Category Types Clinical Picture Pathogens Treatment Category Types Clinical Picture Pathogens Treatment

UTI Acute Dysuria, frequency, urgency, E. coli (85%), S. Fosfomycin 3g x1 Skin/Soft Cellulitis Erythema, edema, diffuse Staph, Strep PO Augmentin 875mg BID
Admit if uncomplicated suprapubic pain + PYURIA (WBCs sapro, Proteus, Nitrofurantoin 100mg BID x5d TissueW/U: tenderness, lymphadenopathy, x7-14d OR IV Pip/Tazo
systemic on UA/LE on dipstick) + organisms Klebsiella Bactrim DS BID x3d Blood cx x4, esp in s/o lymphatic insufficiency, 1.5-3g q6h if sick (IV until
s/sx (UCx pos/nitrates on dipstick) Tissue cx/gram DM, EtOH OK, then PO)
Complicated Systemic s/sx: fever, chills/rigors, GNR, IV ceftriaxone 1g qD OR IV stain, ESR/CRP, Erisipelas Superficial, sharp raised border    
W/U: UA, fatigue/malaise, flank pain, CVA Enterococcus cefuroxime XR to r/o Clostridia Crepitus    
Ucx, CBC, tenderness IV ciprofloxacin 400mg q12h OMDDx: OM, cellulitis
BMP, CT abd Transition to PO bactrim DS BID bacteremia MRSA cellulitis Healthcare, prison, military, recent MRSA PO Clindamycin 450mg
w/o contrast Total abx duration 7-14d abx, IVDA, MSM, HIV, dialysis, hx q6-8h OR IV Vancomycin
OR renal US, Urosepsis Fever >38.4, toxic appearing,     MRSA, lack of response to abx, 15-20mg/kg q8h if sick;
GC/CT, hypotension, poor cap refill, SIRS proximity to indwelling device total abx x7-14d
pregnancy Infected kidney       Pseudomonas Diabetic foot, water exposure, Pseudomonas IV Pip/tazo x7-14d
test stone cellulitis wound through shoe
Renal abscess Recurrent UTI or not improved   Drain + abx x3wk Abscess Fluctuance, purulence Staph aureus Drain + abx x7-14d
DDx: after tx Necrotizing   Polymicrobial SURGICAL EMERGENCY
vaginitis, Emphysematou Visualized on CT   SURGICAL EMERGENCY SSTI
urethritis, s pyelonephritis          
obstruction, Candiduria   Candida (C. Tx only if fungus ball,
PID, painful Osteomyelitis Hematogenou   S. aureus, coag neg  
glabrata, C. neutropenia, renal xplant, W/U: MRI, bone s OM staph, E. coli,
bladder parapsilosis) urologic procedure
syndrome bx is always best. Pseudomonas,
PO fluconazole If indolent, hold Serratia
Amphotericin irrigation abx until can get Contiguous Probe to bone = presume OM. S. aureus, S. Empiric: IV vanc + IV
Catheter-   Enterococcus, Remove/replace catheter, abx positive bx. OM pyogenes, pip/tazo
associated Pseudomonas, x7-14d ESR/CRP to trend Enterococcus, coag Total abx x8wk if no
GNRs, Candida response to neg staph, GN, surgical intervention
Recurrent Questions to ask: how often   Methenamine + Vit C to acidify therapy pseudomonas, If surgery w/ neg margins,
urinate, use of urine pH <6, avoid chronic abx anaerobes tx x14d
foams/lubes/spermicides, STDs, b/c will develop resistance R/o: Bacteremia, Direct trauma      
retain urine, hx kidney stones, (nitrofurantoin OK), f/u urology endocarditis OM
prostatitis r/o structural problems, urine Diabetic foot   Polymicrobial: S.  
