Sepsis Flashcards
(317 cards)
1
Q
define colonisation
A
the presence of a microbe in the human body without an inflammatory response
2
Q
define infection
A
inflammation due to a microbe
3
Q
define bacteraemia
A
the presence of a viable bacteria in the blood
4
Q
define sepsis
A
life threatening organ dysfunction caused by dysregulated host response to infection.
5
Q
define septic shock
A
a subset of sepsis with circulatory and cellular/ metabolic dysfunction with a higher risk of mortality
when the patient has persistent hypotension or lactate >/= 2 after adequate volume resuscitation (30ml/kg and vasopressors)
6
Q
what are the SIRS criteria
A
temp >38/<36
HR >90
RR> 20
WBC count >12,000 or <400
7
Q
why dont you use SIRS anymore
A
as too sensitive and not specific
8
Q
what are the criteria for qSOFA
A
RR>22, sBP <100, altered GCS
9
Q
when do you have sepsis
A
news score >5 with an infection
10
Q
when should you get a ST3 to see the patient
A
news score of 7+
11
Q
list 5 evidences of infection
A
cough, dysuria, abdo pain, abnormal bloods, confusion
12
Q
why do you get confused in sepsis
A
as brain not well perfused due to hypotension
13
Q
what is the mortality of septic shock
A
40%
14
Q
what is sepsis 6
A
take 3
- blood (and appropriate) cultures
- lactate
- measure urine output
give
- oxygen
- IV antibiotics
- IV Fluids
15
Q
what is high lactate a sign of
A
hypoperfusion
is associated with high mortality
16
Q
when should lactate measurements be repeated at 4-6 hours
A
if first one is >4
17
Q
what is urine output a measure of
A
organ perfusion
18
Q
what should you do if after administering O2 you are worried about sats
A
do ABG- will tell you more about any acidosis
19
Q
what antibiotics do you give if you cannot localise the source of the infection in sepsis 6
A
amoxicillin
metronidazole
gentamicin
20
Q
how should you administer fluids in sepsis 6
A
fluid challenge (set volume over set time)- prescribe 250-500 mls over 15 mins (crystalloid 0.9% saline or hartmanns- not dextrose)
21
Q
what is the aim in giving IV fluids in sepsis 6
A
MAP> 65mmHg
30ml/kg over the 1st three hours
22
Q
what should you do if there is a lack of response to IV fluids in sepsis
A
early MHDU for CVC +/- vasopressors
23
Q
how do vasopressors work
A
vasoconstrict to increase BP
24
Q
why do you get hypotensive in sepsis
A
as vasodilation occurs
25
what should you do for the septic patient in hours 2-6
continue resus- 30ml/kg in first 3 hours
MAP > 65
urine output >0.5 ml/kg/hour
aiming to improve NEWS, haemodynamic stability and a reduction in lactate
26
what are the signs of a patient going into septic shock
```
identify deterioration/ lack of improvement
new confusion
high RR
low BO
low blood glucose (BM)
```
27
what news score warrants 15 min observations
7+
28
when should you use vasopressors
in MAP remains <65mmHg via CVC
29
name a vasopressor
Noradrenaline
30
what should you do if the level of vasopressor in increasing
ensure control of the source of infection (abscess, NF)
| consider addition of a steroid, refer to ICU
31
what gram are vibrio (curved rods)
gram -ve
32
what is spirillum
rigid spiral bacterium
33
what is spirochaete
flexible spiral bacterium
34
what is the difference between gram +ve and -ve cell walls
gram +ve have a thick peptidoglycan wall (which holds on to the dye why its purple)
gram -ve have thin peptigoglycan and additional outer membrane
composed by phospholipids and lipopolysaccharides
35
what are obligate aerobes
require oxygen to survive
36
what are obligate anaerobes
are killed by oxygen
37
what are facultative anaerobes
they can tolerate oxygen
38
what strep have alpha haemolysis
S. pneumonia and viridans group
39
how do you differentiate staph aureus
is only staph to be coagulase positive
40
what is virulence
the capacity of a microbe to cause damage to the host
41
what is an opportunistic pathogen
an organism that causes infect when opportunity/ change in natural immunity arises
42
what do gram negative cocci appear in
diplococci (in pairs)
43
what are the normal gut commensals and what type are they
gram negative
```
e. coli (most strains)
klebsiella
enterobacter
proteus
clostridium
```
44
what are the significant gut pathogens
salmonella
shigella
