Infectious Diseases II

Learning Objectives

Compose a plan to incorporate quality metrics (e.g.,

prevention of catheter-associated urinary tract infec-

tions and catheter-related bloodstream infections)

into pre- and postsurgical care.

tools (including biomarkers and rapid diagnostic

tests) used by an antimicrobial stewardship team.

Provide empiric antibiotic therapy recommendations

for critically ill patients with community-acquired

or health care–associated meningitis.

Evaluate therapeutic options for the treatment of

multidrug-resistant pathogens in the intensive care

unit (ICU).

Devise an optimal treatment plan for critically ill

immunocompromised patients with infectious dis-

eases.

American College of Surgeons National

Surgical Quality Improvement Program

ASP

Antibiotic stewardship program

Antimicrobial susceptibility testing

CAUTI

Catheter-associated urinary tract

infection

CDC

Centers for Disease Control and

Prevention

CLABSI

Central line–associated bloodstream

infection

CLSI

Clinical & Laboratory Standards Institute

CMS

Centers for Medicare & Medicaid

Services

CNS

Central nervous system

CoNS

Coagulase-negative Staphylococci

CRE

Carbapenem-resistant Enterobacterales

CSF

Cerebrospinal fluid

CVC

Central venous catheter

ESBL

Extended-spectrum β-lactamase

HAART

Highly active antiretroviral therapy

IDSA

Infectious Diseases Society of America

ICU

Intensive care unit

KPC

Klebsiella pneumoniae carbapenemase

LOS

Length of stay

ionization/time of flight

MIC

Minimum inhibitory concentration

MRSA

Methicillin-resistant Staphylococcus

aureus

MSSA

Methicillin-susceptible Staphylococcus

aureus

NHSN

National Healthcare Safety Network

OI

Opportunistic infection

PCR

Polymerase chain reaction

PCT

Procalcitonin

PD

Pharmacodynamic(s)

PK

Pharmacokinetic(s)

PNA FISH

Peptide nucleic acid fluorescence in situ

hybridization

SCIP

Surgical Care Improvement Project

SOT

Solid organ transplantation

SSI

Surgical site infection

TJC

The Joint Commission

UTI

Urinary tract infection

WHO

World Health Organization

Self-Assessment Questions

Answers and explanations to these questions can be

found at the end of this chapter.

A 56-year-old man (weight 140 kg) is scheduled to

have elective coronary artery bypass surgery with

aortic valve bioprosthetic replacement. The patient

has a medical history of diabetes and hypertension.

He has no drug allergies and has a calculated CrCl

of 90 mL/minute/1.73 m2. It is anticipated that the

patient will be admitted to the cardiovascular sur-

gery ICU after the surgery with two chest tubes

placed for drainage. Which is the most appropriate

antimicrobial prophylactic regimen for the patient?

sion and administered every 8 hours until chest

tubes are removed.

incision and administered every 12 hours until

48 hours after surgery.

sion, re-dosed if surgery lasts more than 4

hours, and continued for 48 hours after surgery.

re-dosed if surgery lasts more than 4 hours, and

continued for 48 hours after surgery.