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Y3 Medicine > 18 - Community and Hospital Acquired Infections > Flashcards

18 - Community and Hospital Acquired Infections Flashcards

1
Q

What is the definition of a notifiable disease?

A

A disease that by law should be reported to government authorities.

Allows PHE to monitor the disease and warn of early outbreaks

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2
Q

How is the severity of Pneumonia scored?

A

CURB65

Determines treatment!

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3
Q

What antibiotics are given for community acquired pneumonia?

A

CURB 1: PO amoxicillin

CURB 2: PO amoxicillin + PO doxycycline OR IV amoxicillin + IV clarithromycin

CURB 3-5: IV co-amoxiclav + PO clarithromycin

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4
Q

What are some features of early and late meningitis?

A
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5
Q

What are some causative organisms of meningitis?

A

Bacteria: N.Meningitidis, S.Pneumoniae, H.Influenzae, Listeria Monocytogenes, E.Coli

Virus: HSV, VZV, HIV, enterovirus

Fungi: cryptococcus

Cancer

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6
Q

What investigations should be done if meningitis is suspected?

A

- Blood cultures before antibiotics

- LP within one hour (do CT head first if suspect shift of brain compartments)

  • Throat swabs
  • EDTA bloods for meningococcal PCR
  • FBC, U+Es, glucose, LFT, Clotting, Lactate, HIV serology
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7
Q

What should you record in a LP for suspected meningitis and what tests should you send off for?

A
  • Opening pressure
  • Appearance e.g bloody, pus, clear, cloudy
  • Send blood serum for glucose at same time

- Tests: glucose, protein

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8
Q

How can you tell the difference between bacterial, viral and TB meningitis based on the CSF from LP:

  • Appearance
  • Predominant cells
  • Cell count
  • Glucose
  • Protein
A
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9
Q

Who and what prophylaxis should be given when a patient has meningitis?

A

Needs to be isolated for first 24 hours and give Ciprofloxacin to household members and anyone who has kissed patient’s mouth

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10
Q

How is bacterial meningitis managed?

A
  • ISOLATE AND INFORM PUBLIC HEALTH
  • Keep euvolemic, give oxygen, glycaemic control

Meningitic:

  • Take blood cultures
  • Perform LP within 1 hour if no signs of increased ICP
  • IV abx (Ceftriaxone)
  • Dexamethasone IV

Septicaemic:

  • Same as above but leave LP unil stable and get ICU help
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11
Q

What antibiotic therapy is given for meningitis:

  • Younger than 60
  • Older than 60
  • Pregnant or Immunocompromised
A
  • Younger than 60: IV Ceftriaxone. If allergic use Meropenem

- Older than 60: IV Ceftriaxone PLUS IV Amoxicillin to cover for listeria. If allergic use Meropenem

- Pregnant or Immunocompromsied: same as above

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12
Q

How does the treatment for meningitis change if it is likely to be bacterial?

A

Add IV dexamethasone!!!!!!!- Dexamethasone is sometimes given with antibiotics in bacterial meningitis because it helps reduce inflammation in the brain, potentially lowering the risk of complications like hearing loss and brain damage.

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13
Q

What are some signs of increased ICP/brain shift in meningitis?

A
  • Papilloedema
  • Uncontrolled seizures
  • Focal neurology
  • GCS<12

NEED TO DO CT HEAD BEFORE LP!!!!!

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14
Q

What are some complications with delayed treatment of meningitis?

A
  • Deafness
  • Seizures
  • Permanent neurological brain damage
  • Shock
  • Death
  • Learning disabilities
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15
Q

How does encephalitis present?

A

Prodome of infection (raised temp, lymphadenopathy, cold sores, conjuncitivitis) then:

  • Odd behaviour or confusion
  • Focal neruology
  • Headache
  • Reduce GCS
  • Seizures
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16
Q

What are some of the causative organisms of encephalitis?

A

COXSACKIE VIRUS MOST COMMON

Viral: HSV1/2, arboviruses, CMB, EBV, VZV, HIV, Measles, Mumps

Non-Viral: bacterial meningitis, TB, malaria, literia

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17
Q

What investigations should you do if you suspect encephalitis?

