Inpatient Antibiotics

Adapted from chalk talks given by Brandon Fainstad, MD and Yilin Zhang, MD
Graphics by Yilin Zhang, MD. 


OBJECTIVES:

  • Identify the spectrum of coverage for the most commonly used inpatient antibiotics
  • Name pathogenic bacteria implicated in common infections (pneumonia, UTI, intra-abdominal and skin and soft tissue)
  • Propose empiric antibiotic regimens for these common sites of infection
  • Optional objectives include:
    • Antibiotics that specifically cover MRSA (additional learning)
    • Review Amp-C inducible organisms and ESBL organisms (in progress!)

Click to skip to Part 2: Sites of Infection


Part 1: Antibiotics and Spectrum of Activity

In evaluating an antibiotic’s spectrum of activity, I ask the following questions:

  1. Does it cover gram positive organisms?
    • Does it cover MRSA?
    • Does it cover Enterococcus? (higher level question)
  2. Does it cover gram negative organisms?
    • Does it cover Pseudomonas?
  3. Does it cover anaerobes?
    • Does it cover Bacteroides (aka intraabdominal anaerobes)?
  4. Does it cover atypical organisms?
    • Mycoplasma, Chlamydophila, Legionella
  5. Does it cover ESBLs (extended spectrum beta-lactamases)? (higher level question)

Board set up: 

Interactive board: Click on each antibiotic section for a pop-up containing teaching script and additional information. 

Final Board: 


Part 2: Sites of Infection

Pneumonia: Interactive Board 

UTI:

Skin and Soft Tissue Infections: Interactive Board

Intra-abdominal Infections:

Final Board:


ADDITIONAL LEARNING:

Review Microbiology 

Antibiotics that cover MRSA 


REFERENCES:

  1. Gilbert, DN, et al. (2017). Sanford guide to antimicrobial therapy 2017. Retrieved from: https://webedition.sanfordguide.com
  2. Mandell, LA et al. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clinical Infectious Diseases. 2007; 44:S27–72
  3. Kalli, AC et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clinical Infectious Diseases. 2016; 63(5):e61–111.
  4. Marik, PE. Aspiration Pneumonitis and Aspiration Pneumonia. NEJM. 2001. 344(9): 665-671.
  5. DiBardino, DM & Wunderink, RG. Aspiration pneumonia: A review of modern trends. Journal of Critical Care. 2015, 30: 40-48.
  6. Gupta, K et al. International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical Infectious Diseases. 2011; 52(5): e103–e120.
  7. Hootn, TM et al. Diagnosis, Prevention, and Treatment of Catheter- Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clinical Infectious Diseases. 2010; 50:625–663
  8. Sievert, DM et al. Antimicrobial-Resistant Pathogens Associated with Healthcare-Associated Infections: Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infect Control Hosp Epidemiol. 2013 ;34(1): 1-14.
  9. Stevens, DL et al. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 2014; 59(2): e10–52.
  10. Anaya, DA & Dellinger, EP. Necrotizing Soft-Tissue Infection: Diagnosis and Management. Clinical Infectious Diseases. 2007; 44: 705–10.
  11. Solomkin, JS et al. Diagnosis and Management of Complicated Intra-abdominal Infection in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clinical Infectious Diseases 2010; 50:133–64