Antibiotics & Infection Control

Question 0

Common hospital acquired infection

Answer 0

• C.difficile – prolonged use disrupts normal bowel flora allowing colonisation by toxin producing C.difficile strains leading to diarrhoea
• MRSA – normal flora eradicated allowing colonisation with resistant skin flora including MRSA, this can go on to cause infection (especially line or wound associated)
• ESBL (extended spectrum beta lactamase) – following broad spectrum antibiotic use these strains are ‘selected out’ and persist as colonisation but can cause subsequent infection (UTI, line infections etc)

Question 1

Factors that increase the risk of antibiotic resistance

Answer 1

• Inappropriate clinical use of ABx
  – Poor infection control
  – Excessive ABx use in non clinical settings:

Question 2

When are antibiotics used in prophylaxis

Answer 2

Therapy given to prevent an infection
•Often given around surgery
•Given to patients prone to particular infections
- Contacts of infected patients
•Given to patients who are specifically immunocompromised

Question 3

Targeted antibiotic therapy

Answer 3

Therapy given when the infection and causative organism is known

Specificity and sensitivity of the organism determined

Question 4

Hospital acquired infection

Answer 4

Onset of an infection after 48 hours of admission I to hospital.

Question 5

Community acquired infection

Answer 5

Acquired in the community, or before 48hrs in hospital

Question 6

Effects of Hospital acquired infections

Answer 6

Stay in hospital 2.5 times longer
Cost 3x as much
7x more likely to die

Question 7

Antibiotic treatment of sepsis

Answer 7

Penicillin, gentamicin,metronidazole

Broad spectrum: meropenem, tazocin

Question 8

Antibiotics for skin and soft tissue infections

Answer 8

Flucloxacillin,

Erythromycin / doxycycline if allergic to penicillin

Question 9

Antibiotics for meningitis

Answer 9

Penicillin
Ceftriaxone
Meropenem (broad)

Question 10

Antibiotics for hospital acquired pneumonia

Answer 10

Amoxicillin plus clarithromycin

Severe: Tazocin (Piperacillin-tazobactam) or co-amoxiclav+clarithromycin

Give for 10 days

Question 11

Antibiotics for UTIs

Answer 11

Trimethoprim
Nitrofurantoin

Amoxicillin (rarely)

Question 12

Antibiotics for URTIs

Answer 12

Penicillin
Amoxicillin
Erythromycin

Question 13

Empirical antibiotic therapy

Answer 13

• Therapy given without knowing the causative organism
• Choice based on practical experience and evidence based medicine
• ‘Best guess therapy’, unlikely to cover all possibilities

Question 14

Control measures for hospital infections

Answer 14

Eliminate source/resovoir
Stop transmission
Enhance patient resistance e.g.vaccination

Question 15

Standard infection control measures

Answer 15

Hand hygiene
Safe use of sharps
PPE
Disposal of contaminated substances