Managing a patient presenting with suspected infection

Question 1

what are the 3 steps for diagnosing an infection?

Answer 1

-Does patient have an infection or is it something else
-Is it: bacterial, viral, fungal or parasitic
-Which specific infection does the patient have: pneumonia, UTI, TB

Question 2

To determine a diagnosis what must be carried out:

Answer 2

-History taking
-Clinical examination - relevant to symptoms
-Investigation / Tests - determine type of pathogen or rule out diagnosis

Question 3

What to ask a patient about a medical and medication history?

Answer 3

-Do you take any prescribed medicine
-What are the name/s of the drug/s
-What is it for
-How often do you take the medication
-When was it started
-Do you take any thing otc
-Do you use any ear drops, eye drops inhalers, patches, injection, creams, gels, ointments, suppositories
-Do you have any allergies, if so what is experienced
-Occupational history
-Recreational use
-smoking
-alcohol

Question 4

What are the generic symptoms of an infection?

Answer 4

-Fever
-Chills
-Headache
-Fatigue
-Malaise
-Muscle aches
-Joint aches
-Swollen lymph nodes

Question 5

What are the symptoms of a respiratory infection? (upper tract infection)

Answer 5

-Sneezing
-Runny nose
-Nasal congestion
-Nasal discharge
-Scratchy or sore throat
-Pain when swallowing
-Coughing
-Sinus pain

Question 6

What are the symptoms of a UTI?

Answer 6

-Back or flank pain (area above the buttock)
-Pelvic pressure
-Lower abdominal discomfort
-Pain or burning when urinating
-A persistent urge to urinate
-Difficulty urinating
-Urethral discharge
-Cloudy urine
-Blood in urine

Question 7

What information is required to be considered when taking history?

Answer 7

Food and drink
Occupational history
Needle use
Travel history
Animal contact
Sexual history

Question 7

What information is required to be considered when taking history?

Answer 7

Food and drink
Occupational history
Needle use
Travel history
Animal contact
Sexual history

Question 8

What is the key test for infections?

Answer 8

Microbiology testing

Question 9

What is microbiology testing?

Answer 9

Method detecting the presence of microorganisms present in the body

Question 10

What testing would be required for: meningitis, c.dif, UTI.

Answer 10

Meningitis- CSF
C.Diff - Stool
UTI -Urine

Question 11

What types of infections are there?

Answer 11

Bacterial
Viral
Parasitic
Fungal

Question 12

Why do you need to have an ideas of what the infection is likely to be?

Answer 12

1. Treatment must be started before taking sample and wait for results. This will give an idea of cause for initial treatment.
   2.

Question 13

How long does it take for results to get back?

Answer 13

wait 24 hours to
identify organism and further 24 hours for sensitivities (this can be weeks for fungal
infections).

Question 14

Why should the patient be treated ASAP?

Answer 14

will affect prognosis to delay treatment

Question 15

How are bacteria and yeast cultured?

Answer 15

They are cultured in a similar
way by encouraging growth on a medium and identifying organism under a microscope

Question 16

What parasite is common in the uk

Answer 16

Giardia and Cryptosporidium

Question 17

what is Giardia

Answer 17

Diarrhoeal disease caused by a parasite. It is generally not a serious
disease, but is fairly common in the UK. It is often acquired from contaminated water.

Question 18

what is Cryptosporidium

Answer 18

microscopic parasite that causes the diarrheal disease

Question 19

How is Giardia and Cryptosporidium tested?

Answer 19

Enzyme-linked immunosorbent assay
(ELISA)

Question 20

What is the ELISA test?

Answer 20

used to detect and quantify substances: antibodies, antigens, proteins and glycoproteins, parasites in biological samples.

Question 21

How are tropical parasites identified?

Answer 21

Identified using a microscope. This looks for parasite and/or eggs.

Question 22

What testing is used for viruses?

