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What is the most common cause of death attributable to infectious diseases?

Pneumonia

What is the most common nosocomial infection?

  • Ventilator-associated pneumonia
  • Hospital-acquired pneumonia (correct)
  • Community-acquired pneumonia

    • Hospital-acquired pneumonia (HAP) is most common in patients in the intensive care unit recovering from thoracic or upper abdominal surgery and in older adults.

    True

    The ______ is the second most common nosocomial infection.

    <p>Hospital-acquired Pneumonia</p> Signup and view all the answers

    A clinical prediction rule for prognosis should be used to determine if hospitalization for CAP is needed.

    <p>True</p> Signup and view all the answers

    Which of these is NOT a factor that contributes to the Pneumonia Severity Index?

    <p>Weight</p> Signup and view all the answers

    Which classification of surgical procedures carries a 30-100% risk of infection?

    <p>Dirty</p> Signup and view all the answers

    What is the main endogenous source of infection during a surgical procedure?

    <p>Patient flora</p> Signup and view all the answers

    Prophylactic antibiotics should be given postoperatively, as this is more effective than administering no prophylaxis.

    <p>False</p> Signup and view all the answers

    What are the two main indications for surgical prophylaxis?

    <p>Common postoperative infection with low morbidity and uncommon postoperative infection with significant morbidity and mortality.</p> Signup and view all the answers

    When should antibiotics be administered for surgical prophylaxis?

    <p>Before</p> Signup and view all the answers

    Redosing antibiotics should be done for extended surgical procedures.

    <p>True</p> Signup and view all the answers

    The appropriate dosage of antibiotics for prophylaxis should only be considered for the specific site being operated on, and not for the patient's weight.

    <p>False</p> Signup and view all the answers

    The duration of antibiotics during a GI procedure should be limited to the time a patient is in the operating room.

    <p>True</p> Signup and view all the answers

    Antibiotics should be avoided if they may be needed for therapy if infection occurs.

    <p>True</p> Signup and view all the answers

    Antibiotic prophylaxis should not cause greater morbidity than the infection it prevents.

    <p>True</p> Signup and view all the answers

    What is the appropriate antibiotic recommendation for a patient with morbid obesity undergoing gastric surgery?

    <p>Cefazolin 2 g before induction</p> Signup and view all the answers

    The biliary tract is normally colonized with organisms.

    <p>False</p> Signup and view all the answers

    What is the recommendation for antibiotic prophylaxis in patients undergoing a high-risk biliary procedure?

    <p>Cefazolin, cefoxitin, cefotetan, or ceftriaxone 2 g or ampicillin/sulbactam 3 g before induction</p> Signup and view all the answers

    What is the recommended antibiotic prophylaxis for a patient undergoing an appendectomy with a perforated appendix?

    <p>Cefoxitin 2 g before induction</p> Signup and view all the answers

    A combined oral and parenteral regimen is typically better than a parenteral regimen alone for colorectal surgery.

    <p>True</p> Signup and view all the answers

    What is the recommended antibiotic regimen for a routine colorectal surgery?

    <p>Cefazolin or ceftriaxone 2 g plus metronidazole 500 mg</p> Signup and view all the answers

    Mechanical bowel preparation is recommended for patients undergoing colorectal surgery.

    <p>False</p> Signup and view all the answers

    Antibiotics are generally not recommended for vaginal hysterectomies.

    <p>False</p> Signup and view all the answers

    Cefazolin is the recommend antibiotic for a Cesarean section.

    <p>True</p> Signup and view all the answers

    Antibiotics are not generally necessary for cardiac surgery.

    <p>False</p> Signup and view all the answers

    Vancomycin is recommended for patients undergoing vascular surgery if they have a history of MRSA colonization.

    <p>True</p> Signup and view all the answers

    What is the general recommendation for antibiotic prophylaxis for urologic procedures?

    <p>Not recommended.</p> Signup and view all the answers

    Antibiotic prophylaxis is indicated for head and neck surgery if an incision will be made through the oral or pharyngeal mucosa.