A

- Bloods: cultures, viral PCR, malaria film, glucose

- LP: send for gram stain, culture, protein, glucose, PCR for HSV/VSV/Enteroviruses/Adenoviruses

- Contrast enhanced CT: do before LP. Bilateral temporal lobe involvment is likely to be HSV

EEG: rule out status epilepticus

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18
Q

What is the treatment for encephalitis?

A
  • Start aciclovir within 30 mins of arrival due to HSV

- Supportive therapy in HDU

- Symptomatic treatment e.g phenytoin for seizures

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19
Q

How is C.Diff infection managed before antibiotics are given?

A

- Send stool sample for C.Difficile toxin ASAP

- Isolate patient

- Review drugs: stop ABX, PPIs, Steroids, Laxatives, Opioids, Loperamide

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20
Q

What antibiotics are given for a C.Diff infection?

A

Vancomycin PO for 10 days

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21
Q

What are some markers of severe C.Diff infection?

A
  • Temp>38.3
  • Low albumin <25
  • WBC rising >15
  • Elevated creatinine
  • Signs of severe colitis on endoscopy or radiologically
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22
Q

What empirical antibiotics are given for peritonitis/billiary sepsis?

A

Mild to Moderate (not severe sepsis or shock)

  • Coamoxiclav IV
  • Use meropenem IV if penicillin allergy

Admitted to ITU so severe:

  • Piperacillin/Tazobactam IV
  • Use meropenem IV if penicillin allergy
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23
Q

What antibiotics are given for the following parasitic causes of gastroenteritis:

  • Cryptosporidiosis
  • Giardiasis
A

Cryptosporidiosis: watery diarrhoea with no specific treatment, give supportive therapy, inform PHE

Giardiasis: PO metronidazole

24
Q

What antibiotics should be given in an entamoeba histoloytica infection?

A

PO Metronidazole

25
Q

If a patient has sepsis of unknown origin, what is the empirical antibiotic used?

A

IV Meropenem

26
Q

If a patient has sepsis of unknown origin with hepatic cirrhosis, what is the empirical antibiotic used?

A

IV Co-Amoxiclav

(meropenem like normal sepsis pathway if penicillin allergic)

27
Q

What investigations should be done for acute spontaneous bacterial peritonitis?

A

- Blood cultures x 2 from separate sites

- Ascitic fluid x 2, one anaerobic, one aerobic

28
Q

What is the empirical antibiotics for SBP?

A

IV co-amoxiclav

(IV ciprofloxacin if penicillin allergy)

29
Q

What prophylaxis is given in cirrhotic ascites to prevent SBP and what is the criteria to give this prophylaxis?

A

Oral Co-trimoxazole or Oral Ciprofloxacin

30
Q

What antibiotics should you give for variceal bleeding in cirrhosis?

A

IV Co-amoxiclav

(IV ciprofloxacin if penicillin allergy)

31
Q

What is the management for gastroenteritis due to bacterial and viral cause?

A
  • Send stool for culture
  • Manage fluids and electrolytes
  • Isolate
  • Avoid antimotility agents
  • Supportive therapy (self limiting so no abx)
  • Consider informing PHE if thing due to food source
32
Q

What antibiotics are given for cystitis?

A

Women: Nitrofurantoin 3 days (or trimethoprim for 3 days if eGFR<45)

Pregnant Women or Complicated: Nitrofurantoin 7 days (or trimethoprim but only if not in first semester)

Men: Nitrofurantoin 7 days (or trimethoprim) and referral to urology

33
Q

What antibiotics are given for pyelonephritis?
What about in pregnancy?

A

Women and Men

  • Oral co-amoxiclav for 10 days (or ciprofloxacin)
  • IV if too unwell

Pregnant Women

  • Oral cefalexin (or ciprofloxacin)
  • IV cefuroxime if too unwell
34
Q

What antibiotics are given for cellulitis?

A

Mild moderate: Flucloxacillin PO (or Doxycycline PO if allergic)

Severe: Flucloxacillin IV 7 days (or Vancomycin IV if allergic)

35
Q

What antibiotics are given for diabetic foot infection?

