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BDS4 Oral Surgery > 3 - Microbiology and antimicrobials > Flashcards

3 - Microbiology and antimicrobials Flashcards

1
Q

Give an example of a gram positive cocci.

A

S. anginosus

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2
Q

Give an example of a gram negative cocci.

A

Veillonella species

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3
Q

Give an example of a gram positive bacilli.

A

Actinomyces israelii

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4
Q

Give an example of a gram negative bacilli.

A

Prevotella intermedia

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5
Q

What is antimicrobial resistance?

A

When micro-organisms change in ways that render medications used to cure infection they cause ineffective

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6
Q

What are the different types of resistance?

A
  • intrinsic resistance
  • acquired resistance
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7
Q

What is intrinsic resistance?

A

Resistance through structure or metabolic pathway

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8
Q

What is acquired resistance?

A
  • mutation
  • acquisition of new DNA
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9
Q

What are the different mechanisms of antibiotic resistance?

A
  • altered target site
  • enzymatic inactivation
  • decreased uptake
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10
Q

Give an example of a microorganism that uses altered target site for antimicrobial resistance.

A
  • viridans group streptococci eg S. mitis
  • penicillin resistance
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11
Q

Give an example of a microorganism that uses enzymatic inactivation for antimicrobial resistance.

A
  • prevotella
  • fusobacterium
  • both use beta-lactamase enzyme
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12
Q

What is the beta-lactamase resistance arms race?

A
  • penicillin resistant bacteria produced penicillinase to destroy the antibiotic
  • chemists produced a new penicillin resistant to penicillinase with a beta-lactam ring
  • bacteria produced beta-lactamase
  • chemists produced extended spectrum antibiotics
  • bacteria produced extended spectrum beta-lactamase
  • this reduces antibiotic choice for infection
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13
Q

How do you treat a ESBL infection?

A

Carbapenems

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14
Q

What are CPEs?

A

Carbapenemase producing enterobacterales

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15
Q

What is MDRI?

A

Multi drug resistant infection

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16
Q

Describe a dental abscess infection.

A
  • endogenous infection (often mixed)
  • Often anaerobes including P. intermedia, P. gingivalis, A. israelii
  • anaerobes: S. anginosus
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17
Q

how to manage dental abscess

A

-if localised infection
- take hisotry
- establish diagnosis and document
- remove source of infection

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18
Q

What is the ideal specimen of a dental abscess?

A
  • pus aspirate
  • as oxygen is toxic to many of the bacteria involved
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19
Q

What bacteria are involved in a periodontal abscess?

A
  • anaerobic streptococci
  • p. intermedia
20
Q

common bacteria found in dentoalveolar abscess, give example of antibiotic against them

A
  • streptococci : streptococcus anginosus
    Penicillin (cell wall)
    Clindamycin (protein synthesis)
  • strict anaerobes: Prevotella intermedia
    Penicillin (cell wall)
    Metronidazole ( DNA synthesis)
21
Q

What bacteria are involved in pericoronitis?

A
  • predominantly mixed oral anaerobes (p. intermedia)
  • s. anginosus
22
Q

What bacteria are involved in dry socket?

A

Mixed oral flora

23
Q

What bacteria are involved in osteomyelitis?

A
  • anaerobic gram negative rods
  • anaerobic streptococci
  • s. anginosus
  • s. aureus
24
Q

What bacteria are involved in salivary gland infection?

A
  • s. aureus
  • mixed anaerobes
25
Q

What is the management of salivary gland infection?

A
  • drainage
  • flucloxacillin
  • metronidazole
26
Q

What is the management of salivary gland infection?

A

6 weeks IV antibiotics

27
Q

What is the management of pericoronitis?

A
  • local measures
  • metronidazole if signs of spreading infection
28
Q

what you must do in antibiotic presciption

A
  • document diagnosis
  • document Ab choice, dose, route, duration
  • document review date
  • document deviation from guidance
29
Q

what guidance to follow for Ab presciption

A

SDCEP
durg presciption for dentistry
BNF

30
Q

What is SOI?

A
  • severe odontogenic infection
  • spread of infection into tissue planes with systemic symptoms and signs of sepsis
31
Q

What bacteria are involved in Ludwig’s angina?

A
  • anaerobic gram negative bacilii (P. intermeida/ P. gingivalis)
  • S. anginosus
32
Q

What is SIRS?

A

Systemic inflammatory response syndrome

2 or more of the following criteria

  • temp <36 / 38C
  • Pulse > 90/min
  • Resp rate > 20/min
  • WCC <4 or >12
33
Q

What is sepsis?

A

Life threatening organ dysfunction caused by dysregulated host response to infection

sepsis = SIRS + suspected/ confirmed infection

34
Q

What does S mean in a microbiology report?

A

Susceptible at standard dose

35
Q

What does I mean in a microbiology report?

A

Susceptible at increased dose

36
Q

What does R mean in a microbiology report?

A

Resistant even with increased dose

37
Q

Define a breakpoint.

A

Chosen concentration of an antibiotic which defines whether a bacteria is susceptible or resistant to the antibiotic

38
Q

Define clinical resistance.

A

When an infection is highly unlikely to reposed even to maximum doses of antibiotic

39
Q

Define antimicrobial stewardship.

A

A coherent set of actions which promotes using antimicrobials resposibly

  • infection prevention
  • decreasing prescriptions
40
Q

When do you prescribe Metronidazole

A
  • strictly anaerobic
  • Periodontal infections
  • when allergic to penicillin
41
Q

what is first line therapy in antibiotics

A
  • Penicillin V (Phenoxymethylpenicllin)
42
Q

pen v vs amoxicillin

A
  • amoxicillin has a broader spectrum of activity than Pen V
  • greater impact on selection of resistance in the host micro-flora
43
Q

dental abscess - phenoxymethylpenicillin presciption dose

A
  • 500mg
  • 5 days
  • 4 times daily

can cause hypersensitivity and anaphylaxis

44
Q

dental abscess - amoxicillin presciption dose

A
  • 500mg
  • 5 days
  • 3 times daily

can cause hypersensitivity and anaphylaxis

45
Q

dental abscess - metronidazole presciption dose

A
  • 400mg
  • 5 days
  • 3 times a day

BDS4 Oral Surgery (23 decks)

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