Week 6 - Infection, Antibiotics & Resistance Flashcards
(57 cards)
Describe the sepsis 6
- High O2 flow
- Blood Cultures
- IV Antibiotics
- IV Fluid resuscitation
- Measure Lactate
- Measure Urine output + Strict fluid balance
Describe hospital acquired infections
Nosocomial Infections
Mostly due to bacteria, since antibiotics are used frequently in hospitals, types of bacteria and their resistance is different to bacteria outside of the hospital.
What is a nosocomial infection?
An infection not present or incubating prior to hospital admittance but generally occurring 24 hours after admittance
What are the risk factors for nosocomial infections?
- Duration of hospital stay
- Inwelling Catheters
- Mechanical ventilation
- Use of total parenteral nutrition
- Antibiotic usage
- Use of histamines receptor blockers owing to relative bacterial overgrowth
- Age - more common in neonates, infants and elderly
- Immune deficiency
Describe Hospital acquired pneumonia (HAP)
- Nosocomial pneumonia - pneumonia acquired from the hospital 48-72 hours after admittance
Describe community acquire pneumonia (CAP)
Caused by bacterial infection rather than a virus
What are 5 bacterias contributing to pneumonia development?
- Pseudomionas aeruginosa
- staphylococcus Aureus
- klebsiella Pneumoniae
- Escherichia Coli - E.Coli
- Non enterobacteriaceae
Describe urinary tract infections
- involves urinary system, urethre, bladder, ureter and kidney
- most common heath care associated infection
- 75% associated with a urinary catheter
Describe bacteria associated with UTI’s
- Enteric pathogens
- Pseudomonas species
- Enterococcus species
- Staphylococcus aureus
- Coagulase
- Enterobacter species + yeast
- Candida
Describe sepsis
- Body’s response to infection injures its own tissue and organs
- life threatening when body’s abnormal immune system response to infection causes organs to fail
- Triggered by any infection, most common = bacteria in lungs, uti and abdominal organs
- Cause multi organ failure
Describe sepsis associations with GI Tract GU Tract Pelvis Lower respiratory tract Vascular system Heart + cardiac vasculature
GI Tract - liver disease, gallbladder, colon abscess, intestinal obstruction + instrumentation
GU Tract - pyelonephritis, intra or peri-nephric abscess, renal calculi, urinary tract obstruction, acute prostatitis or abscess, renal insufficiency, + GU instrumentation
Pelvis - Peritonitis + pelvic abscess
Lower respiratory tract - community acquired anaemia, empyema + lung abscess
Vascular System - infected IV Line or prosthetic device
heart and cardia vasculature - acute bacterial endocarditis and myocardial/ perivalvular ring abscess
Describe the pathophysiology of sepsis
Infection
Excessive cytosine release
Amplification - capillary dilation and increased permeability, oedema of tissues
Hypotension - tachycardia, reduced urine output, reduced cardiac output, multiple organ failure
Anaerobic respiration increases blood lactate
Death or significant morbidity
What are the symptoms of sepsis?
- Shivering, fever, cold
- Extreme pain
- Pale discoloured skin
- Sleepy/ difficult to rouse
- ’ I feel like I might die’
- Short of breath
Describe NEWS for sepsis
National Early Warning Score
Describe methicillin resistant staphylococcus aureus
- Gram positive
- different to other staph aureus strains
- resistant to many antibiotics
Treatment - vancomycin
- teicoplenin
Describe clostridium difficile
- Spore forming anaerobic gram positive bacillus bacteria
- Spores facilitate survival in adverse conditions - resistant to heat, stomach acid, alcohol and alcohol gel
- Produces exotoxins A + B when growing
- Human habitat = large intestine
- Found in soil
- Faeco- oral transmission
Describe the clinical presentation of diahorrea caused by clostridium difficile
- Toxins cause inflammation of intestinal wall resulting in spectrum of disease
1. antibiotic associated diahorrea
2. antibiotic associated colitis
3. Pseudomembranous colitis
4. Fulminant colitis
Signoidoscopy and biopsy required to assess extent and severity of clostridium difficile
What are the risk factors for clostridium difficile?
- Current/ recent antibiotic treatment
- Any antibiotic can induce
- Antibiotics alter gut flora allowing clostridium difficile to flourish
- can occur within two months of antibiotic treatment
What are the risks of antibiotics treating clostridium difficile - categorise the antibiotics
High risk - Cefalosporins - Ciprofloxacin - Clindamycin - IV, multiple/ prologued courses Intermediate - Penicillins - Co- amoxiclav - macrolides Low - Trimothoprim - Nitrofurantoin - Metrondazole
What is the treatment for clostridium difficile ?
Conservative treatment
Stop antibiotics and allow reestablishment of normal microflora
- rehydrate and observations for sepsis
Describe glycopeptide resistant enterococci
Enterococcus species found in normal healthy individuals
Can cause a range of illnesses e.g
- UTI
- Bacterianaemia
- Wound Infections
Resistant to glycopeptide antibiotics - Vancomycin and teicoplanin
What are the two main species of glycopeptide resistant enterococci and their antibiotics?
E. Taccalis - amoxicillin
E. Faecium - Linezoid or daptomycin
Describe the extended spectrum beta lactamases (ESBLs)
- Enzymes produced by bacteria resistant to cefalosporins
- New cases of ESBLs - CTX-M enzymes have emerged and detected across E.Coli bacteria
- ESBLs producing E.coli are resistant to penicillins and cefalosporins found in UTI’s
What are the treatment antibiotics for ESBL’s and AMC?
Aminoglycoside Carbapenem Ciprofloxacin Trimethoprim Nitrofurantoin Tigecycline Temocillin