    <p>True</p> Signup and view all the answers

    What is the recommended antibiotic regimen for head and neck surgery involving an incision through the oral or pharyngeal mucosa?

    <p>Cefazolin or cefuroxime 2 g plus metronidazole 500 mg or ampicillin/sulbactam 3 g or clindamycin 900 mg before induction.</p> Signup and view all the answers

    The most common cause of death attributed to pneumonia is in older adults.

    <p>True</p> Signup and view all the answers

    Which type of pneumonia is acquired outside of the hospital?

    <p>Community-acquired pneumonia</p> Signup and view all the answers

    What is the definition of Community-Acquired Pneumonia (CAP)?

    <p>Acute infection of the pulmonary parenchyma, accompanied by an acute infiltrate consistent with pneumonia on chest radiograph or auscultatory findings, acquired in the community.</p> Signup and view all the answers

    Hospitalization for CAP is primarily based on the clinical severity of the infection.

    <p>True</p> Signup and view all the answers

    What is the second most common cause of death from infectious diseases?

    <p>Hospital-acquired pneumonia</p> Signup and view all the answers

    Hospitalized patients with severe CAP who require mechanical ventilation often require a higher level of care.

    <p>True</p> Signup and view all the answers

    VAP is defined as pneumonia that occurs more than 48 hours after endotracheal intubation.

    <p>True</p> Signup and view all the answers

    Which of the following is NOT a risk factor for nosocomial pneumonia?

    <p>Hypothermia</p> Signup and view all the answers

    What is the most common organism responsible for community-acquired pneumonia?

    <p>Streptococcus pneumoniae</p> Signup and view all the answers

    The most common organism responsible for hospital-acquired pneumonia is Staphylococcus aureus.

    <p>False</p> Signup and view all the answers

    What is the recommended first-line therapy for a non-hospitalized patient with CAP and no comorbidities?

    <p>Amoxicillin</p> Signup and view all the answers

    A respiratory fluoroquinolone is recommended for hospitalized CAP patients with comorbidities or risk factors.

    <p>True</p> Signup and view all the answers

    What is the recommended treatment for a hospitalized patient with severe CAP?

    <p>Ampicillin/sulbactam plus either a respiratory fluoroquinolone or a macrolide</p> Signup and view all the answers

    The recommended treatment duration for CAP is at least 5 days and should be guided clinically.

    <p>True</p> Signup and view all the answers

    If a patient has a history of MRSA infection, vancomycin is recommended in the empiric treatment regimen for CAP.

    <p>True</p> Signup and view all the answers

    The recommended treatment duration for VAP is 7 days.

    <p>True</p> Signup and view all the answers

    What is the recommended first-line therapy for VAP?

    <p>Imipenem</p> Signup and view all the answers

    Both aminoglycosides and fluoroquinolones can be used as second-line agents in VAP treatment.

    <p>True</p> Signup and view all the answers

    A patient with a history of intravenous antibiotic therapy in the past 90 days should receive a regimen that includes MRSA coverage.

    <p>True</p> Signup and view all the answers

    A patient developing septic shock at the time of VAP should receive a regimen that includes MRSA coverage.

    <p>True</p> Signup and view all the answers

    Vancomycin or linezolid are the recommended treatments for MRSA in VAP.

    <p>True</p> Signup and view all the answers

    If a patient has MRSA, ceftazidime and aztreonam can be alternative choices to the antipseudomonal agent.

    <p>True</p> Signup and view all the answers

    Antibiotic therapy for MRSA should be de-escalated on the basis of nasal PCR testing.

    <p>True</p> Signup and view all the answers

    The recommended treatment duration for HAP is 7 days.

    <p>True</p> Signup and view all the answers

    If a patient has a history of receiving antibiotics in the past 90 days, the recommended empiric regimen for HAP should include MRSA coverage.

    <p>True</p> Signup and view all the answers

    Which of the following is NOT a common mechanism of antibiotic resistance?

    <p>Increased sensitivity</p> Signup and view all the answers

    Beta-lactamases are enzymes that can degrade penicillin and cephalosporin antibiotics.

