Antibiogram
- Intermediair in EUCAST 'means' higher dose might kills the bacteria. In CLSI, it means preferably not use the antibiotics.
- Longer incubation needed for bacteriostatic antibiotic, for example: clindamycin.
Antibiotic
- Against anaerobes
Antibiotics active against anaerobes: penicilines, first generation cephalosporines, clindamycin and metronidazoles.
- Quinolones
- Against Gram positive: moxifloxacine > levofloxacine > ciprofloxacine
- Against Gram negative, especially Pseudomonas: ciprofloxacine > levofloxacine > moxifloxacine
- Active against anaerob: moxifloxacine.
Treatment
Febrile neutropenia:
- cefepime + amikacin can be given.
Meningitis and brain abces
- There are limited publications of treatment of Acinetobacter meningitis. in EUCAST there is no information cephalosporines susceptibility. Meropenem is one of the possibility.
- Rx/ of brain abses: ceftriaxon, metronidazol, vancomycin (to cover S.aureus, or Strep after fracture/ operation on the head area).
Pneumonia
- In hospital acquired pneumonia: pip/taz --> moxifloxacin (good activity against S. pneumonia, this drug is not good against Pseudomonas)
- In health care associated pneumonia: ceftriaxone
- In community acquired pneumonia: ampicilline --> moxifloxacine
Prostatitis
- Rx/ Bactrim or Ciprofloxacin.
UWI
- Temocillin, 2g 2dd iv. as alternative in treating UWI in case of ESBL and ciprofloxacin resistance.
- Cefuroxim covers a lot of Gram + but also for Gram -: E. coli, Klebsiella and Proteus.
Listeria
- In baby: almost always from mother.
- Mother gets it from food.
Premature rupture of membrane
- Erythromycin (iv) followed by Azithromycin (po)
Skin and soft tisssue infection
- Streptococcus angionosus can give abses, but is almost always susceptible to penicillin.
Toxoplasmose
- Infection in the first trimester: Treatment with spiramycin and ampicillin for mother.
Echinocandin
- Does not accumulated in the urine, so not good for the treatment of fungal in the urine. Then use Fluconazol.
- Fungal infection is mainly hematogenous.
Antibiotics and laboratory
Disk diffusion test
- 15 minutes on room temperature maximum. Reason: antibiotic will have otherwise a quicker start than bacteria. The results will overestimate the antibiotic effect.
- Corkscrew effect (figure): amoxicillin in the middle and third generation cephalosporins and aztreonam around it. This is done to visualize ESBL bacterias.
Don't forget
- Never give aminoglycosides (gentamycin, amikacin) alone.
- Don't give third generation antibiotics to ESCCAPM organisms that can produce cAMP.
- Clindamycin is good agains toxin producing bacteria (for example: GAS).
- Bordetella parapertussis does not grow on agar which has blood content.
- Aerogenes ureaticum often in kidney stone.
- Streptococcus antibiogram not in Muller Hinton but in blood agar.
Recognition of bacteria
Colony:
- Corynebacterium: dry, rugged
- Klebsiella: mucoid
- E. coli: yellow, not mucoid in general on CLED
- Pseudomonas: not mucoid in general, only mucoid in patients with cystic fibrosis.
- Enterococcus: grey, white inside, not dominatn
- Lactobacillus: cloud figure
- Yeast: flat not white top
- In general size: Streptococcus < Enteroccus < Staphylococcus
- Streptococcus angionosus: caramel smell
- Staphylococcus: catalase positive, white,
Gram:
- Corynebacterium: baseball bat, Chinese letters
- Intermediair in EUCAST 'means' higher dose might kills the bacteria. In CLSI, it means preferably not use the antibiotics.
- Longer incubation needed for bacteriostatic antibiotic, for example: clindamycin.
Antibiotic
- Against anaerobes
Antibiotics active against anaerobes: penicilines, first generation cephalosporines, clindamycin and metronidazoles.
- Quinolones
- Against Gram positive: moxifloxacine > levofloxacine > ciprofloxacine
- Against Gram negative, especially Pseudomonas: ciprofloxacine > levofloxacine > moxifloxacine
- Active against anaerob: moxifloxacine.
Treatment
Febrile neutropenia:
- cefepime + amikacin can be given.
Meningitis and brain abces
- There are limited publications of treatment of Acinetobacter meningitis. in EUCAST there is no information cephalosporines susceptibility. Meropenem is one of the possibility.
- Rx/ of brain abses: ceftriaxon, metronidazol, vancomycin (to cover S.aureus, or Strep after fracture/ operation on the head area).
Pneumonia
- In hospital acquired pneumonia: pip/taz --> moxifloxacin (good activity against S. pneumonia, this drug is not good against Pseudomonas)
- In health care associated pneumonia: ceftriaxone
- In community acquired pneumonia: ampicilline --> moxifloxacine
Prostatitis
- Rx/ Bactrim or Ciprofloxacin.
UWI
- Temocillin, 2g 2dd iv. as alternative in treating UWI in case of ESBL and ciprofloxacin resistance.
- Cefuroxim covers a lot of Gram + but also for Gram -: E. coli, Klebsiella and Proteus.
Listeria
- In baby: almost always from mother.
- Mother gets it from food.
Premature rupture of membrane
- Erythromycin (iv) followed by Azithromycin (po)
Skin and soft tisssue infection
- Streptococcus angionosus can give abses, but is almost always susceptible to penicillin.
Toxoplasmose
- Infection in the first trimester: Treatment with spiramycin and ampicillin for mother.
Echinocandin
- Does not accumulated in the urine, so not good for the treatment of fungal in the urine. Then use Fluconazol.
- Fungal infection is mainly hematogenous.
Antibiotics and laboratoryDisk diffusion test
- 15 minutes on room temperature maximum. Reason: antibiotic will have otherwise a quicker start than bacteria. The results will overestimate the antibiotic effect.
- Corkscrew effect (figure): amoxicillin in the middle and third generation cephalosporins and aztreonam around it. This is done to visualize ESBL bacterias.
Don't forget
- Never give aminoglycosides (gentamycin, amikacin) alone.
- Don't give third generation antibiotics to ESCCAPM organisms that can produce cAMP.
- Clindamycin is good agains toxin producing bacteria (for example: GAS).
- Bordetella parapertussis does not grow on agar which has blood content.
- Aerogenes ureaticum often in kidney stone.
- Streptococcus antibiogram not in Muller Hinton but in blood agar.
Recognition of bacteria
Colony:
- Corynebacterium: dry, rugged
- Klebsiella: mucoid
- E. coli: yellow, not mucoid in general on CLED
- Pseudomonas: not mucoid in general, only mucoid in patients with cystic fibrosis.
- Enterococcus: grey, white inside, not dominatn
- Lactobacillus: cloud figure
- Yeast: flat not white top
- In general size: Streptococcus < Enteroccus < Staphylococcus
- Streptococcus angionosus: caramel smell
- Staphylococcus: catalase positive, white,
Gram:
- Corynebacterium: baseball bat, Chinese letters
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