be indicated w/this impairment status of hepatic &/or renal function
anti-infectives may be more toxic in children or elderly
tetracycline & streptomycin are 2 anti-infective agent capable of crossing placenta
sometimes a combination of anti-infective agents is used to decrease the chance of developing resistance to a single drug
sulfamethoxazole & trimethoprim are combined to treat UTIs
treatment consists of combination of 3/more anti-infective agents tuberculosis
an alternative anti-infective agent should always be used in cases of allergies
allergic hypersensitivity, direct toxicity, & indirect toxicity/superinfection are the 3 categories of __ __ to anti-infective agents adverse reactions
overresponse of body to a specific substance hypersensitivity
rash, uticaria, or mild fever; usually able to treat w/ corticosteroids/antihistamines mild hypersensitivity reaction to anti-infective agents
in the case of a mild hypersensitivity reaction to anti-infective agents the agent is discontinued
may be manifested as anaphylaxis, sudden onset of dyspnea, chest constriction, shock & collapse severe hypersensitivity reaction to anti-infective agents
severe hypersensitivity reaction to anti-infective agents must be treated promptly w/__, __, & __ or death may result epinephrine, corticosteroids, & CPR
severe hypersensitivity reactions to anti-infective agents may occur with __ administration of a specific medication first
severe hypersensitivity reaction to anti-infective agents may occur following a(n) mild hypersensitivity reaction
often severe and sometimes fatal systemic reaction upon 2nd exposure to specific antigen after prior sensitization; characterized by resp. symptoms, fainting, itching, & hives anaphylactic shock
hypersensitivity to foreign proteins/drugs, resulting from prior sensitization to causative agent anaphylaxis
results in tissue damage, ototoxicity, nephrotoxicity, hepatotoxicity, blood dyscrasias, phlebitis, or phototoxicity direct toxicity
direct toxicity damage can be permanent
direct toxicity can be reversible if medication is discontinued
health care worker's responsibilities involve assessment of physical condition & lab reports, and discontinuance of medication at first sign of toxicity
manifests as a new infection with different resistant bacteria or fungi as result of killing normal flora in intestines or mucous membranes, especially w/broad-spectrum antibiotics indirect toxicity, or superinfection
symptoms can incl. diarrhea, vaginitis, stomatitis, or glossitis super infection
consists of antifungal medications & incl. buttermilk or yogurt in diet, or administering Lactinex to help restore normal intestinal flora treatment of super infection
probiotics (available OTC in capsule form) are used __ to prevent super infections, especially severe colitis prophylactically
incl. aminoglycosides, cephalosporins, macrolides, penicillins, quinolones, & tetracyclines therapuetic categories of antibiotics
used to treat many infections caused by gram-positive/negative bacteria aminoglycosides
aminoglycosides are used in short-term treatment of many serious infections, only when less toxic anti-infectives are __ or __ ineffective; contraindicated
enterococci are generally __ to aminoglycosides resistant
due to poor absorption from the GI tract aminoglycosides are usually administered parenterally
often drawn to determine optimal dosing & lessen risk of side effects w/aminoglycosides serum levels
serum levels measure the amount of drug in the blood at different times, allowing for adjustment of __ doses &/or __ between doses subsequent; frequency
drawn 1h after start of aminoglycoside infusion, or IM injection of 3rd dose of aminoglycoside peak serum level
drawn 30min. before next schedule dose of aminoglycosides trough serum level
occur especially in older adults, dehydrated patients, or those w/renal or hearing impairment serious side effects from aminoglycosides
incl. nephrotoxicity, ototoxicity, neuromuscular blocking, & CNS symptoms aminoglycosides serious side effects
incl. pathological kidney condition that can be revered upon DC of medication nephrotoxicity from aminoglycosides
causes both auditory & vestibular and it/they may be permanent ototoxicity from aminoglycosides
incl. respiratory paralysis neuromuscular blocking from aminoglycosides
incl. headache, tremor, lethargy, numbness, seizures, blurred vision, rash & uticaria CNS symptoms from aminoglycosides
applies to patients w/tinnitus, vertigo, & high-frequency hearing loss; reduced renal function; dehydration; pregnancy/nursing; infants & older adults contraindications for aminoglycosides
aminoglycosides may have an interaction w/amphotericin B, cephalosporins, polymixin B, bacitracin, & vancomycin because they are also ototoxic drugs
general anesthetics or neuromuscular blocking agents, such as succinylcholine/curare, can interact w/aminoglycosides because they can cause respiratory paralysis
aminoglycosides can cause interactions w/antiemetics because they may mask symptoms of vestibular ototoxicity
semisynthetic antibiotic derivatives produced by a fungus; broad-spectrum, active against infections of resp. tract, UT, bones/joints, septicemias, some STDs, & endocarditis cephalosporins
cephalosporins are related to the penicillins
cephalosporins vary widely in their activity against __ bacteria specific
cephalosporins are classified as 1st, 2nd, 3rd, & 4th-generation according to the organisms __ to their activity susceptible
1st-generation cephalosporin, usually effective against gram-positive organisms (i.e. causing some pneumonias or UTIs) cephalexin
2nd-generation cephalosporin, usually effective against many gram-positive/negative organisms (i.e. many strains causing bacterial influenza)c cefaclor
3rd-generation cephalosporin; usually effective against more gram-negative bacteria than others & sometimes used for STDs (i.e. chancroid or gonorrhea) ceftriaxone
