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Exam 1- respiratory conditions and infections > Antimicrobial stewardship > Flashcards

Antimicrobial stewardship Flashcards

1
Q

What is antimicrobial resistance?

A

Resistance of a microorganism to an antimicrobial medicine to which it was originally sensitive.

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2
Q

What are the consequences of antimicrobial resistance?

A
  • Prolonged illness
  • Greater risk of spread
  • Increased morbidity
  • Higher mortality
  • Socioeconomic implications
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3
Q

What is antimicrobial stewardship?

A
  • Measures used to select the best therapy for patients for best clinical outcome and minimised toxicity.
  • Aims to prevent overuse and inappropriate use of antibiotics to reduce resistance
  • Using the correct dose, duration etc
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4
Q

What is the TARGET toolkit?

A

A guide for GPs and other healthcare professionals to stop antibiotic overprescribing in community care.

Treat
Antibiotics
Responsibly
Guidance
Education
Tools

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5
Q

What is the golden hour?

A

This is the rule that sepsis patients should be on antibiotics and IV fluid within 1 hour.

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6
Q

What are the outcomes for the 48 hour review of the ‘Start smart and then review’ protocol?

A
  1. Stop if not needed- e.g. if not a bacterial infection
  2. Switch from IV to oral
  3. Change to a more specific antibiotic- narrow spectrum
  4. Continue and review after 24 hours
  5. OPAT- OutPatient Antibiotic Therapy- once a day IV infusion antibiotic given at home.
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7
Q

What methods are used to identify that a patient has an infection?

A
  • Near patient investigations e.g. fever, urinalysis ( dipstick tests not for over 65)
  • Microbiology investigations e.g. bacteria account for UTI is greater than 10^5 organisms per ml
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8
Q

What does ‘S’ and ‘R’ mean on a sensitivities culture?

A

S = sensitive
R= resistant

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9
Q

When should a sample for sensitivities/ microbiology cultures be taken?

A

Before starting empirical treatment

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10
Q

When should empirical treatment be started?

A

In severe conditions, empirical treatments should be started without waiting for microbiology results.

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11
Q

What can be used to demonstrate presence of infections?

A
  • White cell count (WCC)- by taking a blood test
    Normal range= 4-11 x10^9/L
    if this is raised, it can indicate infection

in some cases it won’t raise e.g. accesses, bacterial endocarditis

  • C Reactive protein (CRP)- measure the acute phase protein that is made by the liver after infection.
    normal range = 0-10
    non-specific- could mean infection but also could indicate inflammation
  • Creatinine levels
    Measure kidney function
    can be raised in UTIs or sepsis

near-bed observations- fever, temperature, other symptoms

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12
Q

When does targeted treatment begin?

A

Once microbiology results are available.

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13
Q

What is empiric treatment?

A

Starting treatment according to signs and symptoms and then using hospital guidelines before receiving any test results.

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14
Q

Where do anaerobes bacteria tend to effect and what kind of conditions do they cause?

A

Mouth, throat, sinus, Lowe bowel

  • Abscesses
  • Dental infection
  • Peritonitis
  • Appendicitis
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15
Q

Where do Gram positive bacteria tend to effect and what kind of conditions do they cause?

A

Skin, mucous membranes

  • Pneumonia
  • sinusitis
  • Cellulitis
  • Osteomyelitis
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16
Q

Where do Gram negative bacteria tend to effect and what kind of conditions do they cause?

A

Gi tract

  • peritonitis
  • pancreatitis
  • UTI
  • PID
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17
Q

Where do atypical bacteria tend to effect and what kind of conditions do they cause?

A

Chest, genito-urinary

  • Pneumonia
  • Urethritis
  • PID
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18
Q

What are broad spectrum antibiotics and give examples…

A

Antibiotics that can treat both gram-positive and gram-negative bacteria.
e.g. Co-amoxiclav
meropenem
ceftriaxone
diptazobactam
amoxicllin
doxycycline

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19
Q

Examples of bacteria for gram-positive infections?

A

Vancomycin
Daptomycin
Flucloxacillimn

20
Q

Examples of bacteria for gram-negative infections?

A

Ceftazidime
colistrin
gentamicin

21
Q

What two factors determine how effective empirical treatment will be?

A
  • Local pathogen epidemiology
  • Local antibiotic sensitivity data
22
Q

What does it mean to ‘Streamline’ in antibiotic treatment?

A

To go from a broad spectrum antibiotic to a narrow spectrum antibiotic when sensitivities data becomes available.

23
Q

What organism factors determine antibiotic choice?

