Uncomplicated and wo risk of MDRP similar pathogens as for cystitis Complicated

Uncomplicated and wo risk of mdrp similar pathogens

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Uncomplicated and w/o risk of MDRP: similar pathogens as for cystitis Complicated or at risk of MDRP In severe illness, initial empiric therapy is broad Pyelonephritis - Empiric Treatment 1st line (for those not requiring hospitalization) FQ Levo 750 mg x 5D Cipro 500 mg BID x 7D if local resistance to FQ > 10% consider 1 time dose of IV ceftriaxone or consolidated 24h dose of aminoglycoside Moxi not used for UTIs Other options Bactrim 800/160 mg BID x 14D (if susceptibility known) Oral ß-lactams may be less effective but can be used Require longer courses of therapy Need amox for enterococcus In more severe illness, hospitalization with administration of IV antibiotics is warranted IV FQ, IV ß-lactams (ceftriaxone, cefepime, piperacillin/tazobactam, meropenem, impenem, ertapenem), aminoglycosides should all be used UTIs in Males Always considered complicated Prolonged therapy Single-dose or short course not recommended Duration of therapy usually 7-14 days Asymptomatic Bacteriuria Diagnosis Women: 2 consecutive voided urine specimens w/ same bacterial strain or 1 catheterized urine specimen Men: 1 or the other 10^5 bactera/ml Not an indication for treatment unless patient has specific indications Pregnancy (duration of 3-7 days) Transurethral resection of prostate Urologic procedure with anticipated mucosal bleeding Catheter-acquired bacteriuria persisting > 48h after removal of catheter Nitrofurantoin and fosform z go PFM g og bat
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Rapid Diagnostic Testing Current Diagnostic Options Conventional Phenotype methods Positive blood culture —> gram-stain —> biochemical test Rapid Diagnostic Blood cultur —> gram stain —> rapid diagnostic test Difference between methods Time Conventional: 48-72 h Rapid: within hours Conventional Identification Media inoculation and microbial growth monitorin Gram stain Subculture colonies to agar Identification Susceptibility testing Rapid diagnostics Benefit Much faster Easy detection of resistance mechanism Sensitive: true positive rate Specific: true negative rate Available Rapid Diagnostic Test PCR Multiplex PCR Nucleic acid extraction and PCR amplification PNA FISH MALDI-TOF T2 magnetic resonance Accelerate phenotest PCR (blood, stool) Amplification of target piece of DNA plus organism identification Examples BD GeneOhm’s Cdiff assay Rapid molecular detection of toxigenic C. Difficile Multiplex PCR Amplification of target piece of DNA plus organism detection Examples Biofire diagnostics film array products BCID (blood culture identification panel) Tests for 24 organisms and 3 resistance genes Resistance genes: MecA (methicillin resistance); Van A/B (vanc resistance in enterococci); KPC (carbapenemase producing organism) GI Panel
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Tests for common GI pathogens
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  • Fall '19
  • Tetracycline, UTI, Ceftriaxone

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