Infection 3 - AB resistance + Sepsis + HCAIs Flashcards
Are most antibiotic resistance genes carried on a chromosome or plasmid?
Plasmid
What are the 3 mechanisms of antibiotic resistance?
1) Drug altering enzyme
2) Altered target
3) Altered uptake
How may bacteria acquire antibiotic resistance?
- Vertical gene transfer
- Conjugation
- Transformation
- Tranduction
What is the test to find out whether a bacteria contains antibiotic resistance?
Disc sensitivity testing
What are the main impacts of antibiotic resistance?
- More expensive medications required
- Longer duration of illness and treatment
- Higher healthcare costs
- More danger associated with surgery/chemotherapy
How can we reduce antibiotic resistance?
- Improve cleaning and hygiene (prevent infections)
- Only take AB’s when prescribed, and finish course
- Encourage different treatment options, and more preventions ie vaccines
- Reduce use in animals and plants
- Antimicrobial stewardship (promoting and monitoring of judicious use)
Who is at a higher risk of developing sepsis?
- Very young or old
- Low body weight
- Asplenic
- Immuno-naive/compromised
- Co-morbidities
- Invasive medical device
- Recent infection/transplant/surgery/steroid use
- Long term antibiotic use
Define septic shock:
Persisting hypotension requiring treatment to maintain blood pressure, despite fluid resuscitation
What are the red flags of acute sepsis?
- RR > 25/min
- SpO2 < 91%
- Systolic BP < 91 mmHg
- HR > 130/min
- No urine output for 18 hrs
- Responds only to voice/pain/unresponsive
- Non-blanching rash/mottled/ashen/cyanotic
- Neutropenia or chemotherapy < 6 wks ago
At decision to start Sepsis 6 management, what is the expected lifespan of the patient?
1 hr
What is the Sepsis 6 management?
1) Give high flow O2
2) Take blood cultures
3) Give IV antibiotics (Meropenem unless meningitis suspected = Ceftriaxone)
4) Start fluid challenge
5) Measure lactate
6) Measure urine output
Why is it important to measure lactate during acute sepsis?
Marker of tissue perfusion
- shock causes poor tissue perfusion, causing lactic acidosis
At what point does a high resp rate become a red flag of sepsis?
RR > 25/min
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How do microorganisms cause septic shock?
- Microorganism produces endotoxin, which binds to macrophages
- Macrophages locally release cytokines: alpha-TNF + IL-1, which stimulate wound repair and RAAS
- Systemic release of cytokines stimulate GF, macrophages, and platelets
= Mass vasodilation = Normovolaemic shock
What is the first organ which loses blood supply during sepsis?
Skin
