Transcript Document 7190929

Gram-positive bacteria:
Staphylococci
Staphylococcus aureus
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
%20Handout.pdf
Superantigens
• http://highered.mcgrawhill.com/sites/0072556781/student_view0/
chapter32/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
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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
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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:
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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
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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:
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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
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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