Sepsis

Question 1

How is sepsis diagnosed?

Answer 1

NEWS >5 + infection

Question 2

What is septic shock?

Answer 2

Continued deterioration and hypotension despite adequate fluid resuscitation

Question 3

What is the treatment for sepsis and within what timeframe must this be delivered?

Answer 3

Within 1 hour: BUFALO

Blood cultures (+ other cultures - sputum, urine, stool, joint aspirate)
Urine output (use fluid balance chart >0.5ml/kg/hr)
Fluids IV (30ml/kg/hr over 3 hours saline)
Antibiotics (based upon clinical picture)
Lactate measurement (concern if >4mmol/L, remeasure within 2 house (sign of hypo perfusion))
Oxygen (high flow through non-rebreather)

Question 4

What should be given if patient remains hypotensive after BUFALO?

Answer 4

Vasopressors

Question 5

What colour are gram +ve and gram -ve bacteria on staining?

Answer 5

Positive = Purple
Negative = piNk

Question 6

What strains of streptococcus undergo beta haemolysis?

Answer 6

Strep pyogenes (GAS)
Enterococcus faecalis

Question 7

Which strains of strep undergo alpha haemolysis??

Answer 7

Strep pneumoniae, Strep viridans,

Ent. faecalis

Question 8

What drug is used to treat streptococcal infections?

Answer 8

Amoxicillin

Question 9

What drug is used to treat staph aureus infection?

Answer 9

Flucloxacillin

Question 10

What drug is used for Staph epidermidis infection and what infection is it indicated in?

Answer 10

Vancomycin 
Endocarditis (prosthetic valve)

Question 11

What treatment is used for Ent faecalis and what infections is it indicated in?

Answer 11

UTI, GI infections

Amox + Gent

Question 12

What infections is Strep pneumoniae indicated in?

Answer 12

Pneumonia, otitis media, meningitis

Question 13

What is used as an alternative if the patient is allergic to penicillin?

Answer 13

Doxycycline or vancomycin

Question 14

What bacteria is indicated in throat infections (tonsillitis)?

Answer 14

Strep pyogenes (group A strep)

Question 15

What is the infecting organism in epiglottitis and how is it treated?

Answer 15

Haem. influenzae

Amoxicillin

Question 16

How many days can gentamicin be given for and what is its route of administration?

Answer 16

3

IV

Question 17

What is given as empiric treatment of an infection of unknown origin?

Answer 17

Amoxicillin (gram +ves)
Gentamicin (gram -ves)
Metronidazole (anaerobes)

AGM

Question 18

What broad spectrum antibiotics are most indicated?

Answer 18

Co-amoxiclav

Co-trimoxazole

Question 19

What is the main infecting organism in a UTI?

Answer 19

E. coli

Question 20

How is cystitis managed?

Answer 20

Nitrofurantoin or trimethoprim (3 days)

Question 21

How is pyelonephritis managed?

Answer 21

Gentamicin + amoxicillin IV (hosp)

Community: co-amoxiclav OR co-trimoxazole PO

Question 22

What is the risk with treating E. coli gastroenteritis?

Answer 22

E. coli 0157 = haemolytic-uraemia syndorme (HUS)

Question 23

What infections is Haem. influenzae indicated in?

What is its treatment?

Answer 23

Pneumonia, otitis media, epiglottitis

amoxicillin - despite being gram -ve

Question 24

What are the 4 C antibiotics?

Answer 24

Clindamycin
Cephalosporin
Co-amoxiclav
Ciprofloxacin

Question 25

How is C difficile treated?

Answer 25

Non-severe: oral metronidazole
Severe: oral vancomycin

(oral as topically available in the gut)

Question 26

What is the typical presentation of c diff?

Answer 26

Sevre diarrhoea,

On ABx prophylaxis in hospital following surgery, taking a PPI

Question 27

Give an example of a quinolone? What are the risks associated with them?

Answer 27

Ciprofloxacin
Levofloxacin
Moxifloxacin

Tendon rupture, AAA, seizures

Question 28

What is the risk with Gentamicin and what is indicated instead?

Answer 28

Kidney damage

Aztreonam is indicated in renal disease (also has gram -ve cover)

Question 29

What type of organism is C. diff?

Answer 29

Gram -ve anaerobe