Infection CPC Flashcards
What can be used to estimate the short-term outlook in ART naive HIV-1 patients
CD4 T cell count
What is considered a high community prevalence of HIV in the community
2/1000 of population
What are some atypical infections that can occur in immunocompromised patients (4)
Atypical mycobacteria
Fungal infections
Viral (CMV, HSV)
Toxoplasmosis
What are the broad categories of immunodeficiency (2)
Inherited
Acquired
What are some causes of acquired immunodeficiency (4)
Iatrogenic (e.g. steroids, chemotherapy, radiotherapy)
HIV
Chronic illness (diabetes, cancer)
Malnutrition
What can occur with bacterial infections in a patient with a T cell defect
Sepsis
What bacterial infections can occur in a patient with B cell defects (3)
Streptococcoal
Staphylococcal
Haemophilus
What bacterial infection can occur in a patient with a neutrophil defect (2)
Staphylococcus
Pseudomonas
What bacterial infection can occur in a patient with a complement defect
Neisserial
What viral infection can occur in a patient with a T cell defect (4)
CMV
EBV
Varicella
Respiratory and intestinal infections
What viral infection can occur in a patient with a B cell defect
Enteroviral encephalitis
What fungal and parasitic infection can occur in a patient with a T cell defect (2)
Candida
PCP
What fungal and parasitic infection can occur in a patient with a B cell defect
Giardia
What fungal and parasitic infection can occur in a patient with a Neutrophil defect (3)
Candica
Nocardia
Aspergillus
What type of infections occur in patients with T cell defects
Aggressive, often opportunistic infections
What type of infection occurs in patients with B cell defects
Recurrent sinopulmonary infections
What is ineffective in the treatment of osteomyelitis
Antimicrobial therapy alone is not curative in most cases.
Continuing drugs over a long period of time will lessen the amount of discharge, but it will not cure the disease because it cannot sterilise dead bone or cavities with necrotic content and rigid walls.
What is the most important step in the management of prosthetic joint infections
Removal of prosthesis and adequate debridement.
Antibiotics play a secondary role.
What prosthetic implants can give rise to osteomyelitis (4)
Prosthetic joint replacements. IV lines (venflons, central lines, pic lines, portacaths, etc...) Prosthetic cardiac valves Prosthetic implants (cosmetic or reconstructive)
What are the next steps if a patient has confirmed C.difficile infection (5)
Isolate in a single room.
Assess severity.
Stop offending antibiotics if possible.
Wash hands with soap and water before and after each patient contact and use gloves and aprons.
Commence C.difficile care pathway, fluid balance chart and Bristol stool chart.
What are the Imperial guidelines to assess C.difficle severity (6)
Severe = 1 or more of the following:
T>38.5
HR >90
WCC>15
rising creatinine
Clinical signs of severe colitis, or colitis on radiology
Failure to respond to therapy at 72 hours.
Patients with a score of 1 or more warrant early surgical and gastroenterology review.
What is the Imperial guideline for treatment of non-severe C.difficile infection
Metronidazole 400mg PO TDS for 10-14 days.
If intolerant of metronidazole, or if not responding to treatment at 72 hours (and no other indications of severity), consider changing to:
vancomycin 125mg PO QDS 10-14 days.
What is the Imperial guideline for the treatment of severe C.difficile infection
Vancomycin 125mg PO QDS for 14 days plus consider adding metronidazole 500mg IV TDS
Higher doses of vancomycin may be appropriate in more severely ill patients, and should be discussed with micro/ID
What is the Imperial guideline for the treatment of severe C.difficile infection with colonic dilatation
Vancomycin 125-250mg PO QDS plus metronidazole 500mg IV TDS for 14 days.
Also liase with ID/micro and gastro/surgeons.
What is the Imperial guideline for the treatment of severe C.difficile infection and ileus/vomiting.
Consider intracolonic vancomycin.
Discuss with ID/micro and gastro/surgeons
What is the significance of ribotype 027 c.difficile
Increased severity of disease.
Strain produces: 16 times more toxin A and 23 times more toxin B.
What class of antibiotics are most prone to induce c.difficile
Fluoroquinolones
How is c.difficile spread
Faeco-oral route through spores
What are risk factors for acquiring c.difficile infection (4)
Administration of antibiotics (multiple antibiotics, long duration)
Age over 65 years
Duration of hospital stay (it has been reported than after 4 weeks, 50% of patients tested were culture positive)
Severe underlying disease
What is C.difficile most associated with
Recent history of antibiotic use
When does C.difficile occur
May occur during antibiotic therapy or in the weeks after a course of antibiotics
What is the onset of c.difficile like
Onset is abrupt with explosive, watery, foul smelling diarrhoea.
What is the most common complication os c.difficile infection
Pseudomembranous colitis
How can c.difficile infection be prevented (2)
Cleanliness and hygiene measures
Restrictive approach to antibiotic prescribing
