Severe Infections and MRSA Management

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Questions and Answers

What is the purpose of hospitalization for patients with rare severe infections?

To perform surgical procedures

To monitor dietary habits

To ensure consistent administration of specific therapies (correct)

To provide psychological support

Which therapy is mentioned as a possible treatment for severe infections?

Oral penicillin

Subcutaneous amoxicillin

Topical clindamycin

Intravenous aminoglycoside-cephalosporin combination (correct)

How frequently should fortified topical vancomycin be administered?

Once a day

Every 30 minutes

Every hour to every two hours

Every 15 minutes to hourly (correct)

Which condition does NOT indicate the need to empirically treat for MRSA?

Presence of a viral infection Signup and view all the answers

What is one of the treatment options for managing severe infections aside from the aminoglycoside-cephalosporin combination?

Topical fluoroquinolone monotherapy Signup and view all the answers

What factor is associated with a higher likelihood of MRSA infection that would warrant empirical treatment?

Penetrating trauma Signup and view all the answers

Which of the following best describes the administration method for therapies mentioned for severe infections?

Continuous and consistent Signup and view all the answers

Which of the following is a reason to consider MRSA treatment alongside systemic inflammatory response syndrome (SIRS)?

Positive MRSA culture from another site Signup and view all the answers

Which condition would most likely necessitate empirically treating for MRSA?

Purulent drainage from a wound Signup and view all the answers

What is a significant indicator of MRSA infection risk in patients who use injectable drugs?

History of previous MRSA infections Signup and view all the answers

What is the most common area for erysipelas to occur?

Legs and feet Signup and view all the answers

Which symptom is commonly associated with erysipelas?

Warmth, erythema, and pain Signup and view all the answers

What characterizes the edge of an erysipelas infection?

Elevated and sharply demarcated Signup and view all the answers

How common is facial erysipelas compared to other locations?

Facial erysipelas is less common than leg and foot erysipelas. Signup and view all the answers

Which of the following symptoms would NOT be indicative of erysipelas?

Numbness in the area Signup and view all the answers

What characterizes acute, necrotizing cellulitis in terms of tissue infection?

Extensively alters surrounding tissue Signup and view all the answers

Which of the following symptoms may arise from acute, necrotizing cellulitis?

Gangrene in surrounding tissue Signup and view all the answers

What is the primary tissue affected by acute, necrotizing cellulitis?

Subcutaneous fat and superficial fascia Signup and view all the answers

What alteration may occur in the skin due to necrotizing cellulitis?

Cutaneous anesthesia Signup and view all the answers

Which of the following conditions is associated with the infection altering surrounding tissue in acute, necrotizing cellulitis?

Gangrene Signup and view all the answers

What is the primary basis for making a diagnosis?

Patient history and physical examination Signup and view all the answers

In which scenario is bacterial culture and sensitivity testing recommended?

When MRSA is suspected Signup and view all the answers

Which of the following is NOT a common method for diagnosis?

Prescription of medication Signup and view all the answers

Why is bacterial culture and sensitivity important in certain cases?

It determines antibiotic effectiveness against bacteria. Signup and view all the answers

Which condition would inherently require bacterial cultures due to higher risk?

Suspected MRSA infections Signup and view all the answers

What does the term 'acute infection of the pulmonary parenchyma' refer to?

An immediate and severe infection affecting the lung tissue. Signup and view all the answers

Which factor is NOT mentioned as a characteristic of the infection described?

Acquired in a hospital setting. Signup and view all the answers

Which diagnostic method is indicated to confirm the presence of pneumonia in this definition?

Chest radiograph. Signup and view all the answers

What type of pneumonia is described in this definition?

Community-acquired pneumonia. Signup and view all the answers

Which symptom is most closely associated with the defined pulmonary infection?

Fever. Signup and view all the answers

Study Notes

Student Book of Pharmacology-IV

Fourth Year Pharm D Students
By Prof. Salah Gharieb, Prof. Mona Fouad, Ass. Prof. Islam Ahmed Elazizy
Course covers Infectious Diseases, Surgical Prophylaxis, Respiratory Tract Infections, Skin and Skin Structure Infections, Urinary Tract Infections, Diabetic Foot Infections, Impetigo, Osteomyelitis, Necrotizing Fasciitis, Brain Abscess, Peritonitis, and Intra-abdominal Infections, and Clostridium Difficile Infection.

