BioBurden! Flashcards
What is gram positive look like after gram staining?
Purple circle
What is gram negative look like after gram staining?
Red cyclinders
In bacterial morphology, what are spheres called?
Cocci
In bacterial morphology, what are “pleomorphic” shapes (hybrid between sphere and rod) called?
Coccobacilli
In bacterial morphology, what are rods called?
Bacilli
What is the normal WBC?
4400-11000 cells/mm^3 (4.4-11)
What is the WBC count in Leukocytosis?
Greater than 11000 cells/mm^3 (> 11)
What is a “shift to the left?”
Refers to the finding of a higher proportion of band or stab cells (immature neutrophils)
The presence of what % of bands is considered abnormal?
> 3-5% bands
According to George Allen, what is the most important vital sign to know - The Cardinal Sign of Infection?
HIGH FEVER!
> 38.8 degrees C or 100 degrees F orally
What are the 4 Agranulocytes?
Monocyte
B lymphocyte
T lymphocyte
Macrophages
Monocytes become what?
Macrophages
What are the 3 Granulocytes? Which one is most common
Basophil - 0-1%
Eosinophil - 1-3%
Neutrophil - 50-70%
What are the 5 markers along the Infection Spectrum?
Prophylaxis - No infection (no title) - Infection Empiric - Symptoms (broad) Definitive - Pathogen isolation (narrow-spectrum) Suppressive - Resolution
(P EDS)
Who is Andrew Wakefield?
Fraud.
Stated there was a link between Vaccines and Autism
Proven false
Millions pissed off - but some celebrities digress
What are normal pathogens in the blood?
None! Normally sterile
What are normal pathogens (normal flora) in the genitals?
Staphylococcus. spp Lactobacillus spp. Diphtheroids Enterococcus spp. Streptococcus spp. Gram-negative rods Anaerobes Yeast
All others are bad
According to Christian Jorns, what kills people in MRSA?
PVL - a virulence factor that targets the cell membrane of neutrophils, leading to the release of inflammatory mediators that produce necrosis and abscess formation, as well as possible neutropenia
What are common sites for infection?
Bacterial meningitis Otitis media Pneumonia Skin infections Eye infections Sinusitis URTI Gastritis Food poisoning UTI STDs
What is the microbe that is associated with the greatest risk off MRSA?
Fluoroquinolones
What % of those with skin and soft tissue infections have MRSA?
76%
What are the 5 C’s for the Transmission of MRSA????? (WILL BE EXTRA CREDIT PER SHEA RODRIGUES ET AL)
Crowding Frequent Skin to skin Contact Compromised skin integrity Contaminated items and surfaces Lack of Cleanliness
In regards to patient-specific susceptibility reports, what does R stand for?
Resistance
In regards to patient-specific susceptibility reports, what does I stand for?
Intermediate resistance
In regards to patient-specific susceptibility reports, what does S stand for?
Suspetible
When choosing a drug for a patient, In regards to patient-specific susceptibility reports, what letter do you choose
ALWAYS CHOOSE THE S
What decreases resistance to MRSA
Increased exposure to antimicrobials
Does the evidence state that silver dressings provide benefits for clinically infected wounds?
NO! No evidence supports this claim for the use of silver-based dressings.
In terms of bacterial characteristics, what do spores do?
Enhance survival
In terms of bacterial characteristics, what does Biofilm do?
Allow organisms to adhere to surfaces and limit antimicrobial exposure
In terms of bacterial characteristics, what does plasmid do?
Genetic transmission between microbes
Should you high five or fist bump?
Fist bump
After what event was there a lot of nosocomial transmission?
Haiti Earthquake
Can dogs give you MRSA?
Yes.
Are more people giving vaccines to their children
Despite the increase in overall resistance, the answer is NO! (Thanks to Andrew Wakefield and the celebrities he influenced)
When was the 1st gram + coccus identified for Staphylococcus Aureus?
1880 (named after gold grapes by Alexander Ogston)
What does Staph. A. do? Where does it do its work?
Commonly colonizes the skin and nasal muscosa - a cause of skin/soft tissue infections, pneumonia, meningitis, osteomyelitis, endocarditis, bacteremia, and sepsis
Which position in football poses the greatest risk for MRSA?
Linemen
Which position in football poses the smallest risk for MRSA?
Quarterbacks
Do older people get HA-MRSA or CA-MRSA?
HA-MRSA
If all S in patient-specific susceptibility report, which do you choose?
The antimicrobial with the lowest MIC
Is there a link between antimicrobial use and resistance?
Yes
How many years (Approximately) does it take for a antibiotic to be resisted by the general public?
Only a few years; happens relatively quickly
What is the difference between gram + and - regarding cell walls and petidoglycan layers?
