Bacteria

Question 1

What group of Ax target cell wall synthesis of bacteria

Answer 1

Penicillin
Cephalosporin
Carbapenem 
Glycopeptides
Daptomycin

Question 2

What Ax have B-lactam ring

Answer 2

Penicillin
Cephalosporin
Carbapenem

Question 3

What Ax group target DNA synthesis

Answer 3

Quinolones

Question 4

What Ax group target RNA synthesis

Answer 4

Rifampicin

Question 5

What Ax group target protein synthesis

Answer 5

Macrolides
Aminoglycosides 
Tetracycline 
Clindamycin
Chloramphenicol
Oxazolidones - Linezolid

Question 6

What Ax group target folic acid synthesis

Answer 6

Sulfonmamides
Trimethoprim
Co-trimox = combination of both

Question 7

What can Ax be

Answer 7

Bactericidal - kill

Bacteriostatic - stop reproduction

Question 8

What is better

Answer 8

Use bactericidal

Esp if severe infection or immunocompromised

Question 9

What do you think when choosing Ax

Answer 9

Likely organism
Empirical vs results 
Known resistance
Guidelines vs individual need
Bactercidal vs static
Single or combination 
SE

Question 10

What do you think about for the regime

Answer 10

Route 
Dose
SE
Duration
IV to oral switch
Inpatient or OP
Drug monitoring needed

Question 11

When would you do oral over IV

Answer 11

No vomiting
No GI disturbance
No shock or organ dysfunction
Non-severe infection

Question 12

When do you consider IV-oral switch

Answer 12

After 48 hours if

• improving
• able to tolerate oral

Question 13

What criteria should be met

Answer 13

Able to swallow and tolerate fluid
Temp 36-38 for 48 hours
HR <100 for 12 hours
WCC 4-12

Question 14

When would you continue IV

Answer 14

Oral compromised
Continuing sepsis
Special indication
Febrile neutropenia

Question 15

How can bacteria acquire resistance

Answer 15

Acquire gene that inactivate
Alternative metabolic pathway 
Alteration of target site so Ax can't bind
Decreased permeability in cel wall 
AX removed from bacteria via pump

Question 16

How do ESBL’s work

Answer 16

Acquire B-lactamase enzyme so penicillin’s will not work

Question 17

What are common organisms

Answer 17

Coliforms e.g E.coli / Klebsiella

Question 18

What is MRSA

Answer 18

SA resistance to B-lacytams

Question 19

Ax spectrum of gram +Ve

Answer 19

MRSA
Staph 
Strep 
Enterococcus
Some anaerobes - strep / clostridia

Question 20

Ax spectrum of gram -ve

Answer 20

Coliform - gut - E.coli
Resp - H.influenza, M-catarrhalis 
Pseudomona's 
ESBL
Atypical
Some anaerobes - Bacteriodes

Question 21

What do you say in OSCE

Answer 21

AS PER LOCAL POLICY

Question 22

What do you use for empirical

Answer 22

Broad spec Ax then narrow once sensitivities known

Question 23

How does gram +Ve stain on cultures

Answer 23

Purple as thick peptidoglycan wall that holds dye

Question 24

How does gram -ve stain

Answer 24

Pink as no wall so doesn’t hold dye

Question 25

What can bacteria be split up into

Answer 25

``` Gram -ve Rods Gram -ve Cocci Gram -ve Anaerobes Gram +Ve Rod Gram +ve Cocci Gram +Ve Anaerobes Atypicals Spirochaetes ```

Question 26

What are gram -ve rods that come from the gut i.e. coliform

Answer 26

``` E.coli = most common Pseudomonas aeruginosa Salmonella Shigella Cambylocbacter Proteus Vibro cholera Klebsiella ```

Question 27

Other gram -ve rods

Answer 27

H.influenza Bordetella pertussis H.pylori Legionella

Question 28

What are gram -ve Anaerobes

Answer 28

Bacteriodes fragillis = abscess

Question 29

What are common Rx for anaerobes

Answer 29

Metronidazole

Question 30

What are gram -ve cocci

Answer 30

Neisseria gonorrhoea Neisseria meningitides M.catarrhalis

Question 31

What are gram +ve rods

Answer 31

``` ABCDLM Acitnomyces Bacillus anthrax Clostridia = anaerobe - Perfrinigen - Tetani - Botulinum - Dfficile Diptheria Listeria monocytogenes ```

Question 32

What are gram +ve staphylococci

Answer 32

``` S.aureus = coagulase +Ve S.epidermidits = coag -ve ```

Question 33

What is S.epidermidits

Answer 33

Usually contaminant of blood culture | Doesn't usually cause issue unless metal work in bone / heart

Question 34

What do both organism cause and issue

Answer 34

Joint infections | Form biofilm which prevent Ax working

Question 35

What is MRSA

Answer 35

S.aureus that has become resistant to the beta-lactam Ax

Question 36

How do you prevent

Answer 36

Screen before surgery with nasal or groin swab | Eradicate with chlorhexidine

Question 37

What are Ax options for mRSA

Answer 37

Vancomycin Doxycycline Clindamycin

Question 38

What are gram +ve strep

Answer 38

``` All catalase -ve S.pyogenes (A) = beta haemolytic S.pneumonia = alpha haemolytic S.viridans - found in mouth so common after dental = alpha haemolytic Enterococcus faecalis = non-haemolytic ```

Question 39

What are gram +ve anaerobes

Answer 39

Clostridium Listerai monocytogenes Propionibacerium Lactobacillus

Question 40

What are atypical

Answer 40

Cannot gram stain or be cultured | Ma be weakly gram +ve

Question 41

Examples

Answer 41

``` Mycobacteriua - need ZN showing acid fast bacilli - M.TB - M. pneumonia - M.avium Legionella Chlamydia psittaci Coxiella burnetti ```

Question 42

What are spirochaetes

Answer 42

Boreellia Burgdoferi Treponema pallidum Leptospirosis

Question 43

What are ESBL

Answer 43

Organism resistant to B-lactam Ax by producing beta lactase enzyme which destroy ring

Question 44

What organisms

Answer 44

E.coli Klebsiella Typically cause UTI

Question 45

What are they sensitive to

Answer 45

Carbapenem