How To Use Microbials Flashcards
M.I.N.D M.E?
M - Microbiology Guide wherever possible
I - Indication must be evidence based
N - Narrowest spectrum!
D - Dosage Appropriate! - site & type of infection
M - Minimise Duration of therapy
E - Ensure Monotherapy in most situations
Cause of infectious disease
Bacteria, viruses, fungi, protozoa, toxins (eg from bacteria), parasites, prion
Signs of infection?
Elevated WBC - predominantly neutrophils (left shift)
Local signs - swelling, redness, pus
Vital signs - T, HR, BP, Resp rate, mental state
Eg of signs specific to infections
Whooping cough (Pertussis) Characterisitic rash (Meningococcal disease)
Classifications of UTIs
- Cystitis
- Pyelonephritis
- Complicated UTIs
- Uncomplicated UTIs
Signs & symptoms of UTIs
Urine condition
- foul smelling
- cloudy urine - because of the WBC present
Inflammation
- burning pain during urinating - urine becomes acidic
Incomplete voiding of bladder
Frequent urge to urinate (but only in small amount)
Pyelonephritis
- back/ flank pain
Cystitis?
Infection of bladder.
Pyelonephritis?
When infection spreads to the pyelum (pelvis) of the kidney
Complicated?
Anatomical or functional abnormalities (diabetes, neurogenic bladder, nephrolithiasis), pregnancy, male
Uncomplicated?
Adult non pregnant woman with no functional or anatomical abnormalities.
Common organism for acute cystitis and pyelonephritis
Escheria coli (E.coli) - 70% - 95% Staphylococcus saprophyticus - 5% - 10%
Common organism in complicated UTI
Gram-negative bacteria (Proteus,Klebsiella), enterococci, & Group B streptococci
Why is pyelonephritis is more dangerous?
More severe infection
Kidney has a greater blood flow, bacteria can move into blood and affect more tissue
HIGHER RISK OF SEPSIS
UTI diagnostic test
Urine dipstick - nitrates (breakdown product of bacteria), WBC. low sensitivity and specificity.
Urine microscopy and culture - relatively fast (24 h)
Treatment approaches in an infection
- Empiric therapy
- Directed therapy
- Prophylactic therapy
Empiric therapy
Therapy against the most likely causative organisms of a SUSPECTED/ESTABLISHED INFECTION WITHOUT KNOWING specific organism
How do you what is the most likely causative organism?
- Site of initial infection: common organism for that site, normal flora overgrowing/moving to otherwise sterile area
- Known foreign organism: dog bite, common cold.
- Relevant co-morbidities: immunosuppression, anatomical abnormalities.
Normal human flora
Skin: staphylococcus, streptococcus, HPV
Teeth and Mouth: Bacteroides fragilis
Throat: streptococcus
How does antibiotic cause symptoms eg diarrhoea?
Antibiotics cause overgrowth of normal flora by disturbing balance.
> overgrowth in GIT cause diarrhoea
> overgrowth of mouth and vaginal fungal cause thrush
Back to UTI, how does it get infected?
Bacteria migrate from GI tract or groin to the sterile space and causing infection
Predominantly Gram-negative bacteria
E.coli, Pseudomonas
Pseudomonas uncommon but why is it listed?
Because it is a multi-resistant bacteria and hard to treat once infected by it.
some gram positive too
Staphylococcus saprophyticus, Enterococcus
Common in woman than men, why?
Short urethra.