    <p>True</p> Signup and view all the answers

    Fluoroquinolones can become ineffective due to mutations in the gyrA and parC genes.

    <p>True</p> Signup and view all the answers

    Tetracycline antibiotics are effective against bacteria that have developed resistance to macrolides.

    <p>False</p> Signup and view all the answers

    What is the major symptom of influenza?

    <p>Fever</p> Signup and view all the answers

    Influenza epidemics usually occur in the spring and summer months.

    <p>False</p> Signup and view all the answers

    The most common type of influenza is type A.

    <p>True</p> Signup and view all the answers

    Influenza type A is classified by variations in the hemagglutinin and neuraminidase.

    <p>True</p> Signup and view all the answers

    Antigenic drift primarily involves wholesale changes in the genetic makeup of the influenza virus.

    <p>False</p> Signup and view all the answers

    The influenza virus can only mutate through antigenic drift.

    <p>False</p> Signup and view all the answers

    Which of the following symptoms is more likely to be present in influenza compared to the common cold?

    <p>Muscle aches</p> Signup and view all the answers

    When is treatment with neuraminidase inhibitors recommended for influenza?

    <p>For hospitalized patients and patients with severe or progressive illness</p> Signup and view all the answers

    Adamantanes are typically used to treat influenza.

    <p>False</p> Signup and view all the answers

    Neuraminidase inhibitors are effective against both influenza A and B.

    <p>False</p> Signup and view all the answers

    The only adverse effects of oseltamivir are gastrointestinal side effects.

    <p>False</p> Signup and view all the answers

    Zanamivir is recommended for patients with asthma or COPD.

    <p>False</p> Signup and view all the answers

    The recommended treatment duration for peramivir is 5 days.

    <p>False</p> Signup and view all the answers

    Baloxavir inhibits the viral endonuclease.

    <p>True</p> Signup and view all the answers

    When is influenza vaccination recommended for patients at very high risk of developing complications?

    <p>Both situations A and B</p> Signup and view all the answers

    Amantadine and rimantadine are recommended for preventing influenza because they are effective against both influenza A and B.

    <p>False</p> Signup and view all the answers

    Oseltamivir is recommended for preventing influenza.

    <p>True</p> Signup and view all the answers

    COVID-19 is caused by the SARS-CoV-2 virus.

    <p>True</p> Signup and view all the answers

    COVID-19 is a seasonal illness that only occurs in the winter months.

    <p>False</p> Signup and view all the answers

    The incubation period for COVID-19 ranges from 3 to 6 days.

    <p>True</p> Signup and view all the answers

    Older adults and those with chronic illness are most susceptible to severe COVID-19.

    <p>True</p> Signup and view all the answers

    Ritonavir-boosted nirmatrelvir is the preferred treatment for COVID-19 in non-hospitalized patients who are not on supplemental oxygen.

    <p>True</p> Signup and view all the answers

    Remdesivir is the preferred treatment for hospitalized patients with COVID-19 who have not been placed on supplemental oxygen.

    <p>False</p> Signup and view all the answers

    Molnupiravir can be used for hospitalized patients with COVID-19 if the other preferred therapies are not available or appropriate.

    <p>True</p> Signup and view all the answers

    Dexamethasone is not recommended for hospitalized patients with COVID-19.

    <p>False</p> Signup and view all the answers

    Dexamethasone is typically used in combination with ritonavir-boosted nirmatrelvir for patients with COVID-19.

    <p>False</p> Signup and view all the answers

    The preferred COVID-19 vaccine in the US is Pfizer-BioNTech.

    <p>True</p> Signup and view all the answers

    Moderna's and Pfizer-BioNTech's vaccines are both mRNA vaccines.

    <p>True</p> Signup and view all the answers

    Janssen/J&J’s vaccine is an mRNA vaccine.

    <p>False</p> Signup and view all the answers

    Novavax's vaccine is a protein subunit vaccine.

