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urinary tract
resp tract
intraabdominal
skin/soft tissue
catheter related and unknown
100
e coli, enterococcus, pseudomonas, candida?
community: ceftriaxone or levo/cipro moxi has bad penetration. hospital acquired: levo/cipro or ceftazidime
100
strep pneumoniae, staph au, enterobacteriaceae, atypicals, pseudomonas?
community: levo/moxi, azithro(atypicals)+ ceftriaxone, cipro resistance so no hospital; zosyn or ceftazidime/cefepime + levo/cipro + aminoglycoside + vanco
100
gram negs, enterococcus and anaerobes?
community; zosyn or cipro + metro(anaerobes) hospital: Zosyn or carbapenem(imipenem/meropenem)
100
staph au, staph epidermidis, strep spp? community and hospital?
community: vanc, linezolid or daptomycin hospital acquired: vanc+ unasyn/zosyn
100
staph aureus, gram negs, candida? hospital acquired
vancomycin + ceftazidime/cefepime or an antifungal
200
stress ulcer?
use ppi
200
strep pneumoniae bacteremmia?
beta lactam(ceftriaxone, ceftazidime) + macrolide(azithromycin)
200
Empiric antifungal therapy?
fluconazole, voriconazole echinofungins: caspofungins, micafungin, anidulafungin, amphotericin b n ambisome
200
DVT prophylaxis?
if crcl < 30ml/min use dalteparin or unfractionated heparin(met by proteolysis) otherwise use subq low molecular weight heparin. use mechanical prophylaxis if contraindications present.
200
unknown hospital acquired.
unasyn or ceftazidime/cefepime or imipenem/meropenem any of these with or without vancomycin.
300
when do u do multi antibiotic treatment?
neutropenic patient presence of acinetobacter and pseudomonas(poly resist) sepsis with resp failure
300
pseudomonas aeruginosa bacterimia
zosyn (extended spec beta lactam) + cipro/levo(fluoroquinolone) or an aminoglycoside( genta, strepto)
300
fungal pathogens resp for sepsis
aspergillus and candida
300
bicarbonate?
do not use if sepsis acidemia > or = ph 7.5
300
erythropoetin in sepsis/
no do not use
400
duration of therapy in sepsis
7-10 days
400
what do you do after susceptibility tests?
deescalate do not use combination therapy for more than 3-5 days
400
when should you consider antifungals in the septic patient?
neutropenic for 5 days tpn long term central venous catheter prolonged ICU stay broad spectrum antibiotics
400
inotropic therapy?
dobutamine. if mycardial dysfunction present
400
how is glucose control done?
start insulin if 2 measurements > 180mg/dl target is less than 180 monito q 1-2 hrs if stable q 4 hrs.
500
when can antibiotic therapy be prolonged?
undrainable foci s aureus bacteremia neutropenia funghi n virus slow clinical response
500
importance of site of infection/
ID within first 12 hours
500
fluid therapy?
crystalloids preferred use albumin if large volumes of crystalloids needed.
500
how do we do vasopressor therapy?
goal map >65 norepi vasopressor of choice. then epi then vasopressin( very potent) dopamine phenylephrine(salvage therapy only acts on alpha 1)
500
when to use steroids?
when fluid and vasopressors fail. use continuous infusion of 200mg hydrocortisone.