Microbiology for Elderly Medicine

Question 1

What is the recommended duration of antibiotic treatment in community acquired pneumonia and at what point is an IV to oral switch recommended.

Answer 1

10-14 days of antibiotic treatment with IV to oral switch after 24 hours if the patient is well enough.

Question 2

A patient has recently been treated for community acquired pneumococcal pneumonia. His clinical symptoms have resolved and he appears well but his chest X-ray still shows consolidation. Why is this?

Answer 2

CXR signs of pneumococcal pneumonia take around 4 weeks to completely resolve.

Question 3

How is slowly resolving pneumonia defined?

What is is usually associated with?

Answer 3

Less than 50% clearing of radiological signs within 2 weeks or failure of complete resolution within 4 weeks.

Usually associated with underlying pulmonary disease such as COPD or pulmonary fibrosis.

Question 4

List the common local and systemic clinical findings in a patient with an infection.

Answer 4

Local

1. Inflammation
2. Erythema
3. Pain

Systemic

1. Fever
2. Tachycardia
3. Hypotension (severe infections only

Question 5

What are the common causative organisms in soft tissue infections?

Answer 5

• Beta-heamolytic streptococci

- Staphylococcus aureus

Question 6

What is the most appropriate antibiotic therapy for soft tissue infections?

What is an alternative in true penicillin allergy? (I.e. SJS or anaphylaxis NOT headache or diarrhoea)

What should be given if the patient has a history of MRSA isolation?

Answer 6

Flucloxacillin.

Give vancomycin in true penicillin allergy (A non beta-lactam alternative

Start with an antibiotic with known activity against MRSA E.g. vancomycin in patients with previous isolation.

Question 7

What are the major risk factors for C. Difficile infection?

Answer 7

1. Age
2. Use of broad spectrum antibiotics
3. Cephalosporins, Quinolones

Question 8

What is the commonest iviral cause of diarrhoea and vomiting?

Answer 8

Norovirus