cytology to monitor for dysplasia OM aureus, Strep,
2/2 methenamine, scan for Enterococcus,
kidney stones, schedule voids, Proteus,
hydrate, complete void Pseudomonas,
          anaerobes
Pneumonia CAP outpt Cough, fever, pleuritic CP, dyspnea, Virus, S. Macrolide or doxycycline x5d          
W/U: CXR, sputum production, leukocytosis, pneumo, H. flu, Septic arthritis S. aureus Healthy adult, skin breakdown S. aureus, MRSA Empiric: IV ceftriaxone 2g
blood cx x4, infiltrate on CXR M. catarrhalis, W/U: XR, MRI r/o overlying, hx damage to joint (RA), qD + IV vancomycin 15-
sputum Atypicals OM, prosthesis 20mg/kg q8h
gram stain & CAP inpatient Use CURB 65, PSI to decide if needs Virus, S. Ceftriaxone + azithromycin OR arthrocentesis, Total abx x3-4wk
cx, admission pneumo, H. flu, respiratory FQs x5d gram stain & cx Streptococcus Healthy or asplenic adult S.  
Legionella M. catarrhalis, synovial fluid, epidermidis>>>????
urine Ag, Flu Atypicals blood cx x4, CBC, N. gonorrhea Young healthy sexually active Neisseria  
panel - up to Pseudomonas Structural lung problems: CF, COPD, Pseudomonas   BMP, ESR/CRP adult, tenosynovitis, cesicular gonorrhoea
65% pt will bronchiectasis aeruginosa pustules, neg synovial fluid
have TB TB contacts, immigration, Mycobacterium PPD/Quantiferon; RIPE DDx: OM, cx/gram stain w/ many PMNs
inconclusive homeless, IVDA, HIV, healthcare, tuberculosis bacteremia, Gram negative Immunocompromised, GI infx; Pseudomonas Add IV pip/tazo
ona w/u prison, constitutional sx, chronic sx cellulitis, crystal think of pseudomonas if diabetic
MRSA Recent flu, necrotizing pna, septic MRSA Vancomycin, linezolid, arthropathy, Lyme Erythema migrans, migratory Borrelia burgdorferi  
DDx: shock, abscess, empyema, resp clindamycin reactive arthritis, arthralgia
Effusion, failure spondyloarthritis,
empyema, TB Indolent Mycobacteria  
Fungal No improvement w/ abx in 72h Coccidiomycosis   RA tuberculosis
BOOP, PE, , histoplasma,
ARDS, Fungal Indolent, immunosuppressed    
blastomycosis,
vasculitis Prosthetic Chronic vs acute? Joint removed S. aureus, coag neg 6wk IV abx
cryptococcus
vs retained? staph, GBS, aerobic
Aspiration Dementia, stroke, poor swallowing, Oral Ceftriaxone is OK for anaerobes; GNR, anaerobes,
dec consciousness, TBI, EtOH, drug anaerobes???? can also use MTZ or clindamycin mixed
OD, anesthesia
Hospital- Inpt >48h S pneumo, Pip/tazo OR Cefepime OR
acquired MRSA, GNR (E. aztreonam
coli,
pseudomonas,
acinetobacter)
Category Types Clinical Picture Pathogens Treatment Category Types Clinical Picture Pathogens Treatment
Bacteremia S. aureus Most aggressive bacteremia. Can cause S. AUREUS IS 3wk Endocarditis Endocarditis Fever, heart murmur are seen Staph, Strep, HACEK, Empiric treatment = Vanc +
vertebral OM/sternoclavicular joint OM NEVER A 4wk W/U: Blood cx x4, in 90%. enterococcus, ceftriaxone
Have to find (slow blood flow areas, less likely to cause CONTAMINANT 6wk TTE first then TEE, pseudomonas,
source: SSTI OM elsewhere), septic arthritis, ESR/CRP Risk factors: IVDA, rheumatic candida, GN Surgery if HF 2/2 valve;
(abscess, endocarditis, epidural abscess, mycotic heart dz, congenital heart dz, fungus; GNR; unstable
cellulitis), aneurysms. Sequelae: septic degenerative valve dz, prosthetic valve;
septic TTE 1st, f/u TEE if persistent bacteremia emboli (PE, strokes), prosthetic valve, intracardiac uncontrolled infx
arthritis, GI, w/i 48h metastatic infection, devices (no predisposing (persistently pos blood cx);
GU, pna, Streptococcus Can also cause OM, septic arthritis, S. pyogenes, S.   bacteremia, immune condition in 25-45%) arrhythmias; persistent
