Infection

Question 1

What drugs form part of the Merick protocol

Answer 1

Vitamin C
Hydrocortisone
Thiamine

Question 2

SSI definition

Answer 2

Infection within 30 days of surgery

Or within 1 year if implant left in place

Question 3

Biofilm - discuss

Answer 3

Protective barrier that shields microbes from the surrounding environment, allowing them to thrive and proliferate. Forms within 4 weeks of implant insertion.
Microbe attaches, releases adhesins, proliferates, releases polysaccharide matrix (slime), encases the microbes. Bacteria enter a no growth/sessile phase which increases their resistance to antibiotics that depend on replication to carry out their effect

Question 4

Cell wall synthesis

Answer 4

Cephalosporins
Carbapenems
Penicillins
Vancomycin

Question 5

Folate synthesis

Answer 5

Trimethoprim

Sulphonamides

Question 6

DNA synthesis

Answer 6

Quinolones

Question 7

50s protein subunit

Answer 7

Macrolides
Clindamycin
Chloramphenicol
Linezolid

Question 8

Cell membrane

Answer 8

Colistin

Question 9

Bacterostatic

Answer 9

Inhibit protein synthesis in resting slow growing bacteria

Macro TLC

Macrolides
tetracycline/tige
Linezolid
Chloramphenicol

Question 10

Concentration dependent - which Abx, ideal condition

Answer 10

Quinolones
Aminoglycosides

10x MIC

Question 11

Time dependent - ideal condition

Answer 11

50% time above MIC

Question 12

What are the common antibiotic resistant organisms

Answer 12

ESKAPE

Enterococcus faecium - GPC
Staphylococcus Aureus - GPC
Klebsiella pneumoniae - GNB
Acinobacter Baumanii- GNCB
Pseudomonas - GNB
Enterobacter - GNB

Question 13

What are the mechanisms of antibiotic resistance

Answer 13

• efflux pump
• production of enzymes such as B-lactamases that attack the abx structure
• changing the binding site on the bacteria so antibiotics can’t bind
• horizontal gene transfer
• biofilm production

Question 14

Amonoglycosides

Answer 14

Amikacin
Gentamycin
Tobramycin

Among the most active against GNB’s, including Pseudomonas

Question 15

Anti-fungals

Answer 15

Ampho B - inflamm response and nephrotoxicity. Very effective

Triazoles - fluconazole, itraconazole, variconazole. P450

Echinocandins- capsofungin. Equivalent to ampho for invasive candidiasis

Question 16

Carbapenems

Answer 16

Imipenem - all except MRSA and VRE
Mero - same, crosses BBB
Dori
Erta - not pseudomonas

Question 17

Cephalosporins

Answer 17

1. Cefazolin - most pos, least neg
2. Cefoxatime
3. Ceftazidime, ceftriaxone
4. Cefipime
5. Ceftaroline

Tri and pime do pseudomonas

Question 18

Fluoroquinolones

Answer 18

Ciprofloxacin
Moxifloxacin
Levofloxacin

GNBs rapidly becoming resistant

Question 19

Vancomycin

Answer 19

GPC, aerobic and anaerobic strep

Question 20

Linezolid

Answer 20

Oxazolidonone

Synthetic. Same spectrum as vanco and VRE

Question 21

Nec fasc classification

Answer 21

1. Polymicrobial
2. Monomicrobial. GAS
3. Marine vibrio
4. MRSA

Question 22

LRINEC score

Answer 22

> 6 = 92 PPV

CRP
WCC
Cr
Hb
Na
Glu

Question 23

Hallmark of gas gangrene

Answer 23

Lack of acute inflammatory response

Question 24

Gas gangrene symptom triad

Answer 24

Pain out of proportion - thrombotic vessel occlusion
Tachycardia not explained by fever
Feeling of impending doom

Question 25

Antibiotic for tetanus

Answer 25

Metronidazole