verotoxin producing e coli (e. coli 157)
45
what is a coliform
gram negative large bacilli (inc gut commensals and pathogens):
commensals- e. coli, klebsiella, proteus
pathogens- salmonella, shigella, e. coli 0157
46
what infections can coliforms cause
UTI, peritonitis, biliary tract
47
what is the 1st line antibiotic against coliforms
gentamicin
48
what is an endotoxin
part of cell wall, are released by bacteria die
49
what is an exotoxin
released by living organisms
50
what releases endotoxins
gram negative
51
what releases exotoxins
both gram neg and positive
52
what strep organisms have gamma haemolysis
enterococci
53
what strep organisms have beta hamolysis
strep A and B
54
name a group A strep
strep pyogenes
55
what are the two types of enterococci
eneterococcus faecalis and faecium (both part of normal bowel flora)
56
what infection do enterococci commonly cause
UTI
57
what is the commonest cause of skin, ST, wound, joint and bone infections
S. Aureus
58
what type of bacteria is clostridium
gram +ve anaerobic bacilli
59
what is pseudomembranous colitis associated with
C. diff infection
60
what are the two types of aerobic gram +ve cocci
strep (chains)
| staph (clusters)
61
are strep and staph gram +ve or -ve
gram positive (only gram -ve cocci are diplococci (neisseria)
62
how do you differentiate streptococci
haemolysis:
alpha-partial (green)
beta- complete (can see through plate, golden)
gamma- none
63
what are the alpha haemolytic strep
strep pneumoniae and viridans
64
what does strep viridans cause
infective endocarditis (is usually a teeth commensal)
65
what are the beta haemolytic strep
group A strep = strep pyogenes (GAS skin diseases, throat)
| Group B strep (neonate meningitis)
66
what are the gamma haemolytic strep
enterococcus (gut commensal, UTI)
67
how do you classify staphylococcus
coagulase +ve (staph aureus- wound, skin, bone, joint) or coagulase -ve staph (inc staph epidermis- skin commensal- IV line infections, prosthetic valve endocarditis)
68
what most commonly causes prosthetic valve endocarditis
staph aureus
69
how do you classify gram +ve bacilli
large and small
70
what are the small gram +ve bacilli
corynebacterium (c. diptheriae (diptheria) and diptheroids (skin commensals))
and
listeria monocytogens (meningitis)
71
what are the large gram +ve bacilli
bacillus sp. (bacillus cereus and bacillus anthracis (anthrax)
72
what are the types of anaerobic gram +ve bacteria
anaerobic streptococci (not staph)
bacilli- clostridium sp. (Cl. tetani (tetanus), Cl. perfringens (gas gangrene), Cl. difficile antibiotic associated (pseudomembranous) colitis
73
what are the types of gram negative organims
strict aerobes (bacilli)
aerobes (cocci and bacilli)
microaerophilic (need extra CO2) (bacilli)
strict anaerobes (cocci and bacilli)
74
what are the types of strict aerobic gram -ve bacilli
legionella
| pseudomonas aeruginosa
75
what are the types of aerobic gram -ve cocci
DIPLOCOCCI
neisseria gonorrhoeae
neisseria meningitidis
76
how do you classify gram -ve aerobic bacilli
small and large (coliforms)
77
what are the small gram -ve bacilli
```
bordetella pertussis (whooping cough)
haemophilus influenzae (COPD exacerbation)
```
78
what are the large gram -ve bacilli
```
COLIFORMS
gut commensals:
-escherichia coli (UTI)
-klebsella (UTI, wound)
-proteus (wound)
gut pathogens:
-salmonella
-shigella
-E. coli 0157
```
79
what are the micro aerobic gram -ve bacterias
all bacilli
small curved= camplyobacter
spiral= helicobacter sp
80
what are rhe gram -ve anaerobes
cocci
and
bacilli (bacteroides (gut commensals, wound infection)
81
what antibiotics target the cell wall
pencillins (penicillin, flucloxacillin, amoxicillin, temocillin, co-amoxiclav, piperacillin)
cephalosporins (ceftriaxone)
glycopeptides (vancomycin)
82
what are the B-lactam antibiotics
pencillins: amoxicillin, flucloxacillin, co-amoxiclav
cephalosporins (ceftriaxone)
carbapenems
83
are penicillins safe in pregnancy
yes
84
what penicillins for gram +ves
flucloxacillin
| penicillin
85
what penicillins for gram -ve and +ves
amoxicillin
co-amoxiclav
pencillin (only -ve is neisseria)
86
what pencillin for gram -ves
temocillin
87
what makes up co-amoxiclav
amoxacillin and clavulanic acus
88
what do you use flucloxacillin for
