Gram Negative Organisms

Question 1

Why is amox/met/gent given in bacteraemia/infection of an unknown cause?

Answer 1

Amox: enterococcus
Met: anaerobes
Gent: gram negs

Question 2

What is the alternative to metronidazole for anaerobes?

Answer 2

Clindamycin

Question 3

Diagnosis of sepsis?

Answer 3

NEWs over 5 WITH an infection
q-SOFA over 2
SIRS over 2

Question 4

Sepsis 6?

Answer 4

Give high flow O2 with sats under 94%
Give IV antibiotics 
Give IV fluids 
Take lactate
Take cultures 
Measure urine output

Question 5

What antibiotics are given against gram negs?

Answer 5

Beta lactams (and monobactam - azetreonam)
Aminoglycosides - gentamicin and streptomycin
Macrolides
Tetracyclines
Chloramphenicol
Co-trimoxazole
Polymixins

Question 6

Side effects of quinolones?

Answer 6

Tendonitis
Achilles tendon rupture
Seizure
Ruptured AAA
Psychiatric 
Prolongs QT

Question 7

Treatment of legionella?

Answer 7

Levofloxacin + co-amoxiclav

Question 8

When is aztreonam indicated?

Answer 8

Purley active against gram negs

Alternative to gentamicin when there is kidney failure

Question 9

In what condition is gentamicin CI?

Answer 9

Myasthenia gravis as can cause resp depression

VERY narrow therapeutic window

Question 10

How long do you have to be in hospital before HAP can be diagnosed?

Answer 10

More than 48 hours

Question 11

Bugs in mild CAP?

Answer 11

Pneumococcas

Haemophilus influenzae

Question 12

Bugs in severe CAP?

Answer 12

Pneumococcal
Haemophilus influenzae
Coliforms
Legionella
Mycoplasma
Chlamydia psicati
Coxiella
Staph aureus post influenza or PVL strains causing necrotising pneumonia

Question 13

Bugs in HAP?

Answer 13

Pneumococcus
Haemophilus influenzae
Coliforms
Legionella

Question 14

Describe the structure of H.influenzae?

Answer 14

Gram negative coccobacillus
Aerobic
Grown on chocolate agar

Question 15

What antibiotic is used for H.influenzae?

Answer 15

Amoxicillin

Doxycycline also active

Question 16

What is the treatment for atypical pneumonia?

Answer 16

Doxycycline
Clarithromycin
Levofloxacin for penicillin allergic and legionella

Question 17

Describe the structure of legionella?

Answer 17

Gram negative bacillus

Question 18

Where can legionella be found?

Answer 18

Lukewarm aerosolized water (showers, air conditioning, taps)

Smokers, males, COPD, immunosuppression

Question 19

What is the incubation period of legionella?

Answer 19

2-10 days

Question 20

How is legionella diagnosed?

Answer 20

Urine PCR

Serology

Question 21

Important causes of gram negative sepsis?

Answer 21

E.coli 
Klebsiella
Pseudomonas
Serratia
Acinetobacter
Enterobacter
Neisseria meningitidis

Question 22

What can be used to treat pseudomonas?

Answer 22

Ciprofloxacin ONLY oral treatment

Meropenem for resistant pseudomonas

Question 23

What is a coliform?

Answer 23

Gram negative rod

E.coli, klebsiella, proteus, enterobacter, serratia

Question 24

How are coliforms treated?

Answer 24

IV gent

IV aztreonam if kidney injury

Question 25

What agar plate is used for the diagnosis of e.coli?

Answer 25

MacConkey plate - lactose

Question 26

If you have a type 1 penicillin allergy, what other antibiotics will you be allergic to?

Answer 26

Penicillin
Cephalosporins - cefuroxime, ceftriaxone
Carbapenems - meropenem, ertapenem
Piperacillin-tazobacam

Question 27

What antibiotic can be given in type 1 penicillin allergies?

Answer 27

Aztreonam

Question 28

What can be used to treat ESBLs?

Answer 28

Meropenem

Penicillins, cephalosporins and aztreonam activity lost

Question 29

What is the max dose of gent?

Answer 29

600mg