Concepts in Infection Flashcards by Claire O'Regan

4 bugs that don’t gram stain

mycobacterium tuberculosis,
chlaymdiia,
treponema pallidum (syphillis),
mycoplasma

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Gram positive - what causes it to be purple on gram staining?

thick peptidoglycan layer traps it

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Gram negative - what causes it to be pink?

thin peptidoglycan layer s crystal violet is easily rinsed away leaving behind red dye

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What is on outside of gram negative organisms? What is it’s significance?

Outer membrane has lipopolysacchardies which are highly charged and contribute to pathogenicity of gram -ves, is an endotoxin

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unpasteurised milk associated bugs (4)

brucella,
listeria,
Salmonella,
E.coli

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Coliforms are gram -ve rods. List 5 coliforms

e.coli, 
klebsiella, 
proteus, 
enterobacter, 
serrate

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E.coli can cause what in neonates? (2)

HUS,

neonatal meningitis,

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ciprofloxacin side effects (4)

c.difficile,
lowers seizure threshold so for people,
AA ruptures,
tendonitis

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Antibiotics that may be active against gram negatives (6)

beta lactates, 
aminoglycosides, 
macrolides, 
tetracyclines, 
chloramphenicol, 
co-trimoxazole

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Atypical pneumonias - why are they called atypical?

present atypically to pneumococcus

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Mycoplasma peaks every how many years

4 years

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bronchiectasis associated with what bacterial lung infection

pseudomonas

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COPD

morexella

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coxiella associated with what job

farmers

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psittacosis associated with what

parrots,

parakeets

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mild to - moderate CAP bugs

pneumococcus,

haemophilus influenzae

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what type of bug is haemophilus influenzae and what antibiotic

gram negative coccobacillus - amoxicillin or doxy

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What was associated with haemophilus influenza type b

hearing loss,

vaccine changeds

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List 4 atypical pneuomonias

mycoplasma pneumonia,
acute coxiella brunette,
chlamydophila psittaci,
legionella

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Atypical pneumonias respond to what (4)

doxycycline, (but not legionella!!),
clarithromycin,
quinolone,
amoxicillin doesn’t work!!

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First choice for legionella

quinolone e.g. levofloxacin

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Legionella associated with what

lukewarm water,
showers,
air conditioning,
taps

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Legionella is more common in those with what (7)

smokers, 
males, 
COPD, 
immunosuppressed, 
malignancy, 
diabetes, 
dialysis

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Gram negatives associated with sepsis (6)

e.coli, 
Klebsiella, 
Enterobacter, 
Pseudomonas aeruginosa, 
Neisseria meningitidis, 
Neisseria gonorrhoea

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Gram +ve bacilli to know (4)

corynebacterium (diphtheria), clostridium, listeria, bacillus

corynebacterium disease

diphtheria - can cause prosthetic infection

clostridium diseases

tetanus, colitis, perfringens - skin/soft tissue

Bacillus cereus

gastroenteritis

listeria diseases

``` gastroenteritis, septicaemia, meningitis, encephalitis, pneumonia, neonatal, endocarditis (risks = soft cheeses, unpasteurized milk, meats) ```

IV antibiotics preferable for sepsis most of the time. When are oral antibiotics good for sepsis?

c.diff

Strep in sepsis causes

strep pneumonia, strep viridians, group A strep, group B strep neonates

beta haemolytic

clear zone - complete haemolysis

gamma haemolytic

nothing - no haemolysis

strep pyogenes haemolyiss

beta

strep pneuomniae haemolysis

alpha

strep viridians haemolysis

alpha

strep gallolyticus infections (2)

endocarditis, | gi associations

strep pneumonia treatment

penicillin but if recent travel add vancomycin!

syphillis treatment

penicillin

enterococcus

e. faecalis most common, | e. faecium

enterocossu

UTI, | endocarditis

enterococcus treatment

amoxicillin, (amoxicillin), vancomycin if amoxicillin resistant

staph aureus in sepsis

no longer penicillin sensitive, | fluclox IV or vancomycin IV in allergy or MRSA

staph epidermis

not as virulent as staph aureus, many fluclox resistant

staph aureus causing sepsis tends to come from what two systems

endocarditis, | pneumonia,

gram +ve bacilli in bloods - what risk factors should we check?

``` intra-abdo infection, skin and soft tissue, prosthetic, meningitis/encephalitis/immunosuppressed, PWID/animal skins (anthrax) ```

Which organism is not a typical organism in the major criteria for diagnosing endocarditis?

Escherichia species

intra-abdo sepsis bugs (3)

coliforms, enterococci, anaerobes

initial treatment in intra-abdo sepsis

IV amoxicillin+ gentamicin + metronidazole

step down therapy after sepsis caused by intra-abdominal infection

oral cotrimoxazole and metronidazole

intra abdo sepsis treatment if penicillin allergy

vancomycin + gentamicin + metronidazole

cholangitis/cholecystitis common bug

enterococcus faecalis

diabetic bugs acute & chronic

acute: staph aureus, chronic: staph aureus, coliforms, anaerobes

cellulitis bugs

staph aureus, | group a strep (pyogenes)

bacillus cereus differs in presentation to the other bacterial causes of gastroenteritis how

vomiting more than diarrhoea

4cs

clindamycin, co-amoxiclav, ciprofloxacin/quinolones, cephalosporins

treatment for c.difficile

oral vancomycin ! normally doesn't penetrate gut well so don't do IV

risk factors for c.diff (6)

``` recent hospital stay, recent antibiotic use, use of pips, increasing age, recent surgery, immunosuppression ```

petting zoo (!!) & bbq (not so much), bloody diarrhoea, fever, aki - bug ?

E coli

complication of giving antibiotics in e coli with AKI

HUS

spirochetes (2)

lyme and syphilis

campylobacter presentation

usually watery diarrhoea, sometimes bit bloody but bloody normally e.coli!

C.diff what 3 tests should you think of

stool toxin & culture, WCC, creatinine

C.diff within how many weeks of risk factors

within 12

C.diff does alcohol gel do enough

No doesn't kill spores

C.diff infection control procedures

isolation room, own commode, proper hand washing

Test for legionella

urinary antigen, | sputum PCR

Test for coxiella burnetti/chlamydophilia psittaci

serology

Mycoplasma test

PCR on viral swab

Presentation suggestive of CAP more than Covid (4)

unilateral changes, neutrophilic, lack of lymphopenia, productive cough

CAP treatment and step down for strep pneumonia

IX vo-amoxiclav and oral doxy, | step down to oral amoxicillin

Cellulitis

consider tine pedis, fluclox if mild, doxy if allergic, sepsis fluclox or vancomycin IV, septic shock or NEC fluxloc + clindamycin + gentamicin if allergic just clindamycin and gentamicin

When should you suspect HAP vs CAP?

If in hospital >48 hours

Pseudomonas causes (3)

Pneumonia in people with bronchiectasis, UTI, Otitis externa

Brucella associated with

Sheep, goats, cattle, unpasteurised milk