Answer 22

polymerase chain reaction (PCR)

Question 23

What is the disadvantage of PCRs?

Answer 23

They only test for one type of virus

Question 24

What social history increases the chances of Legionnaires’ disease?

Answer 24

air conditioning systems
humidifiers
spa pools and hot tubs

Question 25

What is the aim of ‘start smart then focus’?

Answer 25

improve safety and quality of patient care and to contribute significantly to reductions in emergence and spread of AMR

Question 26

why can’t treatment be delayed?

Answer 26

increase morbidity, mortality,
cause hospitalisation, or prolong a hospital stay

Question 27

what is empirical treatment

Answer 27

Treatment given based on experience, without precise knowledge of the cause or nature of a disorder. EG: broad spectrum antibiotics while the results of bacterial culture and other tests are awaited

Question 28

What are the DIS of empirical treatment

Answer 28

-Based on signs and
symptoms patient has and what we know to be the typical pathogens that cause the infection think the patient has.
-may be wrong in diagnosis
-patient may have an infection
caused by an atypical pathogen

Question 29

Give examples of broad spectrum antibiotics

Answer 29

azithromycin, amoxicillin, tetracycline

Question 30

what do you need to know when selecting a empirical treatment?

Answer 30

-Location of the primary infection
-Typical pathogens which cause the infection
-Which antimicrobials (or combination of antimicrobials) have a spectrum of activity that covers these typical pathogens
-Local resistance patterns

Question 31

what does bacteriostatic mean?

Answer 31

prevents bacteria growth

Question 32

what does bactericidal mean?

Answer 32

substance which kills bacteria

Question 33

give examples of bactericidal antibiotic

“BANG Q RP.”

Answer 33

Beta-lactams
Aminoglycosides
Nitroimidazoles (metronidazole)*
Glycopeptides (vancomycin)

Quinolones*

Rifampicin
Polymyxins (colistin)

“BANG Q R.I.P.”

Question 34

give examples of bacteriostatic antibiotic
MS. COLT

Answer 34

Macrolides
Sulfonamides*

Chloramphenicol
Oxazolidinones
Lincosamides (clindamycin)
Tetracyclines

Question 35

Why is flucloxacillin use for skin infections?

Answer 35

flucloxacillin is active against Staphylococcus aureus and skin infections are often caused by Staphylococcus aureus

Question 36

What must antibiotic formularies ensure?

Answer 36

information on: drug, dose, frequency and course length
Be evidence based
Be reviewed regularly

Question 37

what are the five antimicrobial prescribing decisions?

Answer 37

-Stop
-Switch
-Change
-Continue
-OPAT

Question 38

On a culture sensitivity report what does ‘S’ mean?

Answer 38

Antibiotic bacteria is sensitive to.

Question 39

On a culture sensitivity report what does ‘R’ mean?

Answer 39

Antibiotic bacteria is resistant to.

Question 40

DIS of using more than one antimicrobial

Answer 40

-Increase costs
-Increase risk of adverse side effects
-Increase risk of interactions
-Increases risk of superinfections

Question 41

ADV of using more than one antimicrobial

Answer 41

-Provide more enough broad spectrum
-Cover for unknown or mixed infections
-Immunocompromised may need to
combine antimicrobials to reach the microorganism at multiple sites to compensate for body’s
natural immune defences not being able to generate a normal immune response

Question 42

What does a synergistic drugs do?

Answer 42

EG: penicillins and gentamicin for the treatment of infective
endocarditis.
penicillin-induced cell wall damage increases permeability of enterococci to aminoglycosides, so
the penicillin effectively facilitates access of the gentamicin to its target site.

Question 43

What does an antagonistic drug do?

Answer 43

acts against and blocks an action.
EG:
tetracyclines antagonise the effects of penicillins, and erythromycin and clindamycin both bind to
same subunit of bacterial ribosomes so will compete with each other for binding sites and not provide any additional effect.