How To Use Microbials

Question 1

M.I.N.D M.E?

Answer 1

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

Question 2

Cause of infectious disease

Answer 2

Bacteria, viruses, fungi, protozoa, toxins (eg from bacteria), parasites, prion

Question 3

Signs of infection?

Answer 3

Elevated WBC - predominantly neutrophils (left shift)
Local signs - swelling, redness, pus
Vital signs - T, HR, BP, Resp rate, mental state

Question 4

Eg of signs specific to infections

Answer 4

Whooping cough (Pertussis)
Characterisitic rash (Meningococcal disease)

Question 5

Classifications of UTIs

Answer 5

1. Cystitis
2. Pyelonephritis
3. Complicated UTIs
4. Uncomplicated UTIs

Question 6

Signs & symptoms of UTIs

Answer 6

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

Question 7

Cystitis?

Answer 7

Infection of bladder.

Question 8

Pyelonephritis?

Answer 8

When infection spreads to the pyelum (pelvis) of the kidney

Question 9

Complicated?

Answer 9

Anatomical or functional abnormalities (diabetes, neurogenic bladder, nephrolithiasis), pregnancy, male

Question 10

Uncomplicated?

Answer 10

Adult non pregnant woman with no functional or anatomical abnormalities.

Question 11

Common organism for acute cystitis and pyelonephritis

Answer 11

Escheria coli (E.coli) - 70% - 95%
Staphylococcus saprophyticus - 5% - 10%

Question 12

Common organism in complicated UTI

Answer 12

Gram-negative bacteria (Proteus,Klebsiella), enterococci, & Group B streptococci

Question 13

Why is pyelonephritis is more dangerous?

Answer 13

More severe infection
Kidney has a greater blood flow, bacteria can move into blood and affect more tissue
HIGHER RISK OF SEPSIS

Question 14

UTI diagnostic test

Answer 14

Urine dipstick - nitrates (breakdown product of bacteria), WBC. low sensitivity and specificity.

Urine microscopy and culture - relatively fast (24 h)

Question 15

Treatment approaches in an infection

Answer 15

1. Empiric therapy
2. Directed therapy
3. Prophylactic therapy

Question 16

Empiric therapy

Answer 16

Therapy against the most likely causative organisms of a SUSPECTED/ESTABLISHED INFECTION WITHOUT KNOWING specific organism

Question 17

How do you what is the most likely causative organism?

Answer 17

1. Site of initial infection: common organism for that site, normal flora overgrowing/moving to otherwise sterile area
2. Known foreign organism: dog bite, common cold.
3. Relevant co-morbidities: immunosuppression, anatomical abnormalities.

Question 18

Normal human flora

Answer 18

Skin: staphylococcus, streptococcus, HPV
Teeth and Mouth: Bacteroides fragilis
Throat: streptococcus

Question 19

How does antibiotic cause symptoms eg diarrhoea?

Answer 19

Antibiotics cause overgrowth of normal flora by disturbing balance.
> overgrowth in GIT cause diarrhoea
> overgrowth of mouth and vaginal fungal cause thrush

Question 20

Back to UTI, how does it get infected?

Answer 20

Bacteria migrate from GI tract or groin to the sterile space and causing infection

Question 21

Predominantly Gram-negative bacteria

Answer 21

E.coli, Pseudomonas

Question 22

Pseudomonas uncommon but why is it listed?

Answer 22

Because it is a multi-resistant bacteria and hard to treat once infected by it.

Question 23

some gram positive too

Answer 23

Staphylococcus saprophyticus, Enterococcus

Question 24

Common in woman than men, why?

Answer 24

Short urethra.