    <p>True</p> Signup and view all the answers

    Sinusitis is an inflammation of the mucosal lining of the nasal passage and paranasal sinuses.

    <p>True</p> Signup and view all the answers

    Viruses are the most common cause of sinusitis.

    <p>True</p> Signup and view all the answers

    A patient with sinusitis is typically treated empirically without the need for diagnostic confirmation.

    <p>False</p> Signup and view all the answers

    If the patient's symptoms have persist for 2-3 days and their temperature is above 39 degrees Celsius, delayed antibiotic prescribing is recommended.

    <p>False</p> Signup and view all the answers

    Antibiotics should be avoided for children between the ages of 6 months and 2 years if they are otherwise healthy and their symptoms are mild and the otitis media is unilateral.

    <p>True</p> Signup and view all the answers

    Antibiotics are not recommended for patients with Otitis Media with Effusion (OME).

    <p>False</p> Signup and view all the answers

    Corticosteroids, antihistamines, and descongestants are recommended for patients with OME.

    <p>False</p> Signup and view all the answers

    Cellulitis is most commonly caused by Streptococcus pyogenes.

    <p>True</p> Signup and view all the answers

    If there is evidence of MRSA, clindamycin is the preferred treatment for cellulitis.

    <p>True</p> Signup and view all the answers

    Erysipelas is a skin infection that involves the superficial dermis and spreads rapidly.

    <p>True</p> Signup and view all the answers

    Erysipelas most commonly affects the arms and hands.

    <p>False</p> Signup and view all the answers

    Necrotizing fasciitis is a serious infection that requires immediate medical attention.

    <p>True</p> Signup and view all the answers

    Necrotizing fasciitis is typically caused by Streptococcus pyogenes.

    <p>True</p> Signup and view all the answers

    The primary treatment for necrotizing fasciitis is antibiotics.

    <p>False</p> Signup and view all the answers

    Osteomyelitis is an infection of the bone.

    <p>True</p> Signup and view all the answers

    The most common cause of osteomyelitis is hematogenous spread.

    <p>True</p> Signup and view all the answers

    Osteomyelitis is most common in children.

    <p>False</p> Signup and view all the answers

    What is the recommended treatment for osteomyelitis caused by Staphylococcus?

    <p>Vancomycin</p> Signup and view all the answers

    A patient with osteomyelitis should receive at least 4 weeks of parenteral therapy.

    <p>True</p> Signup and view all the answers

    Study Notes

    Student Book of Pharmacology-IV

    • Fourth year Pharm D students
    • Authors: Prof. Salah Gharieb, Prof. Mona Fouad, Ass. Prof. Islam Ahmed Elazizy

    Course Contents

    • Week 1: Endocarditis, lectured by Prof. Salah Ghareib
    • Week 2: Surgical prophylaxis, lectured by Prof. Salah Ghareib
    • Week 3: Pneumonia, lectured by Prof. Mona Fouad
    • Week 4: Pneumonia, lectured by Prof. Mona Fouad
    • Week 5: Influenza, Sinusitis, RSV infection, lectured by Prof. Mona Fouad
    • Week 6: Urinary tract infections, lectured by Prof. Mona Fouad
    • Week 7: Midterm exam
    • Week 8: Acute otitis media; Eye infection, lectured by Prof. Mona Fouad
    • Week 9: Skin and skin-structure infections, lectured by Ass. Prof. Islam Ahmed
    • Week 10: Osteomyelitis, lectured by Ass. Prof. Islam Ahmed
    • Week 11: Meningitis; Brain abscess, lectured by Ass. Prof. Islam Ahmed
    • Week 12: Peritonitis, lectured by Ass. Prof. Islam Ahmed
    • Week 13: Clostridium difficile infection, lectured by Ass. Prof. Islam Ahmed

