Grampositive bacteria Staphylococci Staphylococcus aureus causes a variety
Gram-positive bacteria: Staphylococci
Staphylococcus aureus causes a variety of suppurative (pus-forming) infections and toxinoses in humans. It causes superficial skin lesions such as boils, styes and furunculosis; more serious infections such as pneumonia, mastitis, phlebitis, meningitis, and urinary tract infections; and deep-seated infections, such as osteomyelitis and endocarditis. S. aureus is a major cause of hospital acquired (nosocomial) infection of surgical wounds and infections associated with indwelling medical devices. S. aureus causes food poisoning by releasing enterotoxins into food, and toxic shock syndrome by release of superantigens into the blood stream.
Staphylococcus aureus • http: //www. visualdxhealth. com/pdfs/MRSA %20 Handout. pdf
Superantigens • http: //highered. mcgrawhill. com/sites/0072556781/student_view 0/ chapter 32/animation_quiz_4. html
Treatment of Infections Caused by Staphylococcus aureus • Antistaphylococcal penicillins: Nafcillin, oxacillin • First Generation cephalosporins: Cefazolin • Second Generation Cephalosporins: Cefurxime • Third-generation cephalosporins: Ceftriaxone, cefotaxime, ceftizoxime • B-Lactam/b-lactamase inhibitor combinations: Ampicillin-sulbactam, piperacillin-tazobactam, ticarcillin-clavulanate • Carbapenems: Imipenem, meropenem
Treatment of Methicillin-resistant Staphylococcus aureus • • • Vancomycin Linezolid Streptogramins (Quinupristin-dalfopristin) Daptomycin Tigecycline
Gram-positive pathogens: Streptococcus pneumoniae
Streptococcus pneumoniae
Treatment of Streptococcus pneumoniae • Penicillin G • Aminopenicillins: Ampicillin
Treatment of Penicillin-resistant Streptococcus pneumoniae • Second Generation Cephalosoporins: Cefuroxime • Third Generation Cephalosporins: Cefotaxime, Ceftriaxone • Quinolones: Moxifloxacin, Levofloxacin • Vancomycin • Macrolides/ketolines: Telithromycin
Streptococcus pyogenes
Streptococcus pyogenes
Treatment of Streptococcus pyogenes • Penicillin G • Aminopenicillins: Ampicillin • Aminoglycosides are sometimes added for synergy: Gentamicin • Clindamycin is added for severe invasive Streptococcus pyogenes infections
Treatment for Penicillin-resistant Streptococcus pyogenes (and other penicillin resistant Streptococcus) • Vancomycin • Second-generation cephalosporins: Cefuroxime • Third-generation cephalosporins: cefotaxime, ceftriaxone
Enterococci
Enterococcus
Enterococcus Resistance Mechanisms
Treatment of Infections Caused by Enterococcus • • • Penicillin G Aminopenicillins: Ampicillin Extended-spectrum Penicillins: Piperacillin Carbapenems: Imipenem, meropenem For serious infections, add an aminoglycoside for synergy: Gentamicin
Treatment for Infections Caused by Penicillin-resistant Enterococci • Vancomycin
Treatment for Vancomycin Resistant Enterococci (VRE) • Linezolid • Tetracycline-like: Tigecycline • Sometimes also active: – Daptomycin – Quinupristin/dalfopristin
Gram-positive Bacteria: Listeria Monocytogenes
Listeria monocytogenes • http: //www. nature. com/nrmicro/animation/i mp_animation/index. html
Treatment of Infections Caused by Listeria monocytogenes • Ampicillin + Gentamicin • If penicillin allergic: – Trimethoprim-sulfamethoxazole
Bacillus anthracis
Bacillus anthracis
Bacillus anthracis
Treatment of Infections Caused by Bacillus anthracis • Quinolones: Ciprofloxacin • Tetracycline: Doxycycline
