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BDS4 Oral Surgery > Infection- Antimicrobials and antibiotics > Flashcards

Infection- Antimicrobials and antibiotics Flashcards

1
Q

What are examples of gram positive microbes? (purple)

A
  • Cocci- s. aginosus
  • Bacilli- actinomyces israelli
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2
Q

What are examples of gram negative microbes? (pink/red)

A
  • Cocci- veillonella
  • Bacilli- Prevotella Intermedia
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3
Q

What are the different classifications of microbes based on their growth conditions?

A

Aerobic = Oxygen
Capnophilic = Carbon dioxide
Facultative = With & without oxygen
Strictly Anaerobic = without oxygen

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4
Q

What is the only antimicrobial that works on strict anaerobes?

A

Metronidazole

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5
Q

Why are facultative anaerobes resistant to metronidazole?

A

Due to their metabolic pathways

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6
Q

What is antimicrobial resistance?

A

Occurs when microorganisms such as bacteria, viruses, fungi and parasites change in ways (due to selection pressures) that render the medications used to cure the infections they cause ineffective

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7
Q

What are the types of resistance?

A

Intrinsic
-> prevotella to vancomycin

Acquired- via mutation OR acquisition of new DNA (transformation, transduction, conjugation)

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8
Q

What are some examples of resistance mechanisms?

A
  • Alteration of target site- changed receptor for antibiotics (e.g. penicillin resistance in strep. Mitis)
  • Enzymatic inactivation- destroy antibiotics or prevent binding (Beta lactamase can destroy penicillin)
  • Decreased uptake- Klebsiella pneumoniae
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9
Q

What occurred in the beta-lactam arms race?

A

Penicillinase previously developed by microbes to destroy beta-lactam in penicillin
 Resistant penicillin was produced with side chains- but then bacteria developed beta-lactamase
 Extended spectrum antibiotics were produced- but bacteria also produced extended spectrum beta-lactamase

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10
Q

What are carbapenems?

A

New AB- protect beta lactams in penicillin

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11
Q

What are the issues with carbapenems?

A

Bacteria have developed carbapenemase to destroy this
-> some bacteria are resistant to all ABs (Multi-drug resistant microorganisms can be found in dento-alveolar infections)

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12
Q

What are the microbes present in PA infections/abscesses? (endogenous)

A

Mixed- aerobic and anaerobic (synergy)
* Facultative- s.aginosus
* Strict anaerobe- prevotella intermedia (gram-)

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13
Q

What would be the ideal method to take a specimen from a dental abscess?

A

Pus apsirate

-> might be difficult to achieve (likely only done in hospital setting- severe infections)

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14
Q

What microbes are present in periodontal abscesses?

A

Anaerobic streptococci

Prevotella intermedia

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15
Q

What are the treatment options for removing dental infection?

A

Open pulp cavity

Extirpation of pulp

RCT

I/D of abscess

Extraction

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16
Q

What microbes are present in pericoronitis?

A

Mixed anaerobes :
P.intermedia

S.aginosis group

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17
Q

What are the treatment options for pericoronitis?

A

Local measures

Systemic (only if systemic signs/symptoms)

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18
Q

What is Dry Socket?

A

Blood clot becomes dislodged, so healing socket is exposed to oral flora
-> localised alveolar osteitis

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19
Q

How is dry socket treated?

A

LA, debridement and packing with AM gels (not antibiotics)

20
Q

What occurs in osteomyelitis?

A

Dental infection spreads into ramus and lower border of mandible

21
Q

What are the predisposing factors for Osteomyelitis of the jaws?

A

Biphosphonate therapy (BRONJ/MRONJ)

Impaired vascularity of bone (radiotherapy, Pagets disease)

Foreign bodies (implants)

Compound fractures

Impaired host defences (diabetes)

22
Q

Which microbes are involved in osteomyelitis of the jaws?

A

Anaerobic Gram negative rods- p.intermedia

Anaerobic streptococci

Streptococcus anginosus

Staphylococcus aureus (common in bone infections- difficult to treat)

23
Q

How is OM treated?

A

 Curette bone out
 6 weeks course of IV antibiotics

24
Q

Which microbes are associated with MRONJ?

A

S. anginosus

Mixed anaerobes

Actinomyces israelii- gram + bacilli

25
Q

What microbes are associated with salivary gland infection? What is used to treat these?

A

 S.aureus (flucloxacillin)
 Mixed anaerobes- metronidazole

-> drainage if required

26
Q

What should be documented in the notes when prescribing antibiotics to treat dental infection?

A

Document your diagnosis

Document AB choice, dose, route & duration

Document a review date- 24-48 hours after presenting with acute infection

Document deviation from guidance

27
Q

What is the classic presentation of a severe odontogenic infection (Ludwig’s angina)?

A

Bilateral infection of submandibular space

28
Q

Which microbes are associated with SOI?

A

Anaerobic Gram negative bacilli
Streptococcus anginosus
Anaerobic streptococci
P.intermedia

-> s.aurues can also be involved inn head and neck infection of dental origin

29
Q

What are the issues with people being referred to hospital for SOIs?

A

2-3 patients per week admitted to hospital for treatment of SOI
 Many patients need to return to theatre for more treatment
 Very costly to NHS- cause long stays in hospital up to 20 days (as patients had sepsis on admission)

30
Q

What is sepsis?

A

Life-threatening organ dysfunction caused by dysregulated host response to infection:

Presence of infection AND Systemic Inflammatory Response Syndrome (SIRS)

-> can lead to septic shock

31
Q

What are the features of SIRS

A

Pulse- > 90 BPM
Temp- < 36 or > 38
Resp rate- > 20/min
WCC- < 4 or > 12

32
Q

What is septic shock?

A

Sepsis + unresponsive to fluid resuscitation

-> Subset of sepsis with circulatory and cellular/metabolic dysfunction associated with higher risk of mortality

33
Q

What is the role in the primary care dentist in treating sepsis?

A

Diagnosis

-> seek advice and help

34
Q

What are the aspects in the sepsis 6? (secondary care)

A
  1. Give high flow oxygen
  2. Take blood cultures
  3. IV antibiotics
  4. Give fluid challenge
  5. Measure lactate
  6. Measure urine output

-> all in first hour of admission

35
Q

What is the issue with giving amoxicillin for RTI and UTI?

A

Resistance can persist a month after treatment (perhaps even a year

36
Q

What is the issue with pseudomonas aueriginosa?

A

Resistant to ALL but 2 of available antibiotics

-> Colistin and Amikacin

37
Q

How is resistance ascertained?

A

Usually based on in-vitro quantitative testing of bacterial suspensions to antibacterial agents

-> uses Automated susceptibility testing system

38
Q

What is the break point?

A

Concentration of antibiotics which defines whether bacteria is resistant or sensitive

-> Clinically resistant- unlikely to respond to even high (or max) doses of AB

39
Q

What are the issues with biofilms and resistance?

A

Increases chances of resistance and dose needed

-> Bacteria grow slower and metabolic rates are slower

-> can be almost impossible to treat clinically

40
Q

What is recommended when foreign bodies are present in infection?

A

Removal

41
Q

Why is s.aginosus particularly worrisome?

A

Can cause pus accumulation

Break point (minimum inhibitory concentration) has increased (different in EU/US)

Resistance has increased to erythromycin/clindamycin

42
Q

What is antimicrobial stewardship?

A

Multidisciplinary team working to protect antimicrobial medicines and promote their control

43
Q

What are ways that antibiotic prescribing can be reduced in dentistry?

A

Reducing incidence of acute infection and therefore systemic infections (via prevention/SICPs)

Reduce need for unintentional exposure via- prevention, diagnosis (document), making correct treatment decision

44
Q

Why is metronidazole no longer the first line choice for acute dentoalveolar infection?

A

Needs to be a beta-lactam agent

-> Over-prescription is driving metronidazole resistance in strict anaerobes

-> Gram positive cocci are resistant to penicillin but not metronidazole

45
Q

Why is amoxicillin not used as the first line of defence?

A

Amoxicillin is broader spectrum and is more likely to encourage resistance in oral cavity, RT, GIT

46
Q

What is now used as the first line of defence against dentoalveolar infection?

A

Penicillin V (narrow spectrum- for oral infections)

BDS4 Oral Surgery (19 decks)

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