Gram positive - thick peptidoglycan layer and NO outer cell membrane (positive for peptidoglycan)
Gram negative - has an outer cell membrane but a thin peptidoglycan layer
What route of administration is most preferred when giving drugs?
ORAL!
What are the 5 different classifications of Bacteria?
Gram staining Morphology Aerobes versus anaerobes Other growth requirements Biochemical testing
How do we use antimicrobials?
A continuum of infectious diseases exists, including self-limiting infections, acute infections, and chronic diseases. Antimicrobial therapy is often initiated before a diagnosis is made, a pathogen is cultured, and/or antimicrobial susceptibility is known (Prophylaxis)
What are 6 different drug factors to consider?
Spectrum of activity against suspected pathogens Evidence of efficacy Pharmokinetic factors Safety and toxicity of profile Ease of administration Cost
What are 10 host factors for assessing infections?
Age
Suspected site of infection and drug delivery to thaat site
Co-morbidities and predisposing conditions
Severity - osteomyelitis?
Immune status (age, use of systemic corticosteroids, immunosuppression)
Antimicrobial exposure - previous, concurrent
Allergy history
Pharmokinetic Changes (renal hepatic impairment, weight)
Pregnancy and lactation
Epidermiologic factors
What is the PEDIS Scale?
Uninfected - 1 - no signs or symptoms
Mild - 2 - erythema 0.5cm to 2cm. Local infection only to skin and subcutaneous tissue
Moderate - 3 - Local infection involving structures deeper than skin and subcutaneous tissue AND no systemic inflammatory response signs. Erythemia > 2 cm
Severe - 4 - Local infection with signs of SIRS. Has 2 or more of the following: (see PowerPoint - not displaying here)
What is The Treatment Approach? (3)
Topical treatments
Systemic treatments
Surgical interventions
How do you diagnose skin and soft tissue infections? (3)
Gram stain of pus or exudate, etc. Wound cultures (tissue removal, aspiration, swabs) Other tests: -The "probe to bone" test -radiologic imaging
What are 6 infectious agents?
Bacteria Viruses Fungi Parasites Prions Toxins
Aspects of a microbiology report?
Quantity of organisms
Specimen quality
# of samples
Contaminents and normal flora versus pathogens
3 aspects of the microbiology of the skin?
Gram + bacteria
Gram - bacteria
Fungi
What is Measuring antimicrobial susceptibility?
Test of microorganism to grow in presence of particular antimicrobial concentration in VITRO –> used to predict clinical success and measure and detect antimicrobial resistance in VIVO
Qual and Quan methods exist
Performed and interpreted according to guidelines published by the Clinical and Laboratory Standards Institute (CLSI)
How does Disk Diffusion work?
Paper discs are impregnated with a defined amount of antimicrobial.
The diameter of the zone of growth inhibition around each disc is measured and is then used to determine to MIC
A qualitative method of susceptibility testing
How does microdiluation work?
A range of antimicrobial concentrations in 1:2 dilutions is tested; all concentrations are expressed in ,g/L (mcg/mL) of that antimicrobial
How does Etest work?
The Etest is a plastic strip that is impregnated with a range of concentrations of an antimicrobial
The MIC is defined as the point at which the ellipse of bacterial growth intersects with the Etest
A suspention of ? of the bacterium being tested is added for susceptibility testing?
~10^5 CFU/mL
How long are tubes incubated?
24 hours
What is the MIC (minimum inhibitory concentration)
The lowest antimicrobial concentration that inhibits visible growth
How do beta-lactums kill bacteria?
Penicillin-binding proteins (PBPs) cross-link the components of bacterial cell walls –> beta-lactums bind to PBPs and decrease cell wall synthesis, leading to cell death
Individuals exposed to antimicrobials are at nearly a ??? risk of acquiring MRSA?
2-fold
What 3 things are clearly associated with acquisition of MRSA?
Glycopeptides (vancomycin), cephalosporins, and other beta-lactums
What are outcomes of MRSA infection? (6)
Lost productivity Higher hospitalization rates Longer hospital stays Higher rates of co-morbidities such as acute renal failure, hempdynamic instability, ventilator dependency, and ICU resistance Higher healthcare costs Higher mortality
What are the 9 Fallacies in antimicrobial use? (9 things you should NOT do)
Broader is better Failure to respond is failure to cover When in doubt, change drugs or add another More diseases, more drugs Sickness requires immediate treatment Response implies diagnosis Bigger disease, bigger drugs Bigger disease, newer drugs Antibiotics are non-toxic
What are 7 ways to prevent the transmission of MRSA?
MRSA risk assessment, monitoring, & reporting
Compliance with hand-hygiene practices
Contact precautions for colonized or infected patients
Cleaning and disinfection of equipment and the environment
Education of healthcare personnel, patients, and family
Active surveillance in patients and healthcare workers
Routine bathing and decolonization
Is compliance with hand hygiene generally good?
No
