Empiric Antibiotic Therapy for Suspected Bacterial Arthritis #Management #Septic #Bacterial #Infected #Arthritis #Antibiotics

Specific antibiotic in-hospital treatment for community-acquired bacterial meningitis #bacterial #meningitis #management #antibiotics #therapy #treatment #table #duration #empiric

Table 4. Recommended Initial Empiric Antibiotic Therapy for Hospital-Acquired Pneumonia (Non-Ventilator-Associated Pneumonia) #Management #InfectiousDiseases #Empiric #Antibiotics #HAP #HCAP #HospitalAcquiredPneumonia #IDSA2016

Septic Arthritis - Diagnosis and Management Summary Clinical Exam: hot, swollen, pain with passive AND active ROM +/- fever, chills, malaise Ddx: cellulitis, bursitis, tendonitis, osteoarthritis, gout, pseudogout, osteomyelitis, trauma, avascular necrosis, Lyme disease, viral arthritis Workup: arthrocentesis w/ fluid culture, Gram stain, cell count, and crystal evaluation • labs and imaging unlikely to be beneficial in septic arthritis diagnosis Treatment: admission for parenteral Abx, Orthopedics consults for possible washout • Healthy Adults/ChiIdren = staphylococcus, streptococcus, N. gonorrhoeae Vancomycin + Ceftriaxone • HIV or IVDU = staphylococcus, gram negative bacilli Vancomycin + Cefepime OR Ciprofloxacin • Sickle Cell = Salmonella, staphylococcus Vancomycin + Ciprofloxacin OR Imipenem Clinical Pearls: • Atraumatic, hot, swollen, painful = bacterial nongonococcal septic arthritis until proven otherwise • ESR -90% sensitive in pediatrics but NOT adults • Consider gonococcal arthritis in sexually active with migratory arthritis (therefore oral, cervical, anal Cxs) • *** If unable to rule out septic arthritis, patient admitted for treatment until cultures results *** MH/CCF/CWRU EM Res @MetroHealth_EM #Septic #Arthritis #Diagnosis #Management #Summary

Differential Diagnosis of Acute Arthritis Crystal-induced arthritis: Calcium oxalate, gout, cholesterol, pseudogout, hydroxyapatite crystals Infectious arthritis: Bacteria, fungi, mycobacteria, spirochetes, viruses Inflammatory arthritis: Behçet syndrome,* rheumatoid arthritis,* sarcoid, systemic lupus erythematosus,* Still disease,* seronegative spondyloarthropathy (e.g., ankylosing spondylitis, psoriatic arthritis, reactive arthritis, inflammatory bowel disease–related arthritis), systemic vasculitis* Osteoarthritis: Erosive/inflammatory variants* Other: Amyloidosis, avascular necrosis, clotting disorders/anticoagulant therapy, familial Mediterranean fever,* foreign body, fracture, hemarthrosis, hyperlipoproteinemia,* meniscal tear Systemic infection: Bacterial endocarditis, human immunodeficiency virus infection Tumor: Metastasis, pigmented villonodular synovitis #Diagnosis #Differential #Acute #Arthritis #Monoarticular #Septic

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Antimicrobial Regimens for Acute Bacterial Rhinosinusitis in Adults Initial empirical therapy: • Amoxicillin-clavulanate (500 mg/125 mg PO tid, or 875 mg/125 mg PO bid) • Doxycycline (100 mg PO bid or 200 mg PO qd) Beta-lactam allergy: • Doxycycline (100 mg PO bid or 200 mg PO qd) • Levofloxacin (500 mg PO qd) • Moxifloxacin (400 mg PO qd) Risk for antibiotic resistance or failed initial therapy: • Amoxicillin-clavulanate (2000 mg/125 mg PO bid) • Levofloxacin (500 mg PO qd) • Moxifloxacin (400 mg PO qd) Severe infection requiring hospitalization: • Ampicillin-sulbactam (1.5–3 g IV every 6 h) • Levofloxacin (500 mg PO or IV qd) • Moxifloxacin (400 mg PO or IV qd) • Ceftriaxone (1–2 g IV every 12–24 h) • Cefotaxime (2 g IV every 4–6 h) #Antimicrobial #empiric #idsa #antibiotics #Bacterial #Rhinosinusitis #Adults #management #pharmacology

Antibiotic Considerations for the Medical Resident - Reference Cheatsheet Dr. Jesse Burk-Rafel @jbrafel #Antibiotics #Management #Cheatsheet #Pharmacology #Guide #Inpatient #Empiric

Suspected catheter-related bloodstream infection - Management Algorithm • Temperature 37.8 C • Rigors •Tunnel or exit site purulence Obtain blood cultures from the catheter lumen and the dialysis circuit and start empiric antibiotics Antibiotic Management - Uncomplicated CRBSI • Responds quickly to empiric antibiotics • No evidence of metastatic infection • Hemodynamically stable Antibiotic Management - Complicated CRBSI - 6-8 weeks of tailored systemic antibiotics • Hemodynamic instability • Persistent fever and/or bacteremia despite appropriate antibiotic therapy • Evidence of metastatic infection (endocarditis, epidural abscess, osteomyelitis, septic arthritis) Keep catheter if -Presentation is consistent with uncomplicated CRBSI: • Rapid improvement after empiric antibiotics • No hemodynamic stability • No evidence of metastatic infection Remove catheter if - Presentation is consistent with complicated CRBSI: • Severe sepsis • Hemodynamic instability • Evidence of tunnel or exit site infection • Persistent fever and/or bacteremia 48-72 hours after starting tailored antibiotics • Resistant pathogens (S. aureus, fungal or multidrug resistant organisms) Exchange catheter if - Presentation is consistent with complicated CRBSI but patient has limited vascular access options and is: • Afebrile 48-72 hours after starting tailored antibiotics • Hernodynamically stable after treatment initiation • No evidence of tunnel or exit site infection #catheter #bloodstream #infection #Management #Algorithm #CRBSI #diagnosis #management

Table 3. Suggested Empiric Treatment Options for Clinically Suspected Ventilator-Associated Pneumonia in Units Where Empiric Methicillin-Resistant Staphylococcus aureus Coverage and Double Antipseudomonal/Gram-Negative Coverage Are Appropriate #Management #InfectiousDiseases #Empiric #Antibiotics #VAP #VentilatorAssociatedPneumonia #IDSA2016

IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis Algorithm for the management of acute bacterial rhinosinusitis. - Overall Treatment Effect NNT = 18 - Overall Harm NNH = 8 (mostly GI side effects) (see http://www.thennt.com/nnt/antibiotics-for-clinically-diagnosed-acute-sinusitis/) #Diagnosis #Management #IDSA #2012 #Rhinosinusitis #Bacterial #Antibiotics #Algorithm

Risk Factors for Septic Arthritis Contiguous spread Skin infection, cutaneous ulcers Direct inoculation Previous intraarticular injection Prosthetic joint: early and delayed (Table 6) Recent joint surgery Hematogenous spread Diabetes mellitus Human immunodeficiency virus infection Hematogenous spread Immunosuppressive medication9 Intravenous drug abuse Osteoarthritis Other cause of sepsis Prosthetic joint: late (Table 6) Rheumatoid arthritis Sexual activity (specifically for gonococcal arthritis) Other factors Age older than 80 years #Diagnosis #Septic #Infective #Arthritis #RiskFactors

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