Sepsis Flashcards
1
Q
want to give sepsis bundle within what time
A
one hour
2
Q
when do you want to do multiple blood culture sets
A
endocarditis suspected
3
Q
what fluids for sepsis
A
500ml of hartmanns/saline over 15-20 mins
4
Q
if lactate is high consider giving
A
fluids
5
Q
non blanching rash can also be
A
sepsis
6
Q
mottled skin appearance can suggest
A
sepsis
7
Q
what is colonisation
A
presence of microbe in th ebody WITHOUT an inflammatory response
8
Q
what is defined as sepsis shock
A
sepsis and both of persistent HYPOtension (requiring vasopressors to maintain MAP to at least 65) and lactate greater than 2
(despite adequate volume resusitation)
9
Q
refractory hypotension suggests
A
septic shock
10
Q
when do you upgrade to next NEWs level give one example
A
neutropenic
11
Q
when should NEWs not be used for pregnancy
A
if under 16 or in pregnant woman and it may be unreliable in those with spinal cord injury
12
Q
when should you used scale 2 of oxygen sats on News score
A
if hypercapnic
13
Q
vasopressors that can be used in sepsis
A
Norepinephrine, epinephrine, vasopressin
14
Q
what are the empiric antibiotics
A
amoxicilin, gentamicin and metronidazole
15
Q
skin, soft tissue, lines, devices suggest what bacteria
A
gram positive cocci
16
Q
biliary, urinary, gut can suggest what bacteria
A
gram negative bacilli
17
Q
what orgainsm can autolyse so on the gram stain the organism is not seen
A
strep pneumonia
18
Q
if on gram stain it shows a gram postive cocci in clusters aka staph aureus then what to we do
A
rapid PCR test
19
Q
why do we do PCR for staph aureus
A
tells us if its a staph aureus and whether it has the methicillin resistant gene to make it an MRSA
20
Q
PCR can be used to
A
detect specific genes
21
Q
if gram stain shows a gram positive cocci in pairs or chains aka streptococcal species we can do what
A
agglutination assay
22
Q
bad thing about agglutination test
A
not sensitive as read by humans so subject to error
23
Q
difference in apha, beta and gamma haemolysis
A
a- incomplete
b- complete
g- none
24
Q
after gram stain and rapid test we then set up
A
culture plates
25
if big circle in disc diffusion means what
antibitoic is sensitive and working
26
method that tells us whether the organism is resistant or sensitive
disc diffusion
27
what can you do to avoid false negatives
take cultures before starting antibiotics
28
cultures cannot detect dead bacteria. so if culture fails but there is a strong suspicion of infection you can do
PCR or sequencing
29
very high levels of CRP are associated with what infection
bacterial
30
gram negative is what colour
pink
31
why is gram positive purple
thick petidoglycan wall
32
5 main gram negativce
E.coli, Neisseria meningitis, proteus, klebsiella and Enterobacter (not to be confused with gram pos enterococcus)
33
the pathogenicity is often associated with the what layer of the gram negative cell
LPS - lipopolysaccharide
34
e.coli is a
gram neg bacilli/rods
35
what are coliforms
gram neg rods
36
extended spectrum beta lactamases cannot give what antibitotics
penicillins, cephalosporins, aztreonam
37
the bigger the clear circle in culture
the better the antibiotic as there is no bacteria growth
38
what do you need to minitor daily if start patietn on gentamicin
renal function daily
39
gram neg coccobacillus
H. influenza
40
when classed as hospital acquired pneumonia
been in for longer than 48hrs
41
what bacteria needs chocolate agar as will generally not grow on blood agar
h. influenza
42
what antibiotic is often given for h. influenza
amoxicillin
43
what anibiotic is given for atypical pneumonia eg mycoplasma, Coxiella, Chlamydophilia, Legionella
doxycycline
Clarithromycin also works
Levofloxacin if penicilin allergic or Legionella (however c.diff risk as is a fluoquionolone)
44
fluoroquinolones end in
floxacin
45
when to not use urinalysis
those over 65 or those with urinary catheters
46
first line for complicated UTI
amoxicillin and gentamicin
47
if complicated UTI wg with fever what will not be effective
nitrofurantoin
48
finding staph epidermidis is only significant if got
prosthetic material
49
Most e.coli are sensitive to what
co- trimoxazole
50
what can treat staph epidermidis if got proshetic material
Vancomycin
51
what bacteria will you make the patient more unwell if you give them IV antiviotics
c. difficile and e.coli
52
examples of gram NEG COCCI
neisseria meningitidis
53
clostridium is a gram positive
bacilli
54
what is the causative organism of Lyme disease
Borrelia burgdorferi
55
examples of spiral shaped organisms (spiroachaetes)
Borrelia burgdorferi and treponema pallidum
56
coagulase differentiated from staph aureus and epidermidis. But what differentiates between strep and staph
Catalase
57