A

Mild: Flucloxacillin PO 14 days (or Doxycycline if allergic)

Moderate: Flucloxacillin PO PLUS Ciprofloxacin PO PLUS Metronidazole PO for 14 days

Severe: Piperacillin/Tazobactam IV PLUS Vancomycin IV

36
Q

How do you define the severity of a diabetic foot infection?

A

Mild: 2 signs of inflammation with cellulitis <2cm around the ulcer, infection limited to skin and superficial tissues, no systemic illness

Moderate: 2 signs of inflammation with cellulitis >2cm, spread beyond superficial fascia, involvement of muscle tendon, joint or bone

Severe: Foot infection with systemic toxicity (rigors, tachycardia, hypotension)

37
Q

What antibiotics are given for necrotising fascitis?

A

URGENT SURGICAL REFERRAL FOR DEBRIDEMENT!!!!!

Contact microbiology

38
Q

What are the antibiotics given for osteomyelitis?

A

If acutely unwell:

  • IV flucloxacillin
    (IV vancomycin if allergy)
  • Always consider MRSA
39
Q

What antibiotics are given for spondlodiscitis?

A

Only given immediately if patient septic, otherwise consult with spinal surgeon:

  • Flucloxacillin IV (Vancomycin IV if allergic)
40
Q

What is the pathophysiology of spondylodiscitis?

A
41
Q

What antibiotics are given in infective endocarditis?

A

Colloect three sets of blood cultures from separate sites!!!

4 weeks for native valves, 6 weeks for prosthetics!

42
Q

What antibiotics do not work on MRSA?

A
  • Cephalosporins
  • Penicillins
43
Q

How is MRSA treated?

A

- Decolonisation: use nasal mupirocin and 2% chlorhexidine for 5 days

- Infection: oral vancomycin

44
Q

What is ESBL and how do you treat them?

A

Extended Spectrum Beta-Lactamases. Usually released by gram -ve bacteria like E.Coli and Klebsiella.

Resistant to all beta-lactams apart from Carbapenems so use broad spectrum Meropenem

45
Q

How do you treat a line/catheter infection?

A
  • Remove and replace infected line
  • If fever take blood cultures
  • If pus swab for cultures
  • Flucloxacillin PO (or doxycycline) fo 5 days, 14 days if S.Aureus
46
Q

What antibiotics are given for HAP?

A

Mild/Moderate: Co-amoxiclav PO (or doxycyline if allergic)

Severe: Co-amoxiclav IV (or meropenem if allergic)

47
Q

What antibiotics are given for a LRTI that is not pneumonia?

A

- Non purulent sputum: supportive measures

- Purulent sputum: amoxicillin PO (or doxycycline)

- Purulent sputum with severe disease: co-amoxiclav PO (or doxycycline)

48
Q

What are the different ways that infections are spread?

A
  • Contiguous (direct spread)
  • Haematogenous
  • Inocculation
  • Ingestion
  • Inhalation
  • Vector
  • Vertical
  • Sexual
49
Q

What are the management principles of infections?

A
  • Supportive
  • Specific
  • Infection control
50
Q

What is the issue with S.Aureus when it infects heart valves?

A

It uses fibronectins to attach and forms a biofilm which is difficult for antibiotics to penetrate and is destructive

51
Q

If S.Epidermidis is grown in a blood culture what is the most likely diagnosis?

A

Likely due to contamination from the skin!

52
Q

What are some diseases that Group A Strep causes?

A
  • Endocarditis
  • GN
  • Necrotising fascitis
  • Pharyngitis
  • Scarlet Fever
53
Q

What are some risk factors for C.Diff infection?

A
  • Abx use
  • Older age
  • Hospital stay

Risk of toxic megacolon and bowel perforation

54
Q

What are CRO organisms?

A

Carbapenem resistant organisms

55
Q

What is the treatment for neutropenic sepsis?

A

Intravenous piperacillin with tazobactam (Tazocin)

Y3 Medicine (24 decks)

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