Bacteremia

Gram Positive

100

What is the treatment of choice and dosage for treating enterococcus faecalis?

IV Ampicillin 2 g Q4-6H

200

“Osteomyelitis bacteremia could be managed by either parenteral or oral therapy”, true or false?

True

300

What is the difference between enterococcus faecalis & faecium regarding treatment?

E.faecalis is universally susceptible to penicillins, while E.faecium is generally resistant to pencillins and ampicillin

400

What is the treatment and dosage for vanco-susceptible enterococcus faecium (ampicillin-resistant)?

IV vancomycin 15 mg/kg Q12H ± gentamicin 1 mg/kg Q8H

500

Name 2 of the criteria used to define uncomplicated bacteremia?

Patients who have the following:

• Positive blood cultures
• Exclusion of endocarditis
• No implanted prostheses
• Cultures obtained 2-4 days after the initial specimens does not grow MRSA
• No fever within 72 h of initiating effective therapy
• No evidence of infection metastasis

Medications (Part1)

100

What is the duration of treatment for native valve endocarditis?

6 weeks

200

What is the treatment and dosage for native valve endocarditis?

IV vancomycin 15-20 mg/kg/dose OR daptomycin 6 mg/kg/dose IV once daily (we may use 8-10 mg/kg/dose of daptomycin)

300

Why is it recommended to add rifampin AFTER the clearance of bacteremia in osteomyelitis instead of before?

To avoid emergence of resistance

400

What is the gold standard in osteomyelitis bacteremia management?

Surgical debridement and drainage

500

What is the treatment, dosage and duration for prosthetic valve endocarditis?

IV vancomycin 15-20 mg/kg/dose PLUS rifampin 300 mg PO/IV Q8H for at least 6 weeks PLUS gentamicin 1 mg/kg/dose IV Q8H for 2 weeks

Gram Negative

100

What’s the most common entry portal for enterococcal bacteremia?

Intravascular catheters

200

What’s the most common side effect with Augmentin?

Diarrhea 

300

When can we switch to oral therapy in gram negative bacteremia?

Once the patient has improved and remained afebrile for 48 hours

400

What carbapenem should we be cautious when using in patients with epilepsy?

Imipenem

500

Name one drug with the dosage we can use to empirically cover P.aeroginosa?

IV Cefepime 2 g Q8H OR meropenem 1 g Q8H OR piperacillin/tazobactam 4.5 g Q6H ± aminoglycoside

Medications (Part2)

100

What is the recommended loading dose of vancomycin in septic patients?

 25-30 mg/kg

200

What is the goal vancomycin trough for serious infections such as meningitis bacteremia due to MRSA?

15–20 µg/mL

300

Regarding MRSA bacteremia, when can we switch to PO therapy?

When the bacteremia becomes “uncomplicated” meaning that we:

• Excluded endocarditis
• Patient has no implanted prostheses
• Cultures obtained 2-4 days after the initial specimens does not grow MRSA
• No fever within 72 h of initiating effective therapy
• No evidence of infection metastasis

400

Name 2 of the criteria for switching patients from IV to PO therapy in MRSA bacteremia?

• Having received an IV antibiotic for > 48 hours
• Body temperature < 38°C for 24 hours
• Normal or decreasing white cell count
• Tolerating oral intake (eg. no nausea, functioning GI tract)
• Showing clinical improvement in symptoms

500

Vancomycin was found to have more rapid clearance in which two patient populations?

Obese and pediatrics’ patients

Miscellaneous

100

In general, when is the most appropriate time to draw a vancomycin trough level?

30 minutes before the 4th or 5th dose

200

What is the most common organism to cause endocarditis bacteremia in IV drug users?

Methicillin Resistant Staphylococcus Aureus (MRSA)

300

What is the drug commonly known to cause red-man syndrome (an infusion related reaction)?

Vancomycin 

400

Name 2 of the things we need to monitor for during linezolid therapy?

Thrombocytopenia, bone marrow suppression, visual changes, C.diff, serotonin syndrome (if on SSRI/SNRI’s concomitantly)

500

How do we treat vanco-resistant enterococcus faecium?

IV linezolid 600 mg BID OR daptomycin 6 mg/kg/day