Treatment of Infections Caused by Bacillus anthracis • For Inhalation Anthrax, a Second Agent Should be Added from the Following List: – – – – Rifampin Vancomycin Penicillin G Ampicillin Chloramphenicol Carbapenem: Imipenem Clindamycin Macrolide: Clarithromycin
Gram-negative Bacteria: Enterobacteriaceae
Escherichia coli
Klebsiella
Proteus
Escherichia coli. • http: //www. hhmi. org/biointeractive/media/e coli-lg. mov • http: //www. drkoop. com/animation/93/43. ht ml
Treatment of Infections Caused by: E. coli. , K. pneumoniae, Proteus • Aminopenicillins: Ampicillin • First Generation Cephalosporins: Cefazolin • Sulfa drugs: Trimethoprimsulfamethoxazole • Quinolones: Ciprofloxacin, levofloxacin, moxifloxacin
Treatment of Resistant Infections Caused by: E. coli. , K. pneumoniae, Proteus • Third Generation Cephalosporins: Cefoxaxime, ceftriaxone, ceftizoxime • Monobactam: Aztreonam • Extended Spectrum penicillins + blactamase inhibitor: Piperacillintazobactam, ticarcillin-clavulanate • Carbapenems: Imipenem, meropenem, ertapenem • Carbapenem + aminoglycoside in serious infections: Add Gentamicin, Tobramycin, amikacin
Treatment of Infections Caused by: Enterobacter, Serratia, Citrobacter, Providencia, and Morganella Spp. • Carbapenems: Imipenem, meropenem, ertapenem • Sulfa Drugs: Trimethoprimsulfamethoxazole • Quinolones: Ciprofloxacin, levofloxacin • Fourth Generation Cephalosporins: Cefepime • + aminoglycoside: Gentamicin, tobramycin, amikacin
Treatment of Infections Caused by: Salmonella enterica, Shigella spp. • Quinolones: Ciprofloxacin • Third-generation cephalosporins: Cefotaxime, ceftriaxone, ceftizoxime • Macrolides: Azithromycin
Treatment of Infections Caused by: Yersinia spp. • Aminoglycosides: Gentamicin, streptomycin • Tetracyclines: Doxycycline • Quinolones: Ciprofloxacin • Sulfa drugs
Gram-negative Bacteria: Pseudomonas
Pseudomonas
Resistance of Pseudomonas
Treatment of Infections caused by Pseudomonas aeruginosa • Extended spectrum penicillins: Piperacillin, Ticarcillin • Third Generation Cephalosporins: Ceftazidime • Fourth-generation Cephalosporins: Cefepime • Carbapenems: Imipenem, meropenem • Monobactams: Aztreonam • Quinolones: Ciprofloxacin, Levofloxacin • Aminoglycosides: Gentamicin, tobramycin, amikacin
Treatment of Serious Infections Caused by Pseudomonas aeruginosa • Antipseudomonal b-lactam + aminoclycoside: Ceftazidime + Tobramycin • Extended-spectrum penicillin + antipseudomonal quinolone: Piperacillin + Ciprofloxacin
Neisseria
Neisseria meningitidis
Neisseria gonorrhoeae
Treatment of Infections Caused by Neisseria meningitidis • Penicillin G • Third generation cephalosporins: Ceftriaxone, cefotaxime
Treatment of Infections Caused by Neisseria Gonorrhoeae • Third Generation Cephalosporins: Ceftriaxone, cefixime
Curved Gram Negative Bacilli • Includes: – Campylobacter jejuni, – Helicobacter pylori, – Vibrio cholerae
Campylobacter jejuni
Campylobacter jejuni
Treatment of Infection Caused by Campylobacter jejuni • Macrolides: Erythromycin, azithromycin, clarithromycin • Quinolones: Ciprofloxacin
Helicobacteri pylori
Helicobacter pylori
Helicobacter pylori
Duodenal Peptic Ulceration Caused by Helicobacter pylori
Treatment of Infection Caused by Helicobacter pylori • Amoxicillin + clarithromycin + proton pump inhibitor • Metronidazole + clarithromycin + proton pump inhibitor • Bismuth subsalicylate + metronidazole + tetracycline + proton pump inhibitor