s. aureus
89
what is resistant to flucloxacillin
MRSA
90
what does tenocillin work against
coliforms (e. coli, salmonella, enterobacter)
91
are cephalosporins bacteriocidal or static
cidal
92
are cephalosporins safe in pregnancy
yes
93
what type of antibiotic is vancomycin
a glycopeptide
94
are glycopeptides bacteriocidal or static
cidal
95
what does vancomycin work against
gram +ve
96
what are the protein synthesis antibiotics
(usually all bacteriostatic- except aminoglycosides)
aminoglycosides (gentamicin)
tetracyclines (doxycycline)
macrolides (erthromycin, clarithromycin)
97
what do aminoglycosides work against
gram -ve aerobes (coliforms, pseudomonas)
98
what can aminoglycosides damage
kidney and CN VIII
99
name a tetracycline
doxycycline
100
can you use doxycycline in pregnancy
its use is restricted
101
when are macrolides used
commonly in penicillin allergies
102
what antibiotics work against nucleic acids
metronidazole (anaerobes and protozae)
trimethoprine (e. coli UTIs)
fluoroquinolones (gram -ve and +ve)
103
what does metronidazole work against
anaerobes and protozae
104
what does rifampicin target
RNA polymerase
105
are flouroquinolones bacterio cidal/static
cidal
106
what antibiotics inhibit folic acid synthesis
sulphonamides
| trimethroprines
107
what can ciprofloxacin (fluoroquinolone) cause
tendonitis
108
what can you not do when taking metronidazole
drink alcohol
109
what antibiotics should you never combine
any bacteriocidals with a bacteriostatic
110
what are the 4 c antibiotics causing C diff
cephalosporins
co-amoxiclav
ciprofloxacin (and all fluroquinolones)
clindamycin
111
where is candida a commensal
skin, GI (mouth, throat) and GU tract (vagina)
112
can you use antibiotic gel for C diff
no need soap and water as spore forming
113
should the peritoneum and blood be sterile
yes
114
where are corynebacterium commensals
skin
115
what are the commensals of the large bowel
enetrobacteriacaea (e. coli, klebsiella, enterbacterer, proteus)
enterococci (e. faecalis and faecium), candida, clostridium
116
what is the prodrome
early signs of illness (subclinical infection) after the incubation period
117
can aerobic organisms grow without air
yes (unless strict anaerobes)
118
name a strict anaerobe
pseudomonas
119
what turns MacConkey agar pink
e. coli and other lactose fermenters
120
how do you tell if an organisms is intra/extra cellular
extracellular will fill dead space between the cells
121
what antibiotic broadly treats streptococci
penicillin
122
name two spirochete organisms
Borrelia burgdorferi (lyme disease), syphilis (Treponema pallidum)
123
what shape is campylobacter
small curved
124
what shape is helicobacter
spiral
125
in endocarditis how many sets of blood samples should you take in an hour
3
126
what type of bacteria is strep viridans
gram -ve cocci, strep, alpha haemolysis
127
what pathogen in infective endocarditis in IVDU
staph aureus/ epi
128
what criteria to assess infective endocarditis
DUKEs
129
what are the components of DUKEs criteria
major criteria:
- typical microorganism from 2 blood cultures (viridans, strep bovis, HACEK, staph aureus)
- +ve echo for IE/ new valvular regurgitation (both evidence of endocardial involvement)
minor criteria:
- predisposed (heart condition/ IVDU)
- fever
- vascular phenomena (emboli, septic pulmonary infarcts), mycotic aneurysm, intracranial haemorrhage, conjunctival haemorrhage, janeway lesions)
- immunological (glomerulonephritis, olsers nodes, roth spots, RF)
- microbiological (evidence of infection)
- echo/culture that doesnt meet major
two major criteria
one major and three minor
five minor
130
what is the criteria for strep pharyngitis
```
centor and (higher score more likely to be bacterial)
fever PAIN (shows risk of group A strep and need for antibiotic)
```
131
what are the centor criteria
```
(shows likely hood of pharygitis being streptococcal)
age (<14/>45) +1
exudate/ swelling on tonsils
cervical lymphadenopathy
fever (>38)
cough absent +1
```
132
what are the feverPAIN criteria
```
fever in past 24 hrs
absence of cough/ coryza
symptoms onset = 3
purulent tonsils
severe tonsilar inflammation
```
133
what are the CURB65 criteria
```
to asses the severity of pneumonia
C= confusion (new onset)
