Frfr it's CAP
What is staph aureus?
MSSA or MRSA.
What is sterile pyuria?
Proteinuria is variable dependent on the underlying cause of the pyuria.
This is the recommendation on when it is appropriate to use bactrim for cystitis.
What is uncomplicated cystitis without bactrim use in the prior 3 months and when local resistance rates are <20%.
This is the typically described physical exam findings for a patient with prostatitis.
What is an enlarged, tender, and boggy prostate?
This is the definition of "HAP".
What is "an archaic term for luck, chance, or an occurrence"?
JK it's pneumonia that occurs >48hrs post hospitalization (that was not incubating at the time of admission).
These are 3 modifiable risk factors for community-acquired pneumonia.
Think meds. Technically I guess DM2 is 'modifiable' in that you can treat it, but that isn't one I'm looking for.
What are opioid use, PPI use, EtOH use, or smoking?
These are the 2 subclasses of patients who should have asymptomatic bacteriuria screened for and treated.
What are pregnant patients and patients undergoing invasive urologic procedures?
These are 3 commonly prescribed antibiotics for uncomplicated cystitis.
The 3 listed in the ACP slides. Pivmecillinam and beta-lactams will not be counted.
What are nitrofurantoin, Bactrim, and Fosfomycin?
This is when you should screen for bacteriuria in pregnancy.
When is 12-16 weeks of gestation or the first prenatal visit?
What are:
Minimizing mechanical ventilation (consider NIPPV)
Minimize sedation
Intermittent infusions or daily interruption and daily assessment of readiness for extubation
Supine position
Avoid enteral nutrition when possible
Elevate head of bed 30°-45°
Daily oral care; oral care with chlorhexidine may be beneficial in some patients
Facilitate early mobility (speeds extubation)
?
This is the likely causative agent for a patient with the following radiograph, severe pneumonia, vomiting, and suspected SIADH.
What is legionella?
High urine Na, normal to high urine Osm can look like SIADH and SIADH may play a role in the hypoNa of some cases.
This is the definition for asymptomatic bacteriuria in male patients.
According to the ACP slides.
What is a single clean-catch, voided urine specimen with one bacterial species isolated in a quantitative count of ≥ 10^5 CFUs/mL in an asymptomatic patient?
ACP presents this as if there's a different definition for women. There isn't, per the IDSA.
This is the typical duration of antibiotic treatment for pyelonephritis without bacteremia.
What is 5-10 days if patient is responding appropriately (symptomatic improvement in 48-72 hours).
Fluoroquinolones for 5-7 days, bactrim and beta-lactams 7-10 days. For GNR bacteremia, duration is unchanged (up to 14 days if slow response).
These are the preferred agents for treating asymptomatic bacteriuria in pregnancy.
Name 2.
What are beta-lactams (with or without beta-lactamase inhibitor) or fosfomycin?
Nitrofurantoin should be avoided in the first and late third trimester 2/2 uncertainty regarding its connection to congenital anomalies. Bactrim only during the 2nd trimester. Obtain posttreatment UA and culture.
According to Up-To-Date, if any of these risk factors are present in a patient with HAP, you should empirically start treatment with MRSA coverage and a carbapenem.
What are:
Need for ventilatory support due to pneumonia
Septic shock
Receipt of IV abx in the past 90 days
?
This is appropriate antibiotic coverage for a patient with uncontrolled DM2 and CAP with a penicillin allergy and prolonged QT on her last EKG.
What is a 3rd gen cephalosporin and doxycycline?
This is the IDSA recommendation regarding older, functionally or cognitively impaired patients, with nonlocalizing symptoms and a UA with ≥ 10^5 colony forming units/mL.
E.g. falls, delirium, AMS/confusion.
What is assessment for other causes and careful observation rather than antimicrobial treatment?
Strong recommendation, very low-quality of evidence.
If any systemic signs of infection, ok to treat.
This is an appropriate initial workup and management of a patient presenting with hemodynamic instability, fever, chills, flank pain, leukocytosis and a UA suggestive of UTI.
Assume low risk of MDR.
What is:
blood culture, lactate, sepsis bolus (can start with 1L and reassess), empiric abx (ceftriaxone or fluoroquinolone)?
Most people get imaging. Technically you don't need to get it until it's been 48-72 hours, and they still have clinical symptoms.
This is one possible empiric regimen for treating acute prostatitis in the outpatient setting (medication and duration).
Assume no suspicion of STI.
What is bactrim, cipro or levo for 4-6 weeks depending on symptom resolution?
Bactrim only if local E. Coli resistance is <20%.
UTD and AAFP states treat for 2-4 weeks for mild infections, but ACP and other sources say 4-6 weeks generally.
These are risk factors for multidrug resistance in VAP patients.
Name the most common and 2 more.
What are:
IV antibiotic use within the past 90 days, septic shock at the time of VAP, acute respiratory distress syndrome preceding VAP, 5 or more days of hospitalization before VAP, and acute kidney replacement therapy before VAP
?
These are 2 potential indications to get a sputum or blood culture in a patient with CAP.
What are:
severe CAP/patients admitted to the ICU
empiric treatment for pseudomonas or MRSA
prior pseudomonas or MRSA
hospitalization and parenteral abx in the prior 90 days
?
These are the IDSA recommendations regarding treatment course for patients with ASB who are undergoing endoscopic urologic procedures.
What are:
UA and culture prior to the procedure, targeted treatment, with a short course (1-2 doses) rather than prolonged therapy
?
Also suggest initiating therapy 30-60 minutes prior to the procedure. (Guideline XIII)
These are our local resistant rates for non-ESBL E Coli to bactrim.
What is 82%?
From 2024 antibiogram.
A 62 y.o. male patient presents with increased urinary frequency, dysuria, and groin pain for the past 4 months. An initial UA is negative. This is the next step in management.
I.e. refer to urology to do that, unless you're comfortable doing 1 minute of prostate massage for a patient.
A 98 yo F is ventilated in the ICU hypoxic respiratory failure 2/2 COVID pneumonia for the past 5 days. She has been requiring increasing oxygen requirements for the past 24 hours and CXR shows new RLL and RML infiltrates that have developed over the past 48 hours. Her labs are significant for an increasing WBC up to 18.3 this morning.
6 months ago she was admitted for a STEMI. 2 months ago she was admitted for MRSA bacteremia.
This is an appropriate initial treatment for this patient.
What is (any empiric antibiotic regimen with MRSA and double pseudomonas coverage)?
IDSA 2016 guidelines say use double pseudomonal coverage for any patient with risk of MDR organisms and VAP.