Vibrio cholerae
Vibrio cholerae
Treatment of Infection Caused by Vibrio cholerae • Tetracyclines: tetracycline, doxycycline • Sulfa drugs: Trimethoprimsulfamethoxazole • Quinolones: Ciprofloxacin • Macrolides: Erythromycin, Azithromycin
Haemophilus influenzae
Haemophilus influenzae
Haemophilus influenzae
Treatment of Infections Caused by Haemophilus influenzae • Aminopenicillins + b-lactamase inhibitor: – Amoxicillin/clavulanate – Ampicillin/sulbactam • Second-generation cephalosporin – Cefuroxime • Third-generation cephalosporin – Ceftriaxone – Cefotaxime
Bordetalla pertussis
Bordetella pertussis
Treatment of Infection Caused by Bordetella pertussis • Macrolides: Azithromycin, Clarithromycin, Erythromycin
Moraxella catarrhalis • Causes otitis media, pneumonia, and sinusitis • Usually produces b-lactamase
Treatment of Infections Caused by Moraxella catarrhalis • Extended spectrum penicillins: piperacillin, ticarcillin • B-lactam/b-lactamase inhibitor combinations: piperacillin/tazobactam, ticarcillin/clavulanate • Second and third-generation cephalosporins
Acinetobacter • Recent outbreak among soldiers in Iraq • Second leading cause of infection among troops during the Vietnam conflict
Acinetobacter
Treatment of Infection Caused by Acinetobacter • Sulbactam • Carbapenems • Quinolones
Anaerobic Bacteria Gram positive: Clostridia spp.
Clostridium tetani • Clostridium tetani is the etiologic agent of tetanus • Characterized by persistent tonic spasm, usually involving the masseter muscles (lockjaw) • Usually caused by deep wound becoming infected with C. tetani spores.
Clostridium botulinum • Clostridium botulinum is usually acquired by ingestion of food contaminated with C. botulinum spores • Botulinum toxin leads to cranial neuroopathies and weakness rather than muscular spasm.
Treatment of Infections Caused by Clostridium spp. • Penicillin G • Metronidazole (may be associated with better outcomes
Clostridium difficile
Clostridium difficile
Treatment of Infections Caused by Clostridium difficile • Oral metronidazole • Oral vancomycin
Clostridium perfringens is the cause of gas gangrene
Treatment of Infections Caused by Clostridium perfringens • Penicillin + one of the following: – Clindamycin – Tetracycline – Metronidazole
Anaerobic Gram-negative Bacteria
Common Anaerobic Gram-negative Pathogens • Bacteroides fragilis – Usually produces b-lactamase • Prevotella • Porphyromonas
Treatment of Anaerobic Gramnegative Infections • b-lactam/b-lactamase inhibitor combinations – Ampicillin-sulbactam – Piperacillin-tazobactam – Ticarcillin-clavulanate • Carbapenems: Imipenem, Meropenem, Ertapenem • Metronidazole
Atypical Bacteria: Chlamydia
Chlamydia trachomatis • One of the most common sexually transmitted diseases • Also a leading cause of blindness in some parts of the world
Chlamydia trachomatis Chlamydia is a bacterial infection of the genital tract spread through sexual contact. If untreated, it can result in various medical complications, including damage to the reproductive organs. The disease affects both women and men, although reported cases for women greatly exceed those for men. Chlamydia affects people in all age groups, but it is particularly prevalent among teenagers and young adults. According to the U. S. Centers for Disease Control and Prevention (CDC), the infection is most prevalent among women aged 20 to 25.