4th-generation, parenteral cephalosporin; excellent activity against gram-positive/negative bacteria cefepime (Maxipime)
is essential to determine which cephalosporin is appropriate C&S test
cephalosporins are used prophylactically, especially in __ __, for many types of surgery high-risk patients
can incl. hypersensitivity, renal toxicity, mild hepatic dysfunction, nausea, vomiting, diarrhea, resp. distress & seizures side effects of cephalosporins
blood dyscrasias is a side effect of cephalosporins, which will increase bleeding time or transient leukopenia
renal toxicity is a side effect from cephalosporins, especially in older patients
a side effect from cephalosporins can incl. __ w/IV administration & pain at site of IM injections phlebitis
cephalosporins are __ for patients w/renal impairment, known allergies (esp. penicillin w/3-6% cross-sensitivity) pregnant/nursing, & children contraindicated
prolonged use of cephalosporins is contraindicated because it can possibly lead to super infections or severe colitis
interactions of cephalosporins w/Probenecid can increase effectiveness
interactions of cephalosporins w/alcohol ingestion can lead to disulfiram-like reactions
flushing, tachycardia, & shock are __reactions disulfiram
aminoglycosides or loop diuretics taken w/cephalosporins can __ __ of nephrotoxicity increase risk
patients taking cephalosporins should be instructed to pay attention to signs of abnormal bleeding, such as checking stools & urine for blood
used to treat many infections of resp. tract & skin conditions or some STDs when patient is allergic to penicillin macrolides
considered among least toxic antibiotics& preferred for treating susceptible organisms under which more toxic antibiotics may be dangerous erythromycins
gram-negative bacilli and some strains of streptococcus A are __ to macrolides resistant
in combination w/amoxicillin & lansoprazole (Prevpac Kit) is being used to treat Helicobacter pylori in patients w/duodenal ulcer clarithromycin
any of numerous inflammatory diseases of the mouth having various causes (as mechanical trauma, allergy, vitamin deficiency, or infection) stomatitis
inflammation of the tongue glossitis
anorexia, nausea, vomiting, diarrhea, & cramps are GI side effects from macrolides
when erythromycin is mixed w/calcium channel blockers (Verapamil/diltiazem) or antifungal Fluconazole (Diflucan) it can cause abnormal, potentially fatal cardiac arrhythmias
penicillin is the drug of choice for syphilis
penicillin is used prophylactically to prevent recurrences of rheumatic fever or endocarditis
hypersensitivity reactions to penicillin range from rash to fatal anaphylaxis
treatment of hypersensitivity reactions to penicillin incl. the drugs epinephrine & corticosteroids
penicillin V or ampicillin may inhibit the action of estrogen containing oral contraceptives
there are potentially serious side effects from quinolones for children & elderly
quinolones should be reserved for infections that are non-responsive to other antibiotics because of potentially serious side effects
for quinolones, C&S tests should be done before initiating a quinolone
phototoxicity (w/severe sunburn), possible cartilage/tendon damage, & nausea. vomiting, diarrhea, abdominal pain, & colitis are side effects of quinolones
taking antacids while on quinolones causes decreased absorption
taking theophylline while on quinolones can potentiate serious or fatal CNS effects, cardiac arrest, or respiratory failure
tetracycline should be used only when other antibiotics are ineffective or contraindicated because some organisms are showing increasing resistance
tetracycline can cause some super infections, such as vaginitis & stomatitis
photosensitivity, w/severe sunburn & discoloration of teeth in fetus/young children are side effects of tetracycline
antacids, calcium & iron preparations, & dairy product act as __ when taken w/tetracycline, which decreases absorption antagonist
oral contraceptive taken w/tetracycline act as antagonists & may cause breakthrough bleeding or pregnancy may occur
preferable on empty stomach w/full glass of water; 1h before or 2h after meals unless there is gastric distress; do not take at bedtime to prevent irritation from esophageal reflux tetracycline administration
drug of choice for severe fungal infections resulting from immunosuppressive therapy, patient w/AIDS, or for a severe illness such as meningitis Amphotericin B
Amphotericin B is administered IV w/hospitalization
antipyretics, antihistamines, & antiemetics are used to provide symptomatic relief from the __ __ of Amphotericin B side effects
headache, chills, fever, hypotension, & tachypnea are all side effects of Amphotericin B related to vital signs
malaise, muscle & joint pain, & weakness are __ side effects of Amphotericin B musculoskeletal
anorexia, nausea, vomiting, & cramps are __ side effects of Amphotericin B GI
fluconazole is administered orally
limited to severe candidal infections unresponsive to conventional antifungal therapy fluconazole
nystatin can be administered orally or topically
two medications most commonly use for initial or recurrent UTIs Furadantin & Macrodantin
1st new antibiotic approved to treat MRSA and VRE is linezolid (Zyvox)
erythromycin is the __ __ __ macrolide most commonly used
Kaposi's sarcoma is an example of a(n) opportunistic infection
oseltamivir (Tamiflu) & zanamivir (Relenza) are prescribed to treat uncomplicated, acute illness due to influenza Type types A & B infections
treatment of superinfections involves administration of __ medications antifungal
oseltamivir (Tamiflu) is administered by the __ route oral
antiviral drug effective in treating diabetic foot infections acyclovir
used to treat serious resp. tract infections, Pneumocystis carinii, pneumonia, serious female pelvic infections, osteomyelitis, & septicemia Clindamycin
Staphylococcus aureus is a gram-__ bacteria positive
to treat asymptomatic TB __ is administered daily for 6-12 months isoniazid