the abc’s of infections - .pptVIP

The ABC’s of Infections Eleana M. Zamora, MD Department of Internal Medicine Division of Pulmonary/Critical Care/Sleep Objectives Understand the difference between nosocomial and community-acquired Know where to find antibiogram data Have a basic understanding of how to approach common infections in the inpatient and outpatient setting Overview Community vs. nosocomial Upper/Lower respiratory infections C.difficile-associated diarrhea Intra-abdominal infections Skin-soft tissue infections Bacteremia Osteomyelitis, septic joints Gram positives Gram negatives Urine Antibiogram Objectives: Crash Course Commonly encountered infections in inpatient and outpatient settings What bugs? What drugs? Common clinical syndromes Community vs. Nosocomial Why important? Atypicals MDRO MRSA Pseudomonas Broadened definition of “nosocomial” SNF, OPAT, jail, community-living, homeless, etc. Common Outpatient Infections Upper respiratory Lower respiratory Sinusitis Pharyngitis UTI SST Upper Respiratory Infection Def’n: Acute infxn which is typically viral Sinus, pharngeal, or lower airway symptoms may be present, but are not prominent Abx are rarely indicated Although most “colds” have sinus symptoms, less than 2% have complication of acute bacterial sinusitis Presence of green mucus does not necessarily indicate bacterial infection Acute Pharyngitis GAS causes 10% of adult pharyngitis 90% are NOT GAS! DDx: EBV, CMV (less likely), gonococcus, HSV, HIV, Syphilis ABX are rarely indicated for routine pharyngitis Use the Centor diagnostic criteria to decide who to test Treat only positive GAS rapid screens or patients who have all 4 criteria Centor Criteria History of fever Tonsillar exudates No cough Tender anterior cervical LAD ≥2 of the above = treat Treatment of GAS Pharyngitis Treatment of choice: Penicillin V 500mg BID or 250mg QID x 10 days Alternatives Benzathine PCN 1.2 MU IM x 1 dose (for noncompliant patients) 2nd gen cephalosporin: cefuroxime or cefprozil 500 mg qday, etc. e