U= urea >7
R= RR >30/mins
B= BP S<90 or D<61
65= age 65 or older
0-2 mild/mod
3-5 severe
```
134
what are the typical organisms associated with endocarditis
s aureus, enterococcus faecalis, viridans, HACEK (e.g. chlamydia, haemophylis)
135
are babies and the elderly more likely to get hypo or hyper thermic
hypo due to hypothalamic insufficiency
136
what pathogens are most likely to cause a gall bladder infection
coliforms, enterococci and anaerobes (as all found intrabdominally)
137
what does metronidazole work against
anaerobes
138
what does amoxicillin work against
gram +ves (enterococci)
139
what pathogen do you expect to be causing a foot ulcer
staph aureus
140
what bacteria produce toxins
shigella and ecoli 0157
141
what antibiotics for gastroenteritis
none
142
what is the prophylaxis for a total hip replacement
co-amoxiclav and amoxicillin (if high BMI to increase the dose of amoxicillin)
143
what increases the risk of getting C diff
PPIs- reduce stomach acid
steroids + other immunosuppressants
increased age
being an inpatient
144
what can cause bloody diarrhoea
e.coli, campylobacter, c. diff
145
what are the complications of an e.coli 0157 that can be precipitated by antibiotics
haemolytic-uremic syndrome
146
what are the mechanisms of antibiotic resistance
active efflux (pushing it out of cell), target replication, modified drug target, decreased permeability, DRUG INACTIVATING ENZYMES (e.g. beta lactamase)
147
how does the dosage of antibiotic reduce the risk of resistance
high dose for short time
low does doesn't kill- allows resistance
long duration increases risk of resistance
148
should you take samples before/ after giving antibiotics
before
149
are oral or IV antibiotics better
in general oral better- switch down from IV asap
150
where are anaerobes found and what do they cause
```
mouth, teeth, throat, sinuses, lower bowel
cause:
-abscesses
-dental infection
-peritonitis
-appendicitis
```
151
where are atypicals found and what do they cause
```
chest and GU tract
cause
-pneumonia
-urethritis
-pelvic inflammatory disease
```
152
where are gram -ves found and what do they cause
GI tract
- UTIs
- peritonitis
- biliary infection
- pelvic inflammatory disease
153
where are gram +ves found and what do they cause
```
skin and mucous membranes
cause:
-pneumonia
-sinusitis
-osteomyelitis
-wound infection
-line infection
```
154
what are the general side effects for most antibiotics
N&V&D
rashes
candida infections
155
what are the important side effects of penicillin
allergies, skin reactions
156
what are the important side effects of flucloxacillin and co-amoxiclav
cholestatic jaundice
157
what are the important side effects of macrolides
hepatitis, Q-T interval
158
what are the important side effects of quinolones
loads inc QT interval, convulsions, tendonitis
159
what are the important side effects of aminoglycosides/ gylcopeptides
nephrotoxicity
160
what are the important side effects of vanocmycin
red man syndrome (flushing due to histamine)
161
what are the important side effects of tetracyclines (doxycyline)
hepatoxicity, stains teeth (why you never give to children), photosensitive, dysphagia
162
when do you use cholarmphenicol
in eye drops only
163
what is MRSA sensitive to
vancomycin
164
what to treat enterococcus faeclum
gent and vancomycin
165
does the 'garage' have to be joined to the 'house' for a beta lactam allergy to be triggered
yes
166
what are the three important enterococci
E. faecalis. E. faecium, vancomycin resistant enterococcus
167
what are the most important gram +ve bacilli
listeria monocytogenes
coltridia (difficile and perfinigens)
corynebacterium (dipertheroids- not the same as dipetheria)
168
what are the beta lactam drugs
```
penicillin
flucloxacillin
amoxicillin
cephalosporins
piperacillin/tazobactam
carbepenems
```
169
what is the time of beta lactams needed above the MIC of the pathogen
need to give beta lactams several times a day as mod of action depends on amount of time spent above the minimum inhibitory concentration
170
name three aminoglycosides
gentamicin
amikacin
streptomycin
171
name 3 quinolones
levofloxacin
| moxifloxacin
172
where is it hardest for antibiotics to get into
CNS, eyes, prostate
173
where do biofilms commonly form