A
  • ‘Best guess’ prior to cultures and sensitivities
  • Site of infection- ensure the antibiotic will penetrate to the site. e.g. if needed in the brain must be able to cross the blood:brain barrier
  • Effect of drug on organism e.g. kill it= bactericidal or stop growth= bacteriostatic
24
Q

What does a Bactericidal antibiotic do?

A

Kill the organism

25
Q

What does bacteriostatic antibiotics do?

A

Stop the growth of the bacteria

Need to ensure patient has a good immune system as this is required to kill the organism after.

26
Q

What is an example of an antibiotic that induces resistance very quickly?

A

Sodium fusidate

Therefore, this drug must be used in combination usually with flucloxacillin.

27
Q

What patient factors determine antibiotic choice?

A
  • Severity of infection
  • Immune status
  • Pharmacokinteic factors e.g. renal function, liver function, age e.g. gentamicin is nephrotic so wouldn’t give if patient has a bad creatinine clearance
  • Epidemiology- Recent travel, occupation, school
  • Past medical history- Diabetes, heart valve replacement
  • Allergy status
28
Q

What drug factors determine antibiotic choice?

A
  • Activity
  • Route, dose, frequency of administration
  • Pharmacokinetics
  • Drug interactions
  • Adverse effect profile
  • Cost
  • Formulary
  • Sodium content- IV medications can contain high levels of sodium each is not good for those on a fluid-restricted diet.
29
Q

If a patient says they are allergic to penicillin but can’t remember what happened when they had it, do you treat them as allergic?

A

Yes

30
Q

Is GI disturbances a sign of a penicillin allergy?

A

NO

31
Q

What are symptoms/signs that a patient may have community-acquired pneumonia?

A
  • Focal signs on chest exam
  • Shadowing on x-ray at base of a lung, basal consolidation
  • No sore throat or runny nose
  • Cough, chest pain, breathlessness
32
Q

How do you diagnose community-acquired pneumonia?

A
  • With a chest exam- focal signs
  • Chest xray- shadowing at base of lung
33
Q

What two bacterias are the most common cause of community acquired pneumonia?

A
  • Streptococcus pneumonia (40%)
  • Haemophilus influenzae
34
Q

What is the treatment for non-severe community acquired pneumonia?

A
  • Amoxicillin +/- clarithromycin (if suspecting still atypical bacteria) for 5-7 days

if penicillin allergy- can give doxycycline

35
Q

What is the treatment for severe community acquired pneumonia?

A

IV antibiotic Benzylpenicillin + Clarithromycin (Iv or oral, but oral is preferred unless cant swallow due to IV being toxic to veins)
7-10 days

36
Q

What bacteria normally causes UTIs?

A

Gram negative
E.coli (75%)
Proteus

37
Q

How do you diagnose a UTI?

A
  • In under 65 year olds, can use urine dipsticks
  • In over 65 year olds, CAN’T use a dipstick as there is a high rate of asymptomatic bacteria, so use a ‘Midstream urine sample’
    UTI= >10^5 organisms/mL
38
Q

What are the symptoms of a UTI?

A

Dysuria- burning and discomfort on urination
Haematuria- Blood in the urine
needing to urinate more frequently
Urine that looks cloudy, dark or smelly

39
Q

What is the treatment for an uncomplicated UTI?

A

Trimethoprim (200mg BD) or Nitrofurantoin (50mg QDS) or co-amoxiclav

3 days for women
7 days for men

40
Q

What is the treatment for pyelonephritis?

A

( Kidney infection/ upper UTI)

IV gentamicin, tazocin, meropenem, ciprofloxacin

7-10 days

41
Q

If a patient with a UTI has poor renal function, what would you not give and give?

A

Wouldn’t give nitrofurantoin as secretion is reduced causing toxicity and side effects.
Would give trimethoprim instead.

42
Q

What is cellulitis?

A

A bacterial skin infection causing redness, swelling, pain, tenderness and erythema (skin rash).
May also cause local accesses.

43
Q

How is cellulitis monitored in a hospital setting?

A

Use a pen and draw round the red area. If the antibiotics are working, the red area would be seen to shrink.

44
Q

What bacteria are the main causes of cellulitis?

A

Gram-positive bacteria
Group A streptococcus (68%)
Staphylococcus aureus (12%)

45
Q

What is the treatment of cellulitis?

A

Flucloxacillin (500mg qds?) either IV or oral depending on severity
7-14 days also depending on severity

if penicillin allergy, use clarithromycin +/- metronidazole or doxycycline (200mg for 1st day then 100mg OD)

Exam 1- respiratory conditions and infections (11 decks)

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