what is catalase positve
staphylococcus
58
what is catalase negative
strep
59
examples of alpha haemolytic strep
viridans and pneumonia
60
what is given for staph aureus if allergic to fluclox or MRSA species
Iv vancomycin
61
example of beta haemolytic strep
pyogenes
62
where is strep pyogenes found
skin and soft tissue infection
63
what organisms cause subacute endocarditis
viridans and enterococci
64
what are significant pathogens in urinary tract infection
enterococci
65
streptoccus are commensal in the GI tract eg viridans lives in the --- and enterocci lives in the
mouth, bowel
66
what drug are widely used for streptococcus
penicllins
67
green discolouration is what haemolysis
alpha
68
alpha haemolysis can suggest
strep viridans or pneumoniae
69
beta haemolysis - cplete clearing and what colour
bright yellow
70
beta organisms -
strep pyogenes
71
gamma haemolysis organisms
enteroccoi
72
alpha haemoltic strep in suspected endocarditis are suggestive of viridans or pneumoniae but which one is it
viridans - as much more common cause of endocardiits
73
dukes criteria
likelihood of endocardiits
74
classification of streptoccocus using
lancefield antigen
75
pyogenes infections associated with
pharyngitis or skin infections
76
bacteria associated with pregnancy and neonates
strep agalactiae
77
gram positive bacilli includes
listeria, colstridium
78
common gram pos
strep, staph listeria, clostridium
79
drug of choice for enterococcus
amoxicillin
vancomycin if allergic
80
alpha haemolytic
viridans and pneumoniae
81
clostridium perfringens
soft tissue infection
82
more difficult for antibiotics to get into what areas as they have tight junctions
CNS, eyes and prostate
83
sepsis usually requires antibitoics given how
IV
84
what can measure the minimum inhibitory conc of antibiotics
broth dilution
85
when is wound swaps only really recommednded
if open wound with significant exudate
86
strep pyogenes is sensitive to
penicllin
87
pseudomomas aeruginosa is well known to colonise chronic wounds. How do you manage it
nothing just stick with original treatment
88
what antibiotic is usually given for a skin infection
flucloxacillin
89
c. difficle is a
bacilli
90
rf for c. difficile
gastric acid suppression
91
what antibiotic are not effective against C. difficile
IV
92
additional test for c. diff
PCR stool
93
why cannot use hand gel and got to use soap and water for c.diff
spores are resistant to alcohol gel
94
bloody diarrhoea top of the differential is
shiga toxin producing e.coli
95
what is a key concern from shiga toxin producing e.coli
haemolytic uraemic sydnrome
96
haemolytic uraemic syndrome triad
haemolytic anaemia, thrombocytopenia, aki
97
diagnosis of shiga toxin producing e.coli
selective culture and shiga toxin testing of stool
98
management of shiga toxin producing e.coli
supprtive -fluids.
Avoid antibiotics as increased risk of haemolytic uraemic syndrome
99
ideally how do you want to take blood cultures in endocarditis
3 sets 6 hrs apart
however if sepsis- minimum 2 sets over first hour
100
if got implantable cardiac electric device usualy organism is
staph especially staph aureus
101
what staph aureus is most common in ICED infection(cardiac device)
Methycillin sensitive staph aureus ( not resistant)!
102
in ICED can be staph auerus or epidermidis. epidermidis has Mec gene which is MRSA so what do you give
IV vancomycin first lien
103
if septic arthritis is confimed what is mandatory
washout
104
most common pathogens for CAP -comm acquired pneum
step pneum and h. infleunza
105
curb 65 is what (CAP)
new confusion
urea over 7
resp rate over 30
bp <90/60
age over 65
106
curb score -0-2
amoxicillin and doxycycline in allergy
107
what antibiotic for mild curb if penicillin allergic and need IV
clarithromycin
108
curb65 of 3 or more
Co - amoxiclav plus doxycycline
allergy - levofloxacin
109
what antibiotic is used in severe disease for gram neg cover
co-amoxiclav
110
additional investigation if legionella
urinary antigen
111
what should be offered to all pts with pneumonia
HIV testing
112
what is done 6 weeks after penumonia
CXR - to ensure resolution and no underlying malignancy is at risk
113
most common organism for peripheral venous cannula that may have been from surgery
staph aureus
114
staph aureus bacteraemia mx
48 hourly cultures until negative
Thansthoracic echo in all
Minimum 2 weeks IV fluxclo therapy traditionally recommended. if allergic then Iv vancomycin
115
when can you assume someone is neutropenic in cases of potential neutropenic sepsis
if had chemo within the past 3 weeks
116
mx of neutropenic + sepsis and news score is less than 6
Piperacillin/ tazobactam
117
mx of neutropenic septic SHOCK or news over 7
Piperacillin/tazobactam and gentamicin
118
why do cf patients need longer duration of treatment
biofilm forms
119
CMV you get
visual changes
120
what is raised in pneumocystis jiroveci
LDH
121
most common aspergillus
A. fumigatus
122
what lab testing for malaria
blood smears
123
malaria can occur up to how long post travel
up to 1 year
124
plasmodium falciparum
malaria
125
enteric fever can present as
fever and abdo pain - typhoid
126
dengue has what 3 symptoms
fever, athralgia and leukopenia
127
mx for dengue is
supportive care
128
ebola is a
viral haemorrhagic fever
129
risk of c. diff remains up to how long after an antibiotic course
12 weeks
130
4 C antibitoics
co - amoxiclav
clindamycin
ciprofloxacin (and other quinolones)
cephalosporins eg ceftriaxone
131
what should only be used as a last resort
fluoroquinolones
132
what can identify bacteria in 6hrs
MALDI TOF
133
gram neg associated with
GI tract
134
gram pos associated with
skin and mucous membranes
135
vancomycin side effect
red person syndrome
136
nitrofurantoin can cause
peripheral neuropathy
137
what drug is an enzyme inducer
rifampicin
138
what antibiotic interacts with alcohol
metronidazole
139
macrolides and quinolones can prolong the
QT interval
140
side effects common to antibiotics in general
Gi disturbance and skin rash
141
capillary leakage in sepsis can result in
oedema, diarrhoea and vomiting
142
sepsis defined by
News score greater than 5 and infection
143
mottled skin and non blanchign rash can suggest
sepsis
144
septic shock is when
persisten hypotension despite adequate fluid
145
sepsis 6 bundle should be given within how long from recognition
1 hr
146
what oxygen mask for critically unwell eg in sepsis
non re breathe
147
most common source of sepsis
chest
148
antibiotics for cellulitus
fluclox and if allergic then doxycycline
149
what fluids are first line for resuscitation
crystalloids
150
examples of crystalloids
hartmanns, plasmalyte and sodium chloride
151
caution regarding what with lots of hartmanns
potassium overload
152
what can help guide fluid therapy and help guide ICU referral if needed
lactate and Urine output
153
target output for UO in sepsis
0.5ml/kg/hr
154
do get the urine output of a patient you need to do what
catheterise the patient
155
bioavailabilty of the antibiotic refers to
absorption
156
what is - the fraction of the administered drug that reaches the systemic circulation in the unchanged form
bioavailability
157
gentamicin is in what class of antibiotics
aminoglycosides
158
rougly how long does it take for lab results to come back eg how long might they be on empirical antibitiotics
48-72hrs
159
treating what can give antibiotics in the abscence of a positive culture
cellulitis as the most common causative organisms are strep and staph
160
what antibiotics are useless in ESBLs
penicillins , cephalosporins, aztreonam
161
older people often have asymptomatic bacteriuria but it does not indicate
infection
162
what urine does not mean infection
dark or foul smelling - may just be a sign of dehydration
163
how long after giving antibiotics for sepsus should you review to see if can stop or switch therapy
48-72hrs
164
what is the drug of choice for sepsis with coliforms
gentamicin
165
complicatef UTI in priamry care
co amoxiclav or co-trimoxazole
whereas secondary care - amox and gent then step down to co trimoxzole
166
examples of anaerobes
clostridium and bacteriodes
167
antibiotic of choice for sepsis with anaerobes
metronidzole
168
drug of choice for sepsis and enterococci in GI tract
amoxicillin
169
neutropenic sepsis mx
piperacillin/ tazobactam
170
mx for neutropenic sepsis with septic shock
piperacillin/tazobactam and gentamicin
171
mx of bacterial meningitis
ceftriaxone and dexamethasone
172
if listeria cover required in bacterial meningitis then
stop dexamethasone and add amoxicillin
173
what that is not a bacteria will stain methyl purple
candida
174
vibrio shape looks like what
curved c shape
175
diplococci grow in
pairs
176
example of a gram pos diplococci
strep pneumoniae
177
another example of a gram pos cocci in chians
strep pyogenes
178
strep pyogenes infection can present as
tonsilitis, scarlet fever
179
strep pneumoniae and viridans show what haemolysis
alpha
180
staph epidermidis shows what haemolysis
gamma
181
strep pyogenes shows what haemolysis
beta
182
neisseria and h. infleunxa are both gram negative what is slight difference
n- diplococci
h- coccabacilli
183
example of spirochetes
treponema pallidum and borrelia burgdorferi
184
bacteria that dont gram stain
myobacteria tuberculosis hence why you need to do ziehl neelson stain
185
difference between strep penumoniae and strep pyogenes
pyogenes is in chains and pneumoniae is diplococci
186
gram positive clusters can also be
staph epidermidis