meningitis, endocarditis, epidural abscess, mycotic anginosis, complexes emboli/veg; mobile/large
OM, lines, aneurysms. Virdans strep, (grlomerulonephritis, veg
hardware. S. mitis Osler's, Roth's, Culture Most commonly 2/2 abx use HACEK, Coxiella,  
Group A Strep Rapidly progressive, necrotizing SSTI Group A strep, IV Penicillin G 4million units rheumatoid factor), negative Recent hx lice = Bartonella Bartonella quintana,
W/U: Use followed by bacteremia is classic S. pyogenes q4h, clindamycin 900mg IV mycotic aneurysm quintana; unpasteurized Bartonella henselae,
Duke's presentation; also 2/2 pharyngitis, pna. q8h x14-21d milk = Brucella; farm animals Brucella, Chlamydia,
criteria r/o Risk factors: burns, surgery, trauma, DM, Duke's criteria: 2 = Coxiella Mycoplasma,
endocarditis. obese, PVD, cancer, immunosuppression. major; 1 major + 3 Tropheryma
Blood cx High mortality minor; 5 minor whipplei, Legionella,
daily, Fungemia EYE EXAM, repeat in 2wk r/o CANDIDA IS   - Major: cx typical, non-Candida fungi
ESR/CRP endophthalmitis; tell pt if vision changes, NEVER A echo Native valve Typically impacts only Strep viridans  
go to ED. MUST GET ECHO. CONTAMINANT - Minor: fever, risk leaflets (underlying
Total Risk factors: lines, IVDA, broad-spectrum factors, septic structural heart dz),
duration of abx, intraabd process (candida lives in GI), emboli, cx atypical S. aureus, coag-neg
therapy TPN staph, enterococcus
starting GNR Typical sources: UTIs, GI tract, biliary Pseudomonas, IV pip/tazo OR IV cefepime OR Amoxicillin 2g x1 ppx (constipation in old
from date of bacteremia tract, SSTIs, device-related infections E. coli, IV ciprofloxacin for dental age), GNR, fungi,
last clear (lines). Acinetobacter, procedure: any HACEK/cx neg
blood cx Causes endocarditis less commonly but if Klebsiella, prosthetic valve, hx Prosthetic Typically starts at interface <2mo after  
valve dz, must r/o. If clears quickly w/ abx Enterobacter IE, recent heart valve b/w prosthesis and native procedure: more
Empiric abx: <24-48h, don't need echo. repair <6mo, cardiac tissue likely coag neg staph,
vanc + Risk factors: stem cell/solid organ xplant, xplant w/ S. epidermidis is most S. aureus
pip/tazo cirrhosis, DM esp w/ HD, pulm dz, HIV, valvulopathy commonly associated w/ >1y: more likely GNR
chronic steroids prosthesis
IVDU- Things to ask in IVDA: S. aureus,   Viridans strep Subacute presentation, Viridans strep Native valve: Penicillin 12-
associated Use bottled or tap to mix drugs? = water Pseudomonas, fever, wt loss, sweating, 80% 18 million units IV
bacteria pseudomonas, serratia, Serratia, oral will have underlying heart dz continuous x4wk *MIC
aeromonas microbes <0.12
Drink from that bottle? Lick needles? = Prosthetic valve: Penicilin
oral bacteria = Strep, prevotella oris, 24 million units IV
eikenella, kingella, actinomyces continuous x4wk
Cigarette paper or cotton filters? = Enterococus Older pt, subacute, intrinsic Enterococus Dual b-lactam therapy
pantoea anglomerans = cotton fever 2/2 abx resistance (ampicillin + ceftriaxone)
toxin S. bovis Colon cancer S. bovis  
Share needles? How do you store S. aureus Fulminant course w/ high S. aureus MSSA native valve: Oxacillin
needles? mortality, often w/o 12g IV (hepatotoxic);
Skin popping? Where? underlying heart dz; Nafcillin (nephrotoxic)
myocardial abscess, MSSA prosthetic valve: ox +
purulent pericarditis, valve rifampin + gentamycin
ring abscess, DIC MRSA: ventamycin; if
prosthetic add rifampin +
gentamycin x6wk
Gram Prosthetics, cirrhosis, IVDA, Pseudomonas Surgery!
