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Flashcards in Infection Deck (37):
1

Why is important to differentiate between hospital and community acquired infection?

Different infecting organisms

Different antibiotic resistance patterns

Marker for outbreaks/epidemiology

Marker of poor infection control in hospitals (hospitals can be fined if too much hospital-acquired infection)

2

What infections have more resistance hospital acquired or community, why?

Hospital infections have more resistance due to beta lactamases

3

Cell wall inhibitor antibiotics?

Beta lactams:
- Penicillins - amoxicillin, flucloxacillin
- cephalosporins - cefuroxime, ceftriaxone, ceftazidime
- Carbapenems - meropenem, ertapenem, imipenem

Glycopeptides:
- Vancomycin

4

Possible issues with using narrower spectrum antibiotics?

Can lead to C diff infection.

5

In hospital infections what antibiotic groups are not indicated due to beta lactamases?

Penecillins
Cephalosporins

6

Issues with vancomycin?

Has to be given IV
Risk of renal impairment
Therapeutic levels need to be monitored

7

What will vancomycin not work against?

Gram negatives
vanco-resistant enterococci

8

Protein inhibitor antibiotics

- Tetracyclines (bacteriostatic) – doxycycline, tetracycline

- Macrolides (bacteriocidal) – clarithromycin, erythromycin

- Aminoglycosides (bacteriostatic) - gentamicin

9

How can C diff progress?

- Mild diarrhoea
- Pseudomembranous colitis
- Toxic megacolon
- Colonic perforation
- death

10

How do you test for C diff infection?

Stool test

11

Most common causes of C diff infection?

- Cephalosporins
- Ciprofloxacin
- Clindamycin
- Co-amoxiclav

12

Risks associated with tetracyclines?

Risk of photosensitivity
Risk of teeth staining in

13

Risks associated with macrolides?

Risk of cardiac complications
Interact with statins
GI upset

14

Risks associated with aminoglycosides?

Renal toxicity
Ototoxicity

15

DNA synthesis inhibitor antibiotics?

- Quinolones (bacteriocidal) – ciprofloxacin, moxifloxacin, levofloxacin

- Nitroimidazoles (bacteriocidal at higher doses) – metronidazole

- Nitrofurans e.g. nitrofurontoin

16

Risks of Quinolones?

QT prolongation
reduced seizure threshold
achilles tendon rupture
C diff infection

17

Risks of metronidazole?

GI upset, peripheral neuropathy

18

Management of C diff infection?

• Stopping offending antibiotic
• Isolation
• Fluid rehydration
• Avoid anti-motility drugs e.g. loperamide
• Consider stopping PPIs
• Metronidazole/vancomycin

19

Norovirus diagnosis?

Stool PCR

20

Treatment of norovirus?

ORT, paracetamol antiemetics

21

Treatment of MRSA?

IV vancomycin

22

What groups should routine HIV testing be carried out in?

• MSM
• IVDU
• Pregnant women
• Anyone with another STI/a partner with an STI
• Anyone from a country with a high HIV prevalence

23

What is Pneumocystis pneumonia (PCP) how do you treat?

Most common Opportunistic infection in UK in immunosuppressed patients.

Treat with co-trimoxazole (&steroids)

24

What is toxoplasmosis, how is it treated?

protozoan parasite - uncooked food

Can cause SOL in brain, ost infection is fairly asymptomatic

Treated with sulfadiazine (antibiotoc) and pyrimethamine (anti protozaol)

25

What is Kaposi's sarcoma? Treatment?

AIDS associated cancer

Dark/red pigmented lesion from a vascular tumour of spindle cells

Driven by co-infection with HHV-8

Treat with anti-retrovirals and chemo

26

Examples of antiretrovirals?

AZT/ zidovudine – a nucleotride reverse transcriptase inhibitor (NRTI)

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) - Nevaripine

Protease inhibitors (PIs) Indinavir

27

Treatment regimens for HIV?

• 2 NRTIs and a NNRTI
• 2 NRTIs and a PI
• 2 NRTIs and an integrase inhibitor e.g. raltegravir

28

Four modes of action of antibiotics?

Cell wall inhibitor

Inhibit protein synthesis

Inhibit DNA synthesis

Inhibit RNA synthesis

29

RNA synthesis inhibitor antibiotics?

Rifamycins

30

Rifamycin limitations/SEs?

Stains bodily fluids orange

hepatotoxicity

Drug interactions

31

Common hospital acquired infections?

C. diff

MRSA

Norovirus

32

What types of antibiotics is MRSA resistant to?

Beta lactams

33

Major associated conditions with HIV?

Seroconversion illness
Pneumocystis jirroveci pneumonia
Toxoplasmosis
Kaposis sarcoma
Tuberculosis

34

Levels of CD4 associated with PCP?

Lower than 200

35

Predicted total life expectancy of HIV if caught early?

65 years+

36

Common cause of pneumonia and meningitis in the community?

Strep pneumonia

37

Use of monoclonal antibodies against C diff?

Reduce recurrence