Show:
A Bug's Life
I prefer you call me Dr.
PharmD, D as in Drugs
The good the bad and the ugly
I didn't think to study that..
100
These two virulent pathogens must be covered if treating a patient in the ICU for CAP.
What is MRSA and PA
100
This is the gold standard when it comes to clinical diagnosis of PNA. BONUS: What must be present?
What is CXR with infiltrates
100
These are the respiratory FQ
What are Moxi and Levo
100
These are risk factors for multi drug resistant organisms in HAP

MDR Pseudomonas, other gram-negative bacilli, and MRSA: IV antibiotics within the past 90 days 

Risk factors for MDR Pseudomonas and other gram-negative bacilli:

Structural lung disease (bronchiectasis or cystic fibrosis)

A respiratory specimen Gram stain with numerous and predominant gram-negative bacilli

Risk factors for MRSA:

Treatment in a unit in which >20 percent of Staphylococcus aureus isolates are methicillin resistant

Treatment in a unit in which the prevalence of MRSA is not known

100
GT is a 46 year old with a PMH of IVDU admitted into the ICU after being rushed to LGHM with subsequent intubation following a heroin overdose. 3 days into his ICU stay, the attending notes pulmonary infiltrates accompanied by a fever of 101.2. What type (classification and onset) of PNA is this?
VAP (develop >48-72hrs after intubation)
200
These 3 atypical pathogens can cause atypical PNA? BONUS: name 2 atypical presentation signs and symptoms
a. Mycoplasma pneumoniae (lacks cell wall) b. Chlamydophila pneumoniae c. Legionella species (> 90% pneumophila) d. 10 days onset, non productive cough, no chest pain, WBC<10,000
200
PZ is a 45 year old male admitted for CAP being treated with Moxifloxacin 400mg IV. Overnight he decompensates and becomes hypotensive (78/40), febrile (103.1) and tachycardic (124)with O2 saturation into the 70s requiring intubation and ICU transfer. What kinds of diagnostics would you obtain at this time?
a. Induced Sputum-no; endotracheal will test for sputum since he is intubated b. Blood-yes, systemic symptoms c. Endotracheal culture, yes intubated and this can easily obtain sputum
200
Name 3 anti-pseudomonal beta lactams
What is Pip/tazo, cefepime, cetazidime, meropenem, doripenem, imipenem..NOT ERTA!
200
Name 3 advantages of getting a sputum culture for a patient with CAP
a. Noninvasive b. No risk to patient c. May aid in diagnosis and choice of empirical therapy in CAP
200
What is the treatment duration for CAP? Bonus: what can you trend to guide decision to stop abx?
What is 5 days

Bonus: what is procalcitonin

300
This is the treatment duration for HAP/VAP unless the pt is not clinically improving?
What is 7 days
300
JS is a 75 year old female whose daughter brings her to LGHM with subjective reports of labored breathing, confusion and disorientation. Upon exam, her vitals are T 100.3, HR 100, RR 32, and 102/74. Her labs are notable for Scr 1.5, Na 130, K 3.3, and BUN 21. What is her CURB 65 score? BONUS: Where would she classify to be treated? (In/Outpatient)
What is 4 and inpatient
300
Give 2 P.A. regimens for CAP
a.Basic principle: 2 agents with pseudomonal activity + atypical coverage I. Anti-pneumococcal, anti-pseudomonal beta-lactam (piperacillin-tazobactam, cefepime, imipenem, meropenem) + Ciprofloxacin or levofloxacin ii. Anti-pneumococcal, anti-pseudomonal beta-lactam + aminoglycoside + azithromycin iii. Anti-pneumococcal, anti-pseudomonal beta-lactam + Aminoglycoside + antipneumococcoal quinolone (levo)
300
What are the qualifications for a contaminated sputum culture in terms of neutrophils and squamous epithelial cells?
a. < 25 neutrophils b. > 10 squamous epithelial cells
300
These are risk factors for drug resistant S pneumo in adults

What are Age >65 years , Beta-lactam, macrolide, or fluoroquinolone therapy within the past three to six months, Alcoholism, Medical comorbidities, Immunosuppressive illness or therapy, Exposure to a child in a daycare center

400
MM is a 76 year old female who was admitted for acute pyelonephritis after being treated initially with fosfomycin 3g x1 and subsequently ciprofloxacin 250mg BID. Although she was anxious to be discharged, the last 2 days she has been coughing up sputum, is febrile of 101.3, and is experiencing labored breathing (RR 30). Her CXR shows pulmonary infiltrates. What type (classification and onset) of PNA is this? BONUS: When evaluating empiric treatment options, what bugs are you looking to cover?
Late onset HAP, P.A. and MRSA
400
EM is a 29 year old female with no PMH who was given a Z-pack for CAP. She finished the course 2 days ago but reports no improvement of symptoms. What kinds of tests would you perform to aid in the diagnosis and identification of the microbiology behind EM’s symptoms?
What is Sputum, Legionella UAT, Pneumococcal UAT
400
These are 3 criteria that signal a patient's clinical readiness to change to oral abx

improving clinically, hemodynamically stable, and are able to take oral medications can be switched to oral therapy

400
A UAT detects these pathogens that may not be positive in a sputum or blood culture. BONUS: Where does one of the pathogens incubate?
What are legionella (water) and pneumococcal
400
The drug class of choice for ESBL
What are carbapenems (imipenem, ertapenen, or meropenem)
500
Which of these drugs covers atypical pathogens (select all that apply) Azithromycin Levofloxacin Amox/Clav Ceftriaxone Linezolid
a. Azithromycin-yes b. Levofloxacin-yes c. Amoxicillin/Clavulanate-N ~ use this in combo with Azithro when resistance with strep is >25%--Strep is gram positive, makes sense we would use a gram positive covering agent with the beta lactamase d. Ceftriaxone-NO gram+/- NOT P.A. e. Linezolid-no; MRSA
500
KB is a 56 year old male with a history of COPD who presented 3 days ago and was subsequently intubated and admitted to ICU with fever 102.6, BP 90/56, HR 105, RR 30. He was treated with ciprofloxacin 400mg IV BID and ceftriaxone 1g Q24H. Today, he remains febrile and the nurse reports yellow colored sputum. What kinds of diagnostics would you obtain at this time? 
a. Induced Sputum-no, he is intubated so ET will suffice b. Blood c. Endotracheal culture 
500
These are potential treatment options for acinetobacter
Carbepenems- Dori, Imi, Mero, Polymixins, amp-Sulbactam
500
In a patient with PCN allergy and resistant S. Pneumo, what would be the best treatment option for CAP? a. Vancomycin b. Pip/Tazo c. Moxifloxacin
What is Moxi
500
Pts with risk factors for MRSA require one of these two abx for coverage
What is vancomycin and/or linezolid