negative health-care contact (IVDA), salmonella, E.
coli
HACEK   Haemophilis, Ceftriaxone 2g IV q24h
Actinobacillus *MCC, x4wk
Acinetomyces,
Cardiobacterium,
Eikenella, Kingella
Fungal   Mainly candida Surgery!
Pseudomonas COPD, dialysis, IVDA, recent    
surgery, DM, diabetic foot,
hx pseudomonas
 GRAM POSITIVE GRAM NEGATIVE
Cocci Anaerobes Cocci/Coccobacilli Bacilli
Enterococcus Enterococcus Clostridium Bacteroides GI Haemophilus
Staph Neisseria Proteus
MRSA MSSA Streptococcus Peptostrepto- Fusobacterium Moraxella E. coli Klebsiella Pseudomonas ESCHAPPM Atypicals
epidermidis meningitidis mirabilis
faecium faecalis coccus PO PO influenzae
  IV/PO/IM PCN    
  PO Amoxicillin, IV/PO Ampicillin    
  IV Naf/Oxacillin, PO Dicloxacillin    
  IV Amp-Sul/Unasyn; PO Amox-Clav/Augmentin  
    IV Pip-Tazo/Zosyn *poor CNS  
      1st gen: IV Cefazolin/ PO Cephalexin/PO Cefadroxil  
      2nd gen: IV Cefuroxime/IV Cefotetan/IV Cefoxitin/PO Cefaclor  
      3rd gen: IV Ceftriaxone/PO Cefdinir/Omnicef  
  3rd gen: Ceftazidime  
          IV Cefepime  
+dapt
  5th gen: IV Ceftaroline  
o
  IV Aztreonam  
    IV Meropenam  
    IV Imipenam + Cilastin  
    IV Ertapenam      
  IV/PO Azithromycin  
  PO Clarithromycin  
IV/PO Minocycline      
IV/PO Doxycycline      
IV Tigecycline    
    IV/IM Gentamicin  
    IV/IM Tobramycin  
  IV/PO Ciprofloxacin
  IV/PO Levofloxacin
    IV/PO Moxifloxacin    
  IV/PO Clindamycin  
  IV/PO Metronidazole  
        PO Nitrofurantoin  
  IV/PO TMP/SMX  
IV Vancomycin  
IV/PO Linezolid  
IV Daptomycin                      

ESCHAPPM: Enterobacter, Serratia, Hafnia, Acinetobacter, Providencia, Proteus (not mirabilis), Morganella
Sources: Wellington ICU Antibiotic Summary; Microbiology Syllabus; ID Resident Lectures

ESBL organism: carbapenams, FQs, bactrim, tetracycline, aminoglycosides

CRE organism: cetazidime/avibactam or cetolozane/tazobactam
VRE: linezolid, daptomycin, tigecyclin
Use cidal drugs for endocarditis/bacteremia = b-lactams, AG, FQ, MTZ, dapto, linezolid, vanc, nitro
Penetrates CNS: 3/4th gen cephalosporins, meropenam, vancomycin, PCNs, ampicillin, cefepime, FQs, linezolid
Not good for CNS: aminoglycosides, daptomycin, nitrofurantoin polymixins

Things that cause GI upset are things that work on gram negatives (live in GI), and can cause C. diff
ANTIBIOTICS ARE BAD. WHEN YOU USE ANTIBIOTICS, YOU SELECT FOR RESISTANT ORGANISMS
Treating gram negatives can cause induced resistance
 Drug Notes

B-lactam natural PCN ADE = HS, CNS, GI, myelosuppression (RBC, plt). Use: strep, syphilis, S pyo *renal dose
Penicillinase-resistant PCN ADE = HS, CNS, GI, myelosuppression, AIN. Use: MSSA
Aminopenicillin ADE = HS, CNS, GI, myelosuppression, AIN, diarrhea. Use: listeria, H pylori, Enterococcus/VRE *renal
Aminopenicillin + b-lactamase inh ADE = HS, CNS, GI, myelosuppression. Use: Kleb, H flu, E coli *renal <30
Extended spectrum PCN ADE = HS, CNS, GI, myelosuppression. DOC: pseudomonas *renal dose CrCl <40
B-lactam cephalosporins ADE: C diff, HS, seizures, AIN, x-reactive w/ b-lactam (10%) *renal dose.

