CLASP Sepsis Flashcards
Describe gram negative
Pink with thin wall
Describe gram positive
Purple with thick wall
What organism is associated with heart valves in infective endocarditis?
Strep Viridans
Where is Strep Viridans usually found?
GI tract
What criteria is used to assess infective endocarditis?
Duke Criteria
What kind of haemolytic does Enterococcus Faecalis show?
Non-Haemolysis
What organisms are in the major criteria for diagnosing endocarditis?
Enterococcus faecalis, Strep Viridans, HAECK group, Staph Aureus
Is this patient septic ?
*72 year old patient, 2 weeks following a total hip replacement .On a proton pump inhibitor. Co-amoxyclav prophylaxis for their surgery.
*They have profuse green diarrhoea
*BP 90/60 , pulse 130, RR 30, confused
*Oxygen saturation 97% in room air
*Acute kidney injury ( creatinine double patient’s usual value)
Yes
Is this patient in septic shock ?
*72 year old patient, 2 weeks following a total hip replacement .On a proton pump inhibitor. Co-amoxyclav prophylaxis for their surgery. They have profuse diarrhoea.
*Profuse green diarrhoea
*BP 90/60 , pulse 130, RR 30, confused
*Oxygen saturation 97% in room air
*Acute kidney injury ( creatinine double patient’s usual value)
No
What is the most likely pathogen ?
*72 year old patient, 2 weeks following a total hip replacement .On a proton pump inhibitor. Co-amoxyclav prophylaxis for their surgery.
*10 (type 7) bowel motions per hour
*BP 90/60 , pulse 130, RR 30, confused
*Oxygen saturation 97% in room air
*Acute kidney injury ( creatinine double patient’s usual value)
Clostridium Difficile
How do you test for C Diff in Tayside?
Stool Toxin Test
What are risk factors for C Diff?
- immunosuppression
- hospitalisation
- abx in past 3 months
- PPI
What is the most likely pathogen?
*28 year old patient, 2 days after a visit to a petting zoo followed by a barbecue . She has a fever of 39 and new bloody diarrhoea
*No prior medical history
*BP 80/60 , pulse 130, RR 24, sats 97%
*She has acute kidney injury
Her blood pressure remains 80/60 despite adequate intravenous fluid
E Coli
What antibiotics would you give as part of Sepsis 6 ?
*28 year old patient, 2 days after a visit to a petting zoo followed by a barbecue . She has a fever of 39 and new bloody diarrhoea
*No prior medical history
*BP 80/60 , pulse 130, RR 24, sats 97%
*She has acute kidney injury
*Her blood pressure remains 80/60 despite adequate intravenous fluid
Avoid abx - HUS is a complication
What other samples would you send to the laboratory as part of Sepsis 6 ?
*28 year old patient, 2 days after a visit to a petting zoo followed by a barbecue . She has a fever of 39 and new bloody diarrhoea
*No prior medical history
*BP 80/60 , pulse 130, RR 24, sats 97%
*She has acute kidney injury
*Her blood pressure remains 80/60 despite adequate intravenous fluid
*Blood cultures have been sent
Stool cultures
What associated complication may occur and increase mortality in this condition
*28 year old patient, 2 days after a visit to a petting zoo followed by a barbecue . She has a fever of 39 and new bloody diarrhoea
*No prior medical history
*BP 80/60 , pulse 130, RR 24, sats 97%
*She has acute kidney injury
*Her blood pressure remains 80/60 despite adequate intravenous fluid
*
Haemolytic Uraemic Syndrome
What are the gram characteristics of the infecting organism
*28 year old patient, 2 days after a visit to a petting zoo followed by a barbecue . She has a fever of 39 and new bloody diarrhoea
*No prior medical history
*BP 80/60 , pulse 130, RR 24, sats 97%
*She has acute kidney injury
*Her blood pressure remains 80/60 despite adequate intravenous fluid
E Coli = gram negative rod/bacillus
Which of these is the likely responsible gram positive organism ?
*22 year old patient, No prior medical history
*Protracted vomiting and nausea a few hours after eating reheated rice
*BP 110/60 , pulse 90, RR 16, sats 97%
*She is unable to maintain oral intake
Bacillus Cereus
What antibiotic would you use?
*22 year old student, No prior medical history
*Protracted vomiting and nausea a few hours after eating reheated rice
*BP 110/60 , pulse 90, RR 16, sats 97%, her temperature is 37.5 C
*He is unable to maintain oral intake
*White cell count is normal as is renal function.
Supportive management only - vitals look fine.
What antibiotic has no activity against anaerobes?
Gentamicin
What antibiotic is active against gram positive only?
Vancomycin
What antibiotic is active against gram negative only?
Gentamicin
Give examples of quinolones
Levofloxacin, Moxifloxacin, Ciprofloxacin
What antibiotic is safe to use in penicillin type 1 allergy?
Aztreonam
what pathogen is the most likely to cause all these symptoms?
*Mark is admitted to hospital with fevers, a swollen thigh , a discharging right groin wound and a cough over the preceding 2 days. He last injected heroin in to his thigh . He always uses the needle exchange
* He has a fever of 39 C , he has a blood pressure of 90/60 , his pulse is 130 beats per minute . He is confused but has no focal neurology. His respiratory rate is 28.
*He has a newly raised creatinine
Staph Aureus
PWID , fever of 39 C , he has a blood pressure of 90/60 , his pulse is 130 beats per minute . He is confused but has no focal neurology. His respiratory rate is 28. Is this sepsis?
Yes
How many blood cultures are required before antibiotics are given?
3 sets over an hour
What is the next test you would like to request ?
*Mark is admitted to hospital with fevers, a swollen thigh , a discharging right groin wound and a cough over the preceding 2 days. He last injected heroin in to his thigh . He always uses the needle exchange
* He has a fever of 39 C , he has a blood pressure of 90/60 , his pulse is 130 beats per minute . He is confused but has no focal neurology. His respiratory rate is 28.
*He has a newly raised creatinine
Echocardiography
What covers staph aureus in a penicillin allergy?
Doxycycline
What is the duration of abx in severe staph aureus infection cellulitis in a PWID?
6 weeks
