gram -ve bacili Flashcards
enterobacterales:
family of gram — bacilli
enteric means its found in —
common causeless are —
increasing rates of —- is a concern
- —– production as:
-ve pink bacilli
gastrointestinal/enteral
tract
intra-abdominal infection,
urinary tract infection (UTI), respiratory tract infection & bloodstream infection (BSI)
anti microbial resistance
Extended spectrum beta-lactamase (ESBL) and Carbapenemas
( Pseudomonas spp. & related genera are another gram -ve )
Escherichia coli
Klebsiella spp.
Proteus spp.
are all in —-
Salmonella spp.
Shigella spp.
Yersinia spp.
are all in —-
normal intestinal flora
pathogen ( non normal flora )
both are in enterobacteralses
other examples include:
Serratia spp.
Enterobacter spp.
Citrobacter spp.
and toxin producing e coli
most enterobacterales are motile by — w it pointing in all directions except — which is non motile
peritrichous flagella
klebsiella
infections causes by e coli includes:
- Urinary tract infection (UTI)
- Most common causative organism in community & in hospital
- Type 1 fimbriae - Intra-abdominal infections
- Neonatal meningitis
- Bloodstream infection (BSI)
- Gastroenteritis
laboratory diagnosis:
- they are gram – bacilli
- grow on — and — media using — selective agar as for lactose vs non lactose fermenters
- further investigation includes:
-ve
non selective and selective
MacConky
further investigation :
– Biochemical testing
OR
– MALDI-TOF
&
– Antimicrobial susceptibility testing
* Multi-drug resistant (MDR) = resistance to 3 different classes of antimicrobials
check slide 9 for agar sooo important
- Gastroenteritis is — and doesn’t require —- treatment
- Other infections: Depends on the —, so you must perform —testing to confirm what is the best antimicrobial to use for treatment
- Antimicrobial resistance is on the rise
– —- infections have a higher chance of being caused by antimicrobial resistant bacteria than community-acquired
infections – broader spectrum antimicrobials chosen for empiric
treatment of hospital-acquired infections
self limiting
antimicrobial treatment
isolate
ati micorbial susceptibility
hospital acquired
e coli treatment:
* Always check the local antimicrobial prescribing guidelines for the condition you want to treat
* Start smart: β lactams - amoxicillin, co-amoxiclav or cefuroxime for —
Piperacillin- tazobactam for —
* If patient is unwell or sepsis suspected, add a second antimicrobial from a different — , e.g.—-–gentamicin while awaiting susceptibility results
* Then focus:
– Is your patient responding clinically to empiric treatment?
– Once you have your susceptibility results back, can you rationalise
your empiric treatment?
community acquired infection
hospital acquired infection
different class
amino glycoside
proteus mirabilis:
* Complicated — usually in patients with functional or anatomical abnormalities
– Urolithiasis (urinary tract stones/calculi)
– Catheter-associated urinary tract infections (CAUTIs)- to reach the urinary tract, P. mirabilis uses —-
to migrate across the catheter surface
* Urease production:
– generates —
– elevates the — of urine
– calcium and magnesium – in the urine
– blocks the catheter —
– This can result in urinary —, — , –
UTI
swarming motility
ammonia
ph
crystallisation
lumen
retention , bacteruirua , pyelonephritis
- ‘Swarming’ appearance on blood agar due to peritrichous
flagellae - Doesn’t swarm on MacConkey agan: non-lactose fermenting
colonies are both diagnosis for —-
proteus
check slide 14 sooo important
treatment of proteus mirabilis:
* Depends on the isolate, so you must perform antimicrobial susceptibility testing
– —
– Also: — / co- —
– Inherently resistant to — and— - so never use these to treat infection caused by Proteus
– Antimicrobial resistance is on the rise
prevention includes:
b lactase
aminoglycosides / co trimoxazole
nitrofuritoin n tetracylin
* Infection prevention & control
* Urinary catheter care – remove unnecessary catheters
klebsiella spp as k.penumoa n k. oxytoxa
* Normal inhabitant of the – of healthy humans
* Are NOT associated with —
* Infections → Hospital-acquired infections:
– — , including —
– —
– — infections
– — infection
GIT
gastroenteritis/dirrhoeal
penunoma n VAP
UTI
intra abdominal infection
bloodstream
- Specimen depends on the infection type
– Urine / Blood / Sputum - Grows on a wide variety of media
- MacConkey: (mucoid) lactose-fermenting pink
colonies
are laboratory diagnosis for —
klebsiella app check slide 17 sooo important
- Klebsiella spp. are inherently resistant to — – never use this to treat an infection caused by Klebsiella
- Antimicrobial resistance is on the rise:
– ESBL = Resistant to — including 3GC
– Carbapenemase = Resistant to —
including carbapenems
– Aminoglycosides = gentamicin
– Fluoroquinolones = ciprofloxacin
– Multi-drug resistant (MDR) – Resistant to 3GC +
aminoglycosides + fluoroquinolones
amoxilin
beta lactams
beta lactams
treatment of klebsiella ssp:
TREATMENT FOR Klebsiella spp.
* Depends on the isolate, so you must perform antimicrobial susceptibility testing
* Always check the local antimicrobial prescribing guidelines for the condition you want to treat
* Start smart: — or co amoxilav or cefuroxime for — acquired infection
Piperacillin-tazobactam for —
* If patient is unwell or sepsis suspected, add a second antimicrobial from a different — , e.g. —
– — while awaiting susceptibility results
* Then focus:
– Is your patient responding clinically to empiric treatment?
– Once you have your susceptibility results back, can you
rationalise your empiric treatment?
b lactams ( focus on b lactase n amino glycoside)
community
hospital acquired
class
amino glycoside
gentamicin
p/ aeuroginos:
* — pathogen – loves — areas
* Opportunistic especially if pre-existing conditions
– Causes a wide range of — acquired infection (especially — ), infection in — /— / —
* Fewer treatment options than Enterobacterales as intrinsically resistant to many antimicrobials – amoxicillin, co- amoxiclav, cefuroxime
* Treatment options include:
environmental
moist
hospital acquired
medical device
cystic fibrosis
birds
diabetic foot ulcers
treatment:
– Piperacillin-tazobactam
– Ciprofloxacin (quinolone)
– Aminoglycosides e.g. tobramycin, amikacin
– Carbapenems e.g. meropenem (reserved)
