Infectious Diseases I

more than 48 hours after endotracheal intubation

is no longer recommended.

during the first 5 days

Prior intravenous antibiotic therapy in preceding 90 days

Elevate head of bed to 30–45 degrees.

Avoid oral care with chlorhexidine to prevent VAP

Avoid the use of probiotics to prevent VAP in mechanically ventilated patients.

noninvasive sampling with semiquantitative cultures

PSB less than 1000 CFU/mL; BAL less than 10,000 CFU/mL

MSSA, P. aeruginosa, and other gram-negative bacilli.

greater than 10% of gram-negative isolates resistant to an agent being considered for monotherapy

ICU MRSA prevalence greater than 10%–20% of S. aureus.

ICU-specific antibiogram

two antipseudomonal antibiotics from different classes

MRSA: Vancomycin or linezolid

direct inhibition by pulmonary surfactant.

immunocompetent patients not in septic shock and not at a high risk of dying.

immunocompromised patients and those in septic shock or at a high risk of dying.

Carbapenem (e.g., ertapenem; imipenem; meropenem)

7 days for all patients rather than longer durations.

beyond treatment day 3

Fever is the most sensitive clinical finding

inflammation or purulence at the insertion site is the most specific.

paired blood cultures drawn from the catheter (at least one hub/port) and from a peripheral vein

at least two blood cultures be obtained through different catheter hubs/ports.

Catheter removal should be considered in all patients with a confirmed CLABSI.

Vancomycin or daptomycin are preferred; linezolid should not be used for empiric management of CLABSI.

Use of an echinocandin (eg, anidulafungin, caspofungin, or micafungin)

first day of negative blood culture.

4–6 weeks; 6–8 weeks for osteomyelitis.

5–7 days if the catheter is removed.

a minimum of 14 days.

at least 14 days.

primarily for catheter salvage.

7–14 days.

Pyuria without signs and symptoms does not indicate CAUTI;

absence of pyuria in a symptomatic patient suggests a diagnosis other than CAUTI.

Samples from the catheter collection system (e.g., catheter bag) should be avoided

longer than 2 weeks, the catheter should be removed or, if still indicated, replaced

before initiation of antimicrobial therapy.

7 days for patients with resolution of signs and symptoms within 72 hours

up to 14 days in patients with resolution after 72 hours.

infection that extends beyond the hollow viscus of origin into the peritoneal space and is associated with either abscess formation or peritonitis.

peritonitis related to bacterial translocation of proximal small bowel overgrowth and not peritoneal disruption or organ perforation.

leakage of intraluminal fluid and microorganisms secondary to macro- or microperforation of the GI tract.

peritonitis that persists or recurs at least 48 hours after the management of primary or secondary peritonitis.

Secondary peritonitis is typically polymicrobial

operative diversion or resection

percutaneous abscess and fluid drainage.

aerobic and facultative enteric gram-negative bacilli and enteric streptococci.

distal small bowel, appendiceal, or colonic sources.

Either ceftriaxone or cefotaxime in combination with metronidazole (generally considered first line)

Anti-enterococcal and antipseudomonal therapies are not recommended.

MDR Gram negative bacilli (e.g., P. aeruginosa) and obligate anaerobes.

Echinocandins should be used first line in critically ill patients until final culture results are available.

limiting antimicrobial therapy to 4 days after achieving source control

limiting antimicrobial therapy to 8 days in critically ill patients after achieving source control

pancreatitis associated with organ failure that persists for more than 48 hours.

presence of pathogenic microorganisms in the necrotic tissue.

two of the following three features:

greater than 3 times the upper limit of normal

enteral nutrition by nasogastric or nasojejunal access over parenteral nutrition.

suspected or confirmed infected necrosis or pancreatic abscess.

Piperacillin-tazobactam or broad-spectrum carbapenems (e.g., imipenem; meropenem)

if yeast is identified on culture Gram stain.

Characteristic findings of acute pancreatitis on CT scan or magnetic resonance imaging.

do not support routine use of prophylactic antibiotic or antifungal therapy in patients with sterile necrotizing pancreatitis.

up to 14 days.

a spore-forming, anaerobic, gram-positive bacillus.

C. difficile toxin A (TcdA) and C. difficile toxin B (TcdB).

WBC 15 x 103 cells/mm3 or greater

1.5 times or greater than the premorbid level

Hypotension or evidence of shock; Ileus; Megacolon

Antibiotic therapy is the most important risk factor.

clindamycin, fluoroquinolones, cephalosporins/carbapenems, and penicillins.

three or more unformed stools within 24 consecutive hours.

only be performed on unformed stool unless patients have ileus.

Discontinue unnecessary gastric acid–reducing pharmacotherapy.

poor sensitivity may limit their utility.

risk of potential false-positive results.

multistep laboratory process that includes a toxin test (e.g., NAAT plus toxin assay)

fidaxomicin as first-line therapy for first episode, non-fulminant CDI

125 mg four times daily for uncomplicated/nonfulminant CDI

in addition to oral vancomycin for the treatment of severe-complicated/fulminant CDI.

Results of stool testing for C. difficile in patients with resolution of disease do not predict recurrence.

Fidaxomicin 200 mg PO/NG/FT BID for 10 days

Vancomycin 125 mg PO/NG/FT 4 times daily for 10 days

Vancomycin 500 mg PO/NG/FT 4 times daily + metronidazole 500 mg IV TID

Recommend fidaxomicin for first recurrence after initial course of vancomycin or metronidazole

Bezlotoxumab 10 mg/ kg IV once during administration of above antibiotics

Recommend fecal microbiota transplant (FMT) to prevent further recurrences

Severe pain that seems disproportional to the appearance of the wound

Opening of the incision, evacuation of the infected material, and continued dressing changes

No antibiotic therapy necessary

every 24–48 hours

Vancomycin or linezolid

Piperacillin/tazobactam, broad-spectrum carbapenem, or cefepime plus metronidazole

potential decrease in pathogenic toxin and cytokine production

until surgical debridement is no longer necessary and until resolution of infection-related signs and symptoms.

Annual vaccination remains the primary tool for influenza prevention.

viral culture or RT-PCR.

within 48 hours from onset of symptoms.

even 5 days after symptoms in critically ill patients.

Neuraminidase inhibitors continue to be the mainstay of antiviral therapy for recent influenza A and B strains.

Oseltamivir is the drug of choice for hospitalized patients with severe influenza.

Oseltamivir can be administered to critically ill patients by orogastric or nasogastric tube.

increased hospital mortality in adult patients

they are not viable options for the management of contemporary influenza.

75 mg twice a day for 5 days

Longer durations of up to 14 days may be needed for severely ill patients.

SARS-CoV-2

COVID-19 diagnosis is confirmed using RT-PCR.

6 mg per day orally or intravenously for up to 10 days or until hospital discharge

Hospitalized patients requiring high-flow oxygen, noninvasive or invasive mechanical ventilation, or ECMO should receive prophylactic heparin.

Anti-IL-6 receptor monoclonal antibody

tocilizumab 8 mg/kg actual body weight (max of 800 mg)

Baricitinib: Janus kinase inhibitor

Baricitinib can be administered orally or via oral dispersion or gastrostomy or nasogastric tube.

baricitinib 4 mg/day (renally-adjusted as necessary) orally

binds to viral RNA polymerase, terminating RNA transcription and inhibiting viral replication.

200 mg intravenously once, then 100 mg intravenously daily for 5 days