Community-acquired bacterial infections

The most frequent etiologic agents of bacterial tonsillitis and tonsillopharyngitis are Streptococcus pyogenes strains (80-90 %).

Initial antibiotic therapy of bacterial Initial antibiotic therapy of bacterial tonsillitis and tonsillopharyngitistonsillitis and tonsillopharyngitis

Antibiotics of I. choiceAntibiotics of I. choice– penicillin (3-4 x daily)penicillin (3-4 x daily)– macrolides (in patients with allergy to macrolides (in patients with allergy to

penicillins)penicillins)

Etiology and treatment of Etiology and treatment of peritonsillar and tonsillar abscessperitonsillar and tonsillar abscess

Etiology:– Streptococcus pyogenes– anaerobic microbes

(Peptostreptococcus sp.)

ATB of I. choice:– penicillin

Alternative ATB:– clindamycin

Pneumonia–typical –atypical

Pneumonia–community-acquired–hospital-acquired (nosocomial)

Etiology of pneumoniaEtiology of pneumonia–typical pneumonia

Streptococcus pneumoniae Haemophilus influenzae Moraxella (Branhamella) catarrhalisStaphylococcus aureusKlebsiella pneumoniaeother

Etiology of pneumoniaEtiology of pneumonia

atypical pneumoniaatypical pneumonia Chlamydophila pneumoniaeChlamydophila pneumoniaeChlamydophila psittaciChlamydophila psittaciMycoplasma pneumoniaeMycoplasma pneumoniaeLegionella pneumophilaLegionella pneumophilaothersothers

According the data from According the data from olomouc region it is possible olomouc region it is possible

to make a conclusion:to make a conclusion:

typical pneumonias form about 65 %

atypical pneumonias form about 35 %– chlamydia pneumonias 24 % – mycoplasma pneumonias 11 %

Etiology of pneumonia Etiology of pneumonia in children in children

Haemophilus influenzaeMycoplasma pneumoniae

(mainly in children 5 years old and older)

Streptococcus pneumoniaeKlebsiella pneumoniae

According the data from olomouc According the data from olomouc region it is possible to make a region it is possible to make a

conclusion (etiology of conclusion (etiology of pneumonia in children):pneumonia in children):

–Haemophilus influenzae 36 %–Mycoplasma pneumoniae 25 %–Klebsiella pneumoniae 14 %–Streptococcus pneumoniae 11 %–others 14 %

Initial antibiotic therapy of Initial antibiotic therapy of community-acquired pneumoniacommunity-acquired pneumonia

Drug ofDrug of I. I. choicechoice

– amoxicilamoxicilllinin

Alternative antibioticsAlternative antibiotics

– mamaccrolidrolideses ( (e.g. ce.g. claritlarithhromycinromycin, azithromycin, azithromycin))

– doxycycline (in adults and children older than 12 years)doxycycline (in adults and children older than 12 years)

Etiology and treatment of Etiology and treatment of otitis media acutaotitis media acuta

Etiology:– Streptococcus

pneumoniae– Haemophilus influenzae– Moraxella (B)

catarrhalis

Antibiotic of I. choice:– amoxicillin

Alternative antibiotic:– amoxicillin/clavulanic acid– ampicillin/sulbactam– cephalosporins II. gen.

(cefuroxime, cefprozil)– in patients with allergy to

penicilllins - macrolides

Etiology and treatment of Etiology and treatment of otitis media chronicaotitis media chronica

Etiology:– gram-negative rods

(Proteus sp., Pseudomonas aeruginosa)

– Staphylococcus aureus– anaerobic microbes

ATB of I. choice:– fluorochinolones (ofloxacin,

ciprofloxacin)

Alernative ATB:– gentamicin– ceftazidime– gentamicin+ceftazidime

Etiology and treatment of sinusitis acutaEtiology and treatment of sinusitis acuta

Etiology:– Streptococcus

pneumoniae Haemophilus influenzae

– Moraxella (B) catarrhalis

Antibiotic of I. choice:– amoxicillin

Alternative antibiotic:

– amoxicillin/clavulanic acid

– ampicillin/sulbactam

– cephalosporins II. gen. (cefuroxime,

cefprozil)

– in patients with allergy to penicilllins -

macrolides

Etiology and treatment of Etiology and treatment of epiglottitisepiglottitis

Etiology:– Haemophilus

influenzae type b

ATB of I. choice:– cephalosporins of III. generation– ampicillin– amoxicilin/clavulanic acid– ampicillin/sulbactam– cefuroxime

Alternative ATB:– chloramfenikol

(in case of allergy to penicillins)

Etiology of community-acquired Etiology of community-acquired urinary tract infectionsurinary tract infections

Escherichia coli

Proteus mirabilis

Enterococcus faecalis

Streptococcus agalactiae

others

Initial antibiotic therapy of community-Initial antibiotic therapy of community-acquired urinary tract infectionsacquired urinary tract infections

Drug of I. choiceDrug of I. choice– nitrofurantoin, cotrimoxazol, trimethoprim, nitrofurantoin, cotrimoxazol, trimethoprim,

amoxicillin, oxolinic acidamoxicillin, oxolinic acid

Alternative antibioticsAlternative antibiotics– amoxicillin/clavulanic acidamoxicillin/clavulanic acid– ampicillin/sulbactamampicillin/sulbactam– cephalosporins II. gen. (cefuroxime, cefprozil)cephalosporins II. gen. (cefuroxime, cefprozil)

Hospital-acquired Hospital-acquired bacterial infectionsbacterial infections

Therapy in early-onset Therapy in early-onset hospital-acquired pneumoniahospital-acquired pneumonia

ampicillin/sulbactam

or

amoxicillin/clavulanic acid

event. + gentamicin

Therapy in late-onset Therapy in late-onset hospital-acquired pneumoniahospital-acquired pneumonia

carbapenem (imipenem, meropenem)or

piperacillin-tazobactam

event. + aminoglycoside

Etiologic agents of HAP in ICUs Etiologic agents of HAP in ICUs (University Hospital Olomouc)(University Hospital Olomouc)