    Infectious Diseases

    • Infective Endocarditis:
      • Infection of heart valves or endocardial tissue
      • Microorganism colonization forms vegetation
      • Risk factors: mitral valve prolapse, prosthetic valves, intravenous drug abuse
      • Incidence: 3 to 4 cases per 100,000 people per year
      • Symptoms: fever, cutaneous manifestations (petechiae), cardiac murmur, arthralgias, myalgias
      • Lab findings: anemia, leukocytosis, elevated erythrocyte sedimentation rate, positive blood culture
      • Complications: congestive heart failure, emboli, mycotic aneurysm
      • Microbiology: Three to five blood cultures (10 mL each) within first 24-48 hours. Empiric therapy initiated only in acutely ill patients after 15-20 minute blood sample collection period

    Surgical Prophylaxis

    • Clean: Respiratory, GI, genitourinary tracts or oropharyngeal cavity without break in technique and no inflammation encountered, infection rate 1-4%
    • Clean Contaminated: Entry in respiratory, GI, genitourinary or biliary tracts, oropharyngeal cavity without unusual contamination; Infection Rate 5-15%
    • Contaminated: fresh traumatic wounds; gross spillage from the GI tract; major break in technique; or incisions encountering acute nonpurulent inflammation, Infection Rate 16-25%
    • Dirty: old traumatic wounds; perforated viscera; or clinically evident infection; Infection Rate 30-100%
    • Risk factors: Exogenous sources (flaws in aseptic techniques), Endogenous sources (patient flora); extremes of age, nutrition, obesity, diabetes, immunocompromise, hypoxemia, remote infection, foreign body
    • Treatment (treatment Recommendation for Endocarditis): Specific regimens are detailed, covering various organisms and valve types.

    Respiratory Tract Infections

    • Pneumonia:
    • Most common cause of infectious disease related death, especially in older adults
    • Hospital-acquired pneumonia (HAP) is second most common nosocomial infection (0.6%-1.1% of all hospitalized patients).
    • Community-acquired pneumonia (CAP) without hospitalization rate <1%, with hospitalization rate ~14%
    • Ventilator-associated pneumonia (VAP): ~20%-50%
    • Community-Acquired Pneumonia (CAP): Infection of pulmonary parenchyma with acute infiltrate evidenced on chest radiograph/auscultatory examination.
    • Patients must not have been hospitalized recently, nor have had regular exposure to health care
    • Hospital-Acquired Pneumonia (HAP): Occurs 48 hours or more after admission and was not incubating at the time of admission.
    • Ventilator-Associated Pneumonia (VAP): Appears 48 hours or more after endotracheal intubation.

    Skin and Skin Structure Infections

    • Cellulitis: Acute spreading skin infection, deep dermis and subcutaneous fat; non-elevated poorly defined margins; warmth, pain erythema and edema, and tender lymphadenopathy, malaise, fever, and chills. Commonly caused by Streptococcus pyogenes and Staphylococcus aureus.
    • Erysipelas: acute spreading skin infection involving primarily superficial dermis; spreads rapidly through the lymphatic system; usually on legs or feet (face less common), warmth, erythema, pain. Usually caused by group A streptococcus.
    • Necrotizing fasciitis: Acute necrotizing cellulitis involves subcutaneous fat and superficial fascia; infection extensively alters surrounding tissue leading to cutaneous anesthesia or gangrene; very painful. Usually caused by group A streptococci, or mixed infection with facultative and anaerobic bacteria.

    Osteomyelitis

    • Infection of bone with subsequent bone destruction; ~20 cases per 100,000 people

    Urinary Tract Infections (UTIs)

    • Most common bacterial infection in humans (7 million office visits per year; 1 million hospitalizations).
    • More common in women (15%–20%).
    • UTIs occur predominantly in women between ages 1-50 years.
    • Lower UTI: Cystitis (nonspecific symptoms such as mental status changes, abdominal pain, and decreased eating or drinking); dysuria, frequency, urgency.
    • Upper UTI: Pyelonephritis (nonspecific symptoms such as mental status changes, abdominal pain, and decreased eating or drinking)
    • Risk factors: age (older adults), female gender, diabetes, pregnancy, immunosuppression, urinary tract instrumentation, urinary tract obstruction, etc.
    • Recurrence: Relapse (infection with same organism within 14 days), Reinfection (infection with completely different organism).
    • Microbiota: E. Coli (most common)
    • Treatment (Uncomplicated): Low or moderate severity: Trimethoprim/sulfamethoxazole 160/800 mg BID x 3 days, Nitrofurantoin monohydrate 100 mg BID x 5 days; Ciprofloxacin 500 mg, or Levofloxacin 750 mg daily x 5 days

