16 Questions
What should be considered when selecting an antimicrobial regimen for a patient?
Drug specific, patient specific, spectrum of activity, dosing, pharmacokinetic properties, pharmacodynamic properties, adverse effect potential, drug-interaction potential, cost, anatomic location of infection, antimicrobial history, drug allergy history, renal and hepatic function/age, concomitant medications, pregnancy or lactation, and compliance potential.
What is the primary goal of patient education in antimicrobial therapy?
To educate the patient on the proper use of antibiotics, potential side effects, and the importance of compliance.
What is de-escalation of antimicrobial therapy based on culture results?
Discontinuation of antibiotics that are providing a spectrum of activity greater than necessary to treat the infection.
What is monitoring in the context of antimicrobial therapy?
Monitoring for clinical response, adverse effects, efficacy, toxicity, and laboratory data.
What is a common cause of failure of antimicrobial therapy?
Inadequate diagnosis resulting in poor initial antimicrobial or other non-antibiotic drug selection.
What should be reevaluated in cases of antimicrobial therapy failure?
Antimicrobial therapy, source control, and alternative non-infectious diagnoses.
Why is it important to perform source control in antimicrobial therapy?
To remove the source of infection and prevent further infection.
What is the purpose of switching from IV to oral antibiotics?
To reduce cost and promote patient convenience.
Why is correct selection, use, and monitoring of clinical response of antibiotics important?
To cure the patient's infection, limit harm by minimizing patient risk for adverse effects, and limit societal risk from antimicrobial-resistant bacteria.
What are the two types of infections?
Nosocomial and community-acquired infections.
What is the difference between virulence and resistance?
Virulence refers to the ability of a microorganism to cause disease, while resistance refers to the ability of a microorganism to survive in the presence of an antibiotic.
What is the purpose of obtaining bacterial cultures prior to initiating antimicrobial therapy?
To identify the causative microorganism and determine its susceptibility to antibiotics.
What is fever, and what are some other causes of fever besides infection?
Fever is a rise in temperature arising as part of the overall host response to microbial toxins. Other causes of fever include medications, trauma, and other medical conditions such as autoimmune disease, malignancy, pulmonary embolism, and hyperthyroidism.
What are some circumstances where patients with infections may not present with fever?
Elderly patients, patients with overwhelming infection, or patients with localized infections such as UTIs.
What are the goals of antimicrobial therapy?
To cure the patient's infection, limit harm by minimizing patient risk for adverse effects, and limit societal risk from antimicrobial-resistant bacteria.
What are endogenous infections?
Infections that arise from an alteration in one's own normal flora.
Study Notes
Importance of Antibiotic Selection
- Correct selection, use, and monitoring of antibiotics is crucial to ensure proper treatment of infections, prevent harm, and minimize the risk of antimicrobial resistance.
Guiding Principles
- Make an accurate diagnosis
- Minimize harm to the patient and prevent adverse effects, including secondary infections
- Limit the risk of antimicrobial-resistant bacteria in the community
Goals of Antimicrobial Therapy
- Cure the patient's infection
- Minimize harm to the patient by limiting adverse effects, including secondary infections
- Limit the risk of antimicrobial-resistant bacteria in the community
Etiology of Infections
- Nosocomial infections: acquired in a healthcare setting
- Community-acquired infections: acquired outside of a healthcare setting
Pathophysiology
- Endogenous infections: arise from an alteration in one's normal flora
- Exogenous infections: acquired from an external source, such as human-to-human transmission or contact with environmental bacteria
Virulence vs. Resistance
- Virulence: the ability of an organism to cause disease
- Resistance: the ability of an organism to withstand the effects of antibiotics
Clinical Presentation and Diagnosis
- Physical examination: fever, physical signs, and symptoms
- Imaging studies: radiographs, CT, MRI to determine anatomic localization of infection
- Non-microbiologic laboratory studies: WBC, ESR, CRP
- Microbiologic studies: culture, direct examination of specimen (e.g., sputum, blood, urine)
Clinical Presentation of Fever
- Fever: a rise in temperature due to the host response to microbial toxins
- Non-infectious causes of fever: medications, trauma, autoimmune disease, malignancy, pulmonary embolism, and hyperthyroidism
- Some patients may present with hypothermia or be afebrile, especially elderly patients or those with localized infections
Treatment
- Considerations for selecting antimicrobial regimens:
- Drug-specific factors (spectrum of activity, dosing, pharmacokinetic and pharmacodynamic properties, adverse effect potential, drug-interaction potential, cost)
- Patient-specific factors (anatomic location of infection, antimicrobial history, drug allergy history, renal and hepatic function, age, concomitant medications, pregnancy or lactation, compliance potential)
Outcome Evaluation
- Patient education: importance of adherence to treatment, monitoring for adverse effects, and reporting of symptoms
- De-escalation of antimicrobial therapy based on culture results
- Discontinuation of duplicative spectrum antibiotics
- Switching to a narrower spectrum antibiotic once clinically stable
- Switch from IV to oral antibiotics when possible
Monitoring
- Monitor for clinical response, adverse effects, and imaging results
- Evaluate efficacy through vital signs, clinical findings, and physical exam findings
- Monitor for toxicity through adverse effects and laboratory data
Failure of Antimicrobial Therapy
- Causes:
- Inadequate diagnosis resulting in poor initial antimicrobial selection
- Poor source control
- Development of a new infection with a resistant organism
- Alternative non-infectious diagnosis
- Re-evaluation for sources of untreated infection
- Consideration of drug- and patient-specific factors
Learn about the importance of correct antibiotic selection, use, and monitoring to ensure proper treatment of infections and minimize antimicrobial resistance.
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