CF, bronchiectasis, prosthetic material
174
what streptococci catalase +ve/-ve
catalase +ve
175
what are facultative anaerobes
grow aerobically and anaerobically e.g. streptococci
176
describe group A strep
=strep pyogenes
pharyngitis, skin
beta haemolytic
177
describe group B strep
= strep agalactaiae
| pregnancy and neonatal meningitis
178
what is the new name from strep bovis
strep gallollyticus
179
what does streptococcus gallollyticus cause
endocarditis
180
what does strep. pneumoniae cause
pneumonia, otitis media, meningitis
181
name some of the members of the viridans group
e. salivarius, mutans, agalactaiae, anginosus,
182
is there a strep pneumoniae vaccine
yes
183
where do enterococci live
in the large bowel
184
what diseases do enterococci cause
UTI, endocarditis, bacteraemia
185
what antibiotic for enterococci
amoxicillin IV
oral or co-trimoxazole step down
vanocmycin used if amoxicillin resistant
186
what is the mean inhibitory concentration
concentration of drug required to kill 99.9% of organisms during 18/24 hrs
the conc that allows the tube of well containing the organism to stay clear (by visual examination) after 18 to 24 hrs
187
what antibiotic for staph aureus
flucloxacillin IV in sepsis
188
what antibiotic for MRSA
vancomycin IV
189
what is pharmacodynamics
relationship between infection outcome and drug outcome
190
what is pharmacokinetics
is the effect of the body's processes on the drug
191
when is a drug active
when it is unbound
192
what are the C. diff risk factors
```
antibiotic use
prolonged hospital stay
PPIs/ H2 antagonists
age >65y
surgical procedure
immunosuppressants
```
193
what are the main symptoms of c. diff
constipation with overflow diarrhoea
194
what are the severity markers for C. diff
need one or more to be severe:
- temp >38.5
- ileus, colonic dilatation >5cm, toxic megacolon and/or pseudomembranous colitis
- WBC> 15 cells x10(3)L
- acute rising serum creatinine (>1.5 x baseline)
- if persisting
195
what is the treatment for non severe C diff
oral metronidazole 400mg for 10days
(can give IV if oral nor available)
rehydrate
196
what is the treatment for severe C diff
oral vancomycin 125 mg qds for 10 days (NG if oral not available)
197
what is responsible for many of the antigens properties of gram -ves
lipopolysaccharide layer
198
what is the treatment for legionella pneumonia
co-amoxiclav and levofloxacin
199
what antibiotics are active against gram -ve
```
beta lactams (and monobactam)
aminoglycosides
macrolides
tetracylines
chloramphenicol
co-trimoxazole
polymixins
```
200
name an aminoglycoside
gentamycin
201
what are the majority of gram -ve bacteria
bailli
202
name an enterobacteriacae
e. coli
203
how long in hospital before a pneumonia is classed as HAP
>48 hours
204
what type of bacteria is haemophilus influenzae
gram -ve coccobacillus
| generally aerobic
205
what growth factors does haemophilus influenzae need
X factor (hemin), V factor (NAD)
206
what grows in chocolate agar media
haemophilus influenzae
207
what antibiotic is active against haemophilus influenza
amoxicillin
| also doxycycline
208
is there a vaccine against haemophilus influenzae
yes
209
where is UK has high levels of resistant gram -ves
england
210
what causes atypical pneumonia
mycoplasma pneumonia, coxiella burnetii, chlamydophila psittaci, legionella
211
what antibiotics for atypical pneumonia
doxycycline
clarithromycin (has more SEs)
quinolones (in penicillin allergic)
212
which aytpical pneumonia has higher mortality than normal bacterial pneumonia
legionella
213
what type of bacteria is legionella
gram -ve bacilli
214
where is legionella found
in lukewarm aerosolised water
215
who is legionella pneumonia more common in
smoker, males, COPD, immunosuppressed, malignancy, diabetes, dialysis, hot tubs
216
what is pontiac disease
milder form of legionella pneumophila
217
where does legionella grow in body
within alveolar macrophages
218
what type of legionella causes the most disease
serotype 1
219
how do you diagnose legionella pneumonia
urine culture
220
what are the most common causes of gram -ve strep
E. coli, klebsiella, pseudomonas, enterobacter (not gram +ve enterococcus), neisseria meningitidis
221
how do you differentiate coliforms
