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.mcgraw-hill.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 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/imp_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/ecoli-lg.mov http://www.drkoop.com/animation/93/43.html

Treatment of Infections Caused by: E. coli., K. pneumoniae, Proteus Aminopenicillins: Ampicillin First Generation Cephalosporins: Cefazolin Sulfa drugs: Trimethoprim-sulfamethoxazole Quinolones: Ciprofloxacin, levofloxacin, moxifloxacin

Treatment of Resistant Infections Caused by: E. coli. , K Treatment of Resistant Infections Caused by: E. coli., K. pneumoniae, Proteus Third Generation Cephalosporins: Cefoxaxime, ceftriaxone, ceftizoxime Monobactam: Aztreonam Extended Spectrum penicillins + b-lactamase inhibitor: Piperacillin-tazobactam, 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: Trimethoprim-sulfamethoxazole 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: Trimethoprim-sulfamethoxazole 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 Gram-negative 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.nature.com/nrmicro/animation/imp_animation/index.html

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