Ceftriaxone: Can cause biliary sludge, does not need renal dosing b/c hepatically metabolized
Ceftazidime: Good for dialysis pt (covers pseudomonas + gram neg)
Cefepime: AMS, seizures, HS
Ceftaroline: cytopenias (lymphopenia) *renal dose CrCl <50
B-lactam monobactam ADE: GI, rash *renal dose cut by 50% for CrCl <30; 25% for <20
Low cross-reactivity w/ b-lactam allergy (<1%)
B-lactam carbapenams ADE: C diff, HS, CNS/seizures, GI, AIN, phlebitis, x-reactive w/ b-lactam (5%) *renal dose
Imipenam: seizures in pt w/ renal failure
Ertapenam: good in renal failure, intraabd, q1d, no monitoring
Macrolide ADE: GI, QTc prolongation
Clarithromycin: CYP inh
Tetracycline ADE: GI, pill esophagitis, *cations inh abs (avoid dairy, multivites), gray teeth
Minocycline: drug-induced lupus
Tigecycline: black box inc death, can't use for bacteremia; good for complicated abd infx 2/2 ESBL organisms
Aminoglycoside ADE: Nephrotoxicity, ototoxicity (includes vestibular) *renal dose
Monitor peaks + troughs to keep in therapeutic window, don't use as monotherapy b/c distributes into tissues
FQ ADE: Seizures, dizzy, HA, AMS in elderly, QTc, dysrhythmias, C diff, can't abs w/ cations PO (dairy, multivitamins), hyper/hypoglc in DM,
cartilage malformation in kids/fetus, black box: tendinitis & MG exacerbations *renal dose
Use: pna, TB, chlamydia, campylobacter, salmonella, stenotrophomonas. Can't use moxi in UTIs; can't use levo in pna
Clindamycin ADE: GI, tastes bad, C diff
Use: ORAL anaerobes
Metronidazole ADE: Metallic taste, peripheral neuropathy
Use: ABD/PELVIS anaerobes
Nitrofurantoin ADE: pulmonary fibrosis, cough. Used only for UTIs as concentrates in urine
Bactrim ADE: SJS/TEN, inc Cr up to 20%, ATN/AIN, hyperK, myelosuppresion (plt, neut, gr) *renal dose <30
Vancomycin ADE: Redman (not HS; tx inc infusion time), nephrotoxic, ototoxic, neutropenia *renal dose
Goal trough 10-15 (SSTIs) or 15-20 (everything else) 30min before 4th dose or 4h after HD (~50% cleared)
Use: pna, SSTIs, bacteremia, CNS infx, C diff (PO only, IV has poor bowel distribution)
Linezolid ADE: Myelosuppression (plt esp >2wk tx), 5-HT w/ SSRIs/MAOIs/fentanyl, GI, rash, HA, neuropathy
Use: pna, SSTIs, bacteremia, CNS infx (VRE, failed tx w/ vanco); PO is 100% bioavailable
Daptomycin ADE: Rhabdo/inc CPK/myalgias (HMG CoA reductase inh), HA, dizzy, insomnia *renal dose <30Use: SSTIs, bacteremia,
endocarditis, NOT PNA (inactivated by lung surfactant)*Check CPKs, d/c if CPK >5x ULN w/ sx or >10x w/o sx