biochemical tests
222
what organisms turn macConkey agar pink
e coli and other lactose fermenters
223
what is the main cause of gram -ve antibiotic resistance
alteration to enzyme (Beta lactamase)
224
what often mediates the spread of beta lactamases
plasmid
225
what is the main concern in gentamicin prescribing
nephrotoxicity (limit duration (<72 hrs), monitor renal function daily)
226
what do phagocytes act against
bacteria and fungi
227
what do T lymphcytes act against
viruses, fungi and protozoa
228
what do antibody and B lymphocytes work against
bacteria and viruses
229
what do eosinophils work against
fungi, protozoa and worms
230
what do mast cells work against
worms
231
what does complement work against
bacteria
232
what in immunology works against bacteria
phagocytes, antibody and B lymphocytes and complement
233
what immunological components work against viruses
T lymphocytes and complement
234
what immunological components work against fungi
phagocytes, antibody and B lymphocytes, complement
235
what immunological components work against protozoa
T lymphocytes, eosinophils
236
what immunological components work against worms
eosinophils and mast cells
237
what antimicrobials do keratinocytes secrete
defensins
238
what is the secretory immunoglobulin
IgA
239
what does incompltete urinary voiding lead to
urinary stasis- increased infection risk
240
what are phagocytes
neutrophils (blood) and macrophages (tissue)
| ingest organisms following opsonisation
241
what can cause phagocyte deficiency
haematological malignancy, cytotoxic chemo
242
what causes T lymphocyte deficiency
HIV, lymphoma, primary immunodefiency syndromes (SCID)
243
how does HIV affect the immune system
infects CD4+ lymphocytes causes progressive decline in numbers
244
what is there high risk of in HIV
pneumococcal disease (recurrent pneumonias)
245
what can cause hypospenism
splenectomy
| sickle cell, cirrhosis, coeliac disease
246
what are you act risk of in hyposplenism
infection from encapsulated disease s. pneumoniae, h. influenzae, neisseria meningitidis
247
what signs of infection may be absent in immunocompromised patients
fever, inflammatory response (CRP/ neutrophilia)
248
what infections are steroids associated with
fungal infections
249
what infections are anti-TNF therapies associated with
```
mycobacterium tuberculosis
fungal infections (aspergillus)
```
250
who gets influenza vaccines
```
pregnant
chronic heart/lung.kidney/liver disease
immunocompromised
diabetes
age >65
```
251
who gets a s. pneumoniae vaccination
```
chronic heart/lung/kidney/liver disease
hyposplenism
immunocompromised
diabetes
age >65
```
252
who gets h influenzae vaccines
all children
253
what pulmonary dysfunction exists in sepsis
endothelial injury/ capillary leak
diffuse alveolar oedema (ARDS)
resp failure
254
what renal dysfunction exists in sepsis
acute kidney injury (rise in urea/creatinine)
255
what liver dysfunction exists in sepsis
shock liver(high ALT/AST)
256
what CNS dysfunction exists in sepsis
delirium, confusion due to diffuse central hypoperfusion
| may become drowsy/ decreased conscious level
257
what haematological dysfunction exists in sepsis
dissesminated coagulation (low Plts, prolonged APTT/PT)
258
do all quinolones cause C diff
yes- ciprofloxacin represents all of them in 4 c's (all end in -acin)
259
are all these statements true? penicillins:
- inhibit cell wall synthesis
- are bacterialcidal
- an allergy to one means an allergy to all
- all are absorbed orally
no some are not absorbed orally
260
what antibiotic causes photosensitivity
doxycycline
261
what antibiotic worsens epilecptic control
all quinolones ( all end in -acin e.g. levofloxacin)
262
why do you add clarithromycin in pneumonia
to cover atypical organisms
263
which antibiotic for strep pneumoniae
amoxicillin (doxycycline has some cover but not as good)
264
what has better oral absorption amoxicillin or penicillin
amoxicillin
265
what is the resp quinolone
levofloxacin
266
does ciprofloxacin cover strep pneumonia
no
267
how is aztreonam administered
IV
268
when vancomycin is given orally is it absorbed systemically
no
269
can c diff be carried asymptomatically
yes
270
what is the most common cause for CAP
strep pneumoniae
271