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

Part I

By Prof. Salah Gharieb

Infectious Disease: Infective Endocarditis

Introduction:
- Infection of heart valves or endocardial tissue.
- Vegetation (platelet-fibrin complex) infected with microorganisms.
Presentation and Clinical Findings:
- Fever (low-grade, remittent)
- Cutaneous manifestations (petechiae, Janeway lesions, splinter hemorrhages)
- Cardiac murmur
- Arthralgias, myalgias, low back pain, arthritis
- Fatigue, anorexia, weight loss, night sweats
Laboratory Findings:
- Anemia, normochromic, normocytic
- Leukocytosis
- Elevated erythrocyte sedimentation rate
- Positive blood culture (78%-95% of patients)
Complications:
- Congestive heart failure (38%-60% of patients)
- Emboli (22%-43% of patients)
- Mycotic aneurysm (5%-10% of patients)
Microbiology:
- Three to five blood cultures (10 mL each), obtained within 24-48 hours.
- Empiric therapy should be initiated only in acutely ill patients, before cultures come back. -Table showing incidence of microorganisms in endocarditis.

Surgical Prophylaxis

Introduction: Giving antibiotic before bacterial contamination
Classification of Surgical Procedures: Clean, Clean-Contaminated, Contaminated, and Dirty Procedures, and their infection rates
Recommended Prophylaxis for Dental or Respiratory Tract Procedures (list of procedures and dosages/regimens)

Respiratory Tract Infections: Pneumonia

Definition: Acute infection of pulmonary parenchyma.
Hospital-Acquired Pneumonia (HAP):
Second most common nosocomial infection.
Ventilator-Associated Pneumonia (VAP): Higher incidence in ICU, surgery patients
Community-Acquired Pneumonia (CAP): less than 1% mortality without hospitalization.
- About 14% mortality with hospitalization.
Mortality Rates:
HAP: 38%-60%
Emboli: 22%-43%
Mycotic aneurysm: 5%-10%

Skin and Skin Structure Infections

Cellulitis: Acute spreading skin infection.
Erysipelas: Acute spreading skin infection, usually in extremities. Poorly defined margins.
Necrotizing Fasciitis: Acute, necrotizing cellulitis involving subcutaneous fat and superficial fascia
Microorganisms: Streptococcus pyogenes
Treatment: Penicillin G, Cefazolin, or Ceftriaxone (if severe, MRSA associated).

Urinary Tract Infections

Lower UTI: Cystitis, frequent urination, pain, dysuria
Upper UTI: Pyelonephritis, costovertebral angle tenderness, fever, chills.
Microorganisms: Escherichia coli most common.
Predisposing factors: Age, female sex, diabetes, pregnancy, immunodeficiency, urinary tract instrumentation, obstruction, renal disease
Treatment: Trimethoprim/sulfamethoxazole, Levofloxacin, or Ciprofloxacin (outpatient) depending on severity
Recurrent Cystitis: Relapse vs. Reinfection.

Diabetic Foot Infections

Epidemiology: 25% of people with diabetes develop foot infections.
Etiology: Neuropathy, vasculopathy, immunologic defects
Microorganisms: Polymicrobial, including S. aureus, Group A Streptococcus.
Therapy: Mild infections: Dicloxacillin; Moderate/severe infections: vancomycin and clindamycin

Impetigo

Definition: Acute skin infection affecting superficial layers of epidermis.
Types: Bullous and nonbullous
Causes: S. pyogenes or S. aureus
Treatment: Topical antibiotics (mupirocin, retapamulin, or other topical antibiotics) or Systemic antibiotics (cephalexin).

Osteomyelitis

Definition: Infection of the bone.
Causes: Direct extension, hematogenous spread.
Signs/Symptoms: Fever, localized pain, tenderness, swelling
Treatment: Intravenous antibiotics tailored to the suspected pathogen.

Brain Abscess

Pathophysiology: Direct extension, retrograde septic phlebitis, or hematogenous spread.
Signs/Symptoms: Expanding intracranial mass lesion, seizures, fever, headache
Microorganisms: Usually polymicrobial (Streptococcus spp., anaerobes)
Treatment: Surgical debridement and drainage, often with antibiotics.

Peritonitis

Definition: Inflammation of the peritoneum lining the abdominal cavity.
Types: Primary (spontaneous) and secondary (due to another abdominal process).
Causes of Secondary Peritonitis: Perforation, GI organ perforation, operative contamination.

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Description

This quiz delves into the critical aspects of managing severe infections, specifically focusing on MRSA treatment and hospitalization protocols. Test your knowledge on the therapies used, indicators for MRSA, and treatment alternatives, enhancing your understanding of infection management.