Bacterial sepsis following pregnancy GTG

Question 1

What factors increases risk of maternal sepsis?

Answer 1

DM
Obesity
Immunosuprresed
Anaemia
Vaginal discharge
Hx pelvic infection
Invasive procedures
Cervical cerclage
PROM
RPOC
Vaginal trauma/CS/haematoma
GAS in close contact
Black or minority ethic background

Question 2

What antibiotic covers both typical and atypical pneumonia

Answer 2

Beta-lactam and macrolide (clinda)

Question 3

Haemoptysis is a feature of which pneumonia>

Answer 3

Pneumococcal

Question 4

What could severe haemopysis and low WCC indicate?

Answer 4

PVL-associated staphylococcal necrotising pneumonia

Mortality rate 70% in young people

Question 5

What criteria should be used to assess pharyngitis to assess for GAS?

Answer 5

Centor criteria (fever, tonsillar exudate, no cough, tender anterior cervical lymphadenopathy) 3/4 - give Abx

Question 6

If GAS suspected what is the best Abx?

Answer 6

Clindamycin

Question 7

What analgesia should be avoided in sepsis

Answer 7

NSAIDS

Question 8

If agonising pain out of proportion to clinical signs, what must be considered?

Answer 8

Deep infection and necrotising fasciits/myositits

Question 9

What contacts should you enquire about when considered GAS?

Answer 9

Contact with streptococcal infections (pharyngitis, impetigo, cellulitis)

Question 10

If GI symptoms such as diarrhoea or vomiting, what to consider?

Answer 10

C.Diff
Early toxic shock

Question 11

All cases of PP sepsis should be discussed with whom?

Answer 11

Microbiology or ID physician

Question 12

When sending stool culture what to consider?

Answer 12

Routine stool culture - salmonella/campylobacter

Need to send specific C.Diff, if recent Abx/particullar offensive

If consider listeria (recent soft cheese/cured meats)

Hx travel (parasites, typhoid, cholera)

Question 13

If high platatelts, high CRP, swinging pyrexia - what does this suggest

Answer 13

Collection of pus - ?infected haematoma

Question 14

What is the mortality of untreated C.Diff in mothers?

Answer 14

30%
Whilst results pending can consider PO metronidazole, oral vancomycin

Question 15

What infections are at risk of infecting the baby?

Answer 15

GAS and PVL producing S aureus

Question 16

Which infections requires prophylaxis for family/staff

Answer 16

Neisseria Meningitidis
GAS

Question 17

If superficial skin infection but higher risk of MRSA (such as IV Drug user), what abs?

Answer 17

Oral vancomycin

Question 18

Severe sepsis without clear source?

Answer 18

IV meropenem, clindamycin and stat gentamicin

Question 19

What % of women with chlamydua trachomas at time of delivery develop a puerperal infection?

Answer 19

30%

Question 20

What % of neonates who mothers have active chlamydia trachoma’s at birth develop
i) Ophthalmia neonatroum
ii) Chlamyda pneumonitis

Answer 20

i) 50%
ii) 15%

Question 21

What disease are tested for in newborn blood spot screening>

Answer 21

Phenylketonuria
Congenital hypothyroidism
Sickle cell disease
Cystic fibrosis
Medium chain acyl CoA dehydrogenase deficiency