is smoking a risk factor for CAP
yes
272
why is the first line for UTIs amox and gent
as 40% of e. coli is resistant to amoxicillin
273
what are the side effects of quinolones
abdo aortic rupture, psychiatric SEs, diffuse tendonitis and tendon rupture, c diff
274
is the oral availability of quinolones the same as IV
yes
275
what is clindamycin activa against
strep pygoenes, s aureus, anaerobes
| doesnt cover gram -ves
276
how is gentamicin adminstered
IV for sepsis
| can be used as drops
277
is listeria gram -ve or +ve
+ve
278
are these gram -ve or pos:
| salmonella, campylobacter, shigella
gram -ve
| gastroenteritis think gram -ve bacilli
279
what antibiotic can give deranged LFTs
co-amoxiclav
280
what are the biochem markers in bacterial sepsis
raised IL 6, CRP, WBC
| lowered platelets
281
what are the defining aids conditions
recurrent pneumonia, oropharyngeal candida, salmonella bacteraemia
282
what is extended spectrum beta lactamase (ESBL) klebsiella sensitive and resistant to
sensitive: meropenam
resistant: amoxicillin, cephalosporins, aztreonam, piperocillin/tazobactam
283
what antibiotics reacts with a lot of things
rifampicin
284
what antibiotic should be avoided in children <12
tetracyclines (e.g. doxycycline)
285
what are the main pathogens in celluitis
s aureus and s pyogenes
286
does penicillin cover staph aureus
no
287
is flucloxacillin sufficient to cover animal bites
no
288
what causes walking pneumonia
mycoplasma pneumoniae
289
what do you get kplick spots in
measels
290
what antibiotic should you never prescribe as a monotherapy
rifampicin
291
when should you repeat blood cultures in MSSA bacteraemia
2/3 days
292
what are the groups of beta haemolytic strep
groups A, C and G
293
what culture should all patients with suspected sepsis get
blood
294
why do you only do urine cultures when there is signs of infection
as many will have asymptomatic bacteruria
295
can you culture CSF, pleural or ascitic fluid
yes
296
what does serolgy measure
either the antibody- IgM and/ or IgG (EBV, CMV, syphilis)
| or the antigen (hep B- HBsAg)
297
how do antibodies reflect the immune systems memory for a pathogen
IgM recent exposure
| IgG was exposed at some point
298
what is serology most useful in
viruses, spirochaetes (lyme, syphilis), protozoa
299
how does PCR work
makes direct copies of DNA
- Taq polymerase
- primers
- repeated cycles of heating and cooling
can be done on bloods (HIV, hep B, hep C, bacterial meningitidis)
or swab/ fluid (viruses- influenza, HSV, VZV, norovirus. bacteria (N.meningitis, S. pneumoniae)
300
what is PCR the main test for
virus detection
301
how is PCR used for diagnosis
throat swab- viral resp tract infections (influenza, parainfluenza, RSV, coronavirus)
stool sample- norovirus
CSF- HSV, enterovirus, N. meningitidis
sputum- mycobacterium tuberculosis
blood- HIV, hep B, hep C, bacterial meningitidis
302
how is PCR used for monitoring
shows how much of organisms is present
HIV- control
Hep b- control
hep C- cure
303
what is maldi-tof
type of mass spectometry
identifies organisms
v specific
doesn't provide sensitivities
304
what is whole genome sequencing used for
shows entire DNA of organism
can show antibiotic resistance
used for epidemiology and outbreaks
305
can antibiotics get into pus
no- in quinsy or an abcess need ENT person or drainage
306
can other antbiotics cause c diff
yes they all can inc the ones that treat it
307
what do you screen any one who has travelled anywhere for
gram -ves - do a rectal swab
308
is gentamicin active against anaerobes
no only gram -ves
309
is vancomycin active against gram -ves
no only gram +ves
310
is aztreonam safe in penicillin allergy
yes
311
how long antibiotics for endocarditis
6 weeks
312
how long antibiotics for bacteraemia
14 days
313
How much 0.9% saline IV should be given initially to patients with sepsis?
500mls bolus
314
tx for sepsis caused by a diverticular abscess
Amoxicillin,gentamicin and metronidazole (all IV)
step down oral Co-trimoxazole and metronidazole
315
what is the prevalence of type 1 penicillin allergy in the population
<0.5 %
316
tx for (ESBL (extended spectrum beta lactamase )producing coliform in blood)
Intravenous meropenem
317
what does gentamicin work against
gram -ves