Chlamydia trachomatis Some signs and symptoms that may be present in people infected with chlamydia are: • • • Abnormal discharge from the penis or vagina Burning sensation during urination Lower abdominal or back pain Nausea Fever Pain during intercourse Burning or itching around the head of the penis Swollen or tender testicles Bleeding between menstrual cycles Proctitis (inflammation of the rectum)
Treatment of Infections Caused by Chlamydia trachomatis • Tetracyclines – Tetracycline – Doxycycline • Macrolides – Azithromycin – Erythromycin – Telithromycin • Quinolones – Ofloxacin – Moxifloxacin – Gemifloxacin
Mycoplasma pneumoniae
Mycoplasma pneumoniae
Treatment of Infections Caused by Mycoplasma pneumoniae • Macrolides: Azithromycin, clarithromycin, erythromycin telithromycin • Tetracyclines: Tetracycline, doxycycline • Quinolones: Levofloxacin, moxifloxacin, gemifloxacin
Atypical Bacteria: Legionella • Legionella pneumophila is the most common species, and is the causative agent of Legionaires’ disease • Once in the lung, Legionella organisms are taken up by macrophages and multiply within them.
Legionalla pneumophila • http: //www. natur e. com/nrmicro/a nimation/imp_an imation/index. ht ml
Treatment of Infections Caused by Legionella pneumophila • Macrolides: Azithromycin • Quinolones: Levofloxacin, moxifloxacin
Brucella • Brucellosis is a disease of animals, that is occasionally transmitted to humans • Contact with animals and/or ingestion of unpasteurized milk or cheese are risk factors
Brucella
Brucella
Treatment of Infections Caused by Brucella spp. • Doxycycline + rifampin • Dixycycline + gentamicin • Doxycycline + streptomycin
Francisella tularensis
Francisella tularensis
Treatment of Infections Caused by Francisella tularensis • Aminoglycosides: Streptomycin, Gentamicin • Tetracyclines: Tetracycline, doxycycline
Rickettsia spp
Rickettsia rickettsii Rocky Mountain spotted fever is the most severe and most frequently reported rickettsial illness in the United States. The disease is caused by Rickettsia rickettsii, a species of bacteria that is spread to humans by ixodid (hard) ticks.
Treatment of Infections Caused by Rickettsia spp. • Tetracyclines – Doxycycline – Tetracycline
Spirochetes: Treponema pallidum
Treponema pallidum
Treponema pallidum
Treponema pallidum
Treatment of Infections Caused by Treponema pallidum • Penicillin G (including benzathine penicillin) • Tetracyclines • Third Generation Cephalosporins
Penicillin G benzathine
Procaine penicillin G http: //www. chemblink. com/products/54 -35 -3. htm
Borrelia borgdorferi
Borrelia burgdorferi
Borrelia burgdorferi is the causative agent of Lyme Disease
Treatment of Infections Caused by Borrelia burgdorferi • Tetracyclines: Doxycycline • Aminopenicillins: Amoxicillin
Leptospira interrogans
Leptospira interrogans
Treatment of Infection Caused by Leptospira interrogans • Tetracyclines: Doxycycline • Aminopenicillins: Amoxicillin • Severe Disease can be treated with Penicillin G, Ampicillin, or Ceftriaxone
Mycobacteria • Mycobacterium tuberculosis • Mycobacterium avium complex • Mycobacterium leprae
Mycobacterium tuberculosis
Mycobacterium tuberculosis
Mycobacterium tuberculosis
Treatment of Infections Caused by Mycobacterium tuberculosis • Active Disease – Isoniazid + Rifampin + Pyrazinamide + Ethambutol for two months – Followed by: Isoniazid + Rifampin for Four months • Latent Disease – Isoniazid for 9 months
Mycobacterium avium complex
Mycobacterium avium complex
Treatment of Infections Caused by Mycobacterium avium complex (MAC) • Clarithromycin + ethambutol + rifabutin
Mycobacterium leprae
Mycobacterium leprae
Leprosy
Treatment of Infections Caused by Mycobacterium leprae • Dapsone + rifampin + clofazimine
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