Common Infections Flashcards

1
Q

Following the O’Neil review on Antimicrobial resistance, NHS England introduced which two quality premiums for 2017-2019

A
  1. Reducing gram negative blood stream infections across the whole health economy by at least 10%
  2. Reduction of inappropriate antibiotic prescribing for UTI’s in primary care by at least 10%
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2
Q

Signs and symptoms of lower UTI

A
back pain
dysuria
polyuria & urgency
haematuria
subrapubic tenderness

Additionally:
fever, chills, flank pain, renal angle tenderness, N&V would be for an upper UTI

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3
Q

Most common organism causing UTI

A

E.coli

Other possible are : proteus app, enterobacter app, enterococcus app, staphylococcus app, pseudamonus aeruginosa.

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4
Q

What part of the urinary tract is a lower UTI and what is its other name?

A

Bladder and urethra

cystitis

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5
Q

What part of the urinary tract is an upper UTI and what is its other name?

A

Ureter and kidneys

Pyelonephritis

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6
Q

Give some examples of co-morbidities when a UTI would be complicated…

A
  • poorly controlled diabetes mellitus
  • pregnancy
  • AKI or CKD
  • suspected or known urinary tract obstruction
  • presence of an indwelling urethral catheter, stent, nephrostomy tube or urinary diversion
  • functional or anatomic abnormality of the UTI
  • renal transplant
  • other immunocompromising conditions (neutropenia, advanced HIC, chronic high dose corticosteroid use, B or T leukocyte deficiency)
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7
Q

Should we give ABX to elderly if they have bacteruria?

A

No because prevalence of this rises with age due to poor immune system, higher intravaginal pH in post menopausal women, bladder outlet obstruction etc. They may not actually be sick with it.

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8
Q

Why is the prevalence of UTI’s less in women than men

A

They have a longer urethra so further for bacteria to travel. Their prostatic fluid has some antibacterial properties and a drier periurethral environment.

This is why all mens UTI’s are classes as complicated.

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9
Q

Is a urine dipstick test a reliable test in patients with catheter?

A

No because between two - ten days after catheter insertion around 30% of patients have bacteruria so will yield a positive dipstick result

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10
Q

What do we test for with urine dipstick?

A
nitrates (urinary nitrates break down to nitrated by the bacteria)
leucocyte esterase (produced by the increased neutrophils present in the urine)
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11
Q

urine microscopy, sensitivity and testing……

A

pyuria - white blood cells
haematuria - erythrocytes
bacteruria - bacteria

not individually a positive result for an infection but together they can be

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12
Q

When is urine culture recommended…..

A
  • Those who have failed first line therapy or have persistent symptoms
  • Pregnant women at their first antenatal visit (as asymptomatic bacteria is associated with pyelonephritis and premature delivery and should always be treated)
  • suspected UTI in med
  • Suspected pyelonephritis
  • Recurrent UTI, anatomical abnormalities of the genitourinary tract and those with renal impairment (as they are more likely to be associated with resistant organisms)
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13
Q

first line ABx for uncomplicated UTI in in women and men (complicated)

A

trimethoprim
nitrofurantoin
women 3/7
men 7/7

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14
Q

What ABX would we start with in pyelonephritis whilst waiting for cultures to come back?

A

cipro, co-amoc or gent

then start smart then focus

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15
Q

When can we use nitro in patients with eGFR <45ml/min

A

When their eGFR 30-45ml/min
They have a lower UTI and can only be treated for a short course 3-7/7
They are suspected to have multi drug resistance
benefit outweighs the risk

Approximately 25-30% of nitro is excreted in the urine and in renal impairment the desired concentration is not achieved

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16
Q

Can we use nitrofurantoin in upper UTI

A

plasma concentrations of a therapeutic dose are low therefore they are nota good candidate for UUTI.

17
Q

What things do we counsel when patient is on nitrofurantoin

A

Not to take alkalising agents such as potassium citrate as it is affected by urinary pH.
Also to take with food as it is better absorbed with gastric contents.

18
Q

What bacteria can cause skin and soft tissue infections?

A
  • beta-haemolytic streptococci (usually streptococcus pyogenes)
  • staphylococcus aureus.

Therefore vigilance to MRSA is important especially if response to treatment is poor.

19
Q

How does bacteria cause necrotising fasciitis?

A

Bacteria produce two exotoxins - a protease that degrades host cell proteins and a ‘super antigen’ that excited the immune system causing healthy cells to commit suicide (apoptosis)

20
Q

A similar skin condition like cellulitis but involved the upper dermis?

A

erysipelas - it involved the upper-dermis and is raised above the skin with a well-demarcated edge.

Cellulitis involved the deeper dermic and s/c fat. It does not have a well-demarcated edge.

21
Q

fresh water and sea water pathogens that may cause infections

A

fresh water - aeromonas species

sea water - vibrion vulnificus

22
Q

Panton-Valnetine Leukocidine (PVL) toxin destroys white blood cells and is produced by some Staph aureus

A

suspect this in patients with necrotising SSTI, recurrent furuncles/carbuncles or clustering os SSTI’s. Remember the 5 C’s

Contaminated items
Close contact
Crowding
Cleanliness (or lack of)
Cuts
23
Q

What guidelines should be followed to determine the severity of cellulitis?

A

CREST
Class 1 - fine - oral ABX
Class 2 - well or unwell but an uncontrolled co-morbidity such as vasculitis
Class 3 - systemic upset e.g. confusion, lethargy and may have co-morbidy may be limb/life threatening
class 4 - sepsis or necrotising facititis

24
Q

treatments for cellulitis

A

flucloxacillin
flucloxacillin + ben pen
co-amoxiclav

25
Q

How to treat cellulitis if a patient is allergic to penicillin?

A

clarithromycin

clindamycin

26
Q

What two organisms are often associated with cellulitis?

A

Staph aureus

strep pyogenes

27
Q

Is PVL-SA only seen in MRSA cases?

A

No

28
Q

A patient grows MRSA from a wound swab and is systemically unwell. Which ABX would be most appropriate to add to their regime?

A

Vancomycin

29
Q

True or False

Fusidic acid should not be used as a mono therapy when treating skin infections caused by staph aureus?

A

TRUE

30
Q

High doses of Benpen can effect electrolytes? How?

A

HYPERnatraemia

HYPOkalaema

due to high sodium content

31
Q

Can chronic urinary retention cause UTIS?

A

Yes