    Diabetic Foot Infections

    • Epidemiology: 25% of people with diabetes and ~1 in 15 need amputation
    • Etiology: Neuropathy (mechanical, thermal injuries); Vasculopathy (decreased lower-limb perfusion); Immunologic defects (cellular and humoral).
    • Causative Organisms: Polymicrobial (average 2.1-5.8 microorganisms); S. aureus, Group A or B Streptococcus, Enterococcus, Proteus, E. coli, Klebsiella, and others.
    • Treatment: Preventive; Antimicrobial for mild infections (<2cm erythema); Severe/moderate infections include extended-duraction antibiotics and surgical intervention.

    Impettigo

    • Highly contagious superficial skin infection commonly in children
    • Commonly caused by S. pyogenes or S. aureus

    Otitis Media

    • Inflammation of middle ear and usually characterized by middle ear effusion and inflammation.
    • Risk factors: Younger age, day care attendance, absence of breastfeeding, family history of AOM, lower socio-economic status.
    • Diagnosis: Signs include bulging tympanic membrane, reduced or absent movement of tympanic membrane, presence of purlulent fluid in middle ear, erythema of tympanic membrane, otalgia.

    Conjunctivitis

    • Definition: Inflammation of bulbar and or palpebral conjunctiva
    • Etiologies: Bacterial (30%), Viral, Fungal (rare). Staphylococcus, Streptococcus, Corynebacterium, Haemophilus, Pseudomonas, Moraxella are common bacteria.
    • Treatment: Topical (eye drops or ointment) antibiotics.

    Meningitis

    • Definition: Inflammation of the meninges (protective membranes surrounding the brain and spinal cord)
    • Microbiota: Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type B
    • Risk factors: Head trauma, immunosuppression, CNS shunts, neurosurgical patients, alcoholism.
    • Diagnosis: History and physical exam, elevated WBC count in cerebral spinal fluid (CSF), Gram stain of CSF (suggestive of Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type B), CSF culture

    Neonatal Sepsis

    • Infection in first 3 days of life
    • Early onset (within 3 days): Risk factors - extremely low birth weight, prolonged rupture of amniotic membranes, prolonged labor, maternal GBS colonization, maternal endometritis, chorioamnionitis.
    • Late onset (after 3 days): Risk factors – obstetric risk factors, iatrogenic factors (e.g., endotracheal tubes, central venous catheters).

    Brain Abscess

    • Extension or retrograde septic from otitis media, mastoiditis, sinusitis, or facial cellulitis.
    • Hematogenous spread is often from lung abscess or infective endocarditis.
    • Signs: headache, fever, seizures, expanding intracranial mass lesion – focal neurologic deficits.
    • Treatment: surgical intervention including incision and drainage using craniotomy or stereotactic needle aspiration.

    Peritonitis

    • Inflammation of the peritoneum;
    • Definitions: Primary (spontaneous or idiopathic; no primary focus of infection), Secondary (occurs secondary to an abdominal process)
    • Etiology: Peptic ulcer, perforation of a GI organ, appendicitis, or secondary to intrauterine device implantation, pancreatitis, operative contamination, diverticulitis, intestinal neoplasms, secondary to peritoneal dialysis.
    • Microbiota: E. coli, Enterococcus, obligate anaerobes (e.g., Bacteroides, Clostridium perfringens), aerobic and facultative gram-positive and gram-negative organisms (e.g., Streptococcus, Enterococcus, Klebsiella, Proteus, Enterobacter).
    • Clinical Presentation: Fever, tachycardia, elevated WBC, pain aggravated by motion, rebound tenderness, bowel paralysis, pain with breathing, decreased renal perfusion, ascitic fluid.

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