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Semester 3 > Infection Session 8 > Flashcards

Infection Session 8 Flashcards

1
Q

Can a vector be inanimate?

A

Yes

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2
Q

What are the three communicable natures of infections?

A

Common source
Person-to-person direct
Person-to-person indirect

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3
Q

Give some examples of common source infections.

A

Legionella pneumophilia
Food poisoning
Rabies

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4
Q

Give some examples of person-to-person direct communicable infection causative agents

A

Influenza
Norovirus
Neisseria gonorrhoea

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5
Q

What are the consequences of transmission of infection?

A

Endemic disease
Outbreak
Epidemic
Pandemic

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6
Q

What is endemic disease?

A

Usual background rate of a disease

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7
Q

What is the definition of an outbreak in infection?

A

> /= 2 cases linked in time and place

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8
Q

What is the definition of an epidemic?

A

Rate of infection > usual background rate (strictly defined for some infections)

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9
Q

What is the definition of a pandemic?

A

V. high rate of infection spreading across many regions, countries and continents

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10
Q

What is basic reproduction number?

A

The average number of cases one case of infection generates over the course of its infectious period in an otherwise uninflected, non immune population

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11
Q

What is seen when basic reproduction number (R0) is >1?

A

Increase in cases –> ourtbreak

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12
Q

How does the R0 of measles compare to that of influenza?

A

Much higher

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13
Q

What pathogen factors can cause outbreaks, epidemics and pandemics?

A

Antigenic drift
Antigenic shift
Toxin production –> environmental contamination

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14
Q

What patient factors can contribute to outbreaks, epidemics and pandemics?

A

New hosts
Immunosuppressed population
Healthcare

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15
Q

What practice factors can contribute to outbreaks, epidemics and pandemics?

A

Social practice e.g. Sexual behaviour, drug use

Healthcare practice e.g. High bed occupancy

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16
Q

What place factors can contribute to outbreaks, epidemics and pandemics?

A

Migration introducing new pathogens of native infection to unexposed populations

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17
Q

What factor determining transmissibility varies by microorganism, it’s presentation and immunity of potential host?

A

Infectious dose

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18
Q

Give some examples of high and low infectious dose microorganisms.

A

High: salmonella, cholera, bacillus anthracis
Low: C. Parvum, E.coli

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19
Q

What does small scale outbreaks being stochastic in nature mean?

A

Cases show random distribution leading to a normal epidemic curve shape which can alter position

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20
Q

What is the implication of small scale outbreaks being stochastic in nature?

A

Interventions can only be proven to work if they are effective in more than one outbreak

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21
Q

What non-biological factor might cause an increase in the number of lab reports of an infection?

A

Change in ascertainment (how infection is reported)

22
Q

What three stages cause the normal shape of an epidemic curve?

A

Susceptible (lots of secondary cases) –> infected –> recovered/increased immunity/death

23
Q

What patient interventions can be used to prevent infection?

A

Improve health of population
Passive immunity
Active immunity
Herd immunity

24
Q

What does the proportion of people needed to vaccinate for effective herd immunity depend on?

A

R0 (higher it is, greater % need vaccinating)

25
Q

What practice interventions can be used to prevent infection?

A

Avoid pathogen/vector geographically, PPE and behaviourally (safe sex, safe disposal of sharps, food and drink prep)

26
Q

What place interventions can be used to prevent infection?

A

Environmental engineering to provide safe water and air
Good quality housing
Well designed care facilities

27
Q

What aids local infection control to reduce risk?

A

Surveillance to monitor local, global and future trends

28
Q

What are the consequences of good infection control?

A

Decreased incidence or elimination of disease

29
Q

What are the consequences of poor infection control?

A

Decreased exposure to pathogen –> decreased immune stimulus –> lack antibodies –> increased number of susceptibles –> outbreak
Later average age of exposure due to decreased environmental levels leads to greater severity of disease experienced

30
Q

Why is Abx resistance almost as old as the Abx themselves?

A

Produced naturally by bacteria and moulds for evolutionary advantage

31
Q

What is the implication of carbapenem-resistant enterobacteriaceae?

A

It has genes which code for carbapenamase which also confer resistance to other Abx therefore the last resort Tx for G-ve bacteria is ineffective

32
Q

Is it just inappropriate prescribing of Abx that causes antimicrobial resistance?

A

No, any exposure of bacteria to antimicrobials can

33
Q

What is the implication for using empirical Abx therapy in antimicrobial resistance?

A

Much more likely to get empirical Abx estimate wrong and hence increase mortality

34
Q

What is the definition of a multi-drug resistant (MDR) microbe?

A

Non-susceptibility to =/>1 agent in =/>3 antimicrobial categories

35
Q

What is the definition of an extensively drug resistant (XDR) microbe?

A

Non-susceptibility to at least 1 agent in all but 2 or fewer antimicrobial categories

36
Q

What is the definition of a pan-drug resistant (PDR) microbe?

A

Non-susceptible to all agents in an antimicrobial category

37
Q

What does laboratory evidence provide to indicate antibacterials causes resistance?

A

Biological plausibility

38
Q

What evidence do ecological studies provide to indicate antibacterials cause resistance?

A

Overall high levels of antibacterial use lead to more resistance

39
Q

What individual level data provides evidence that antibacterials cause resistance?

A

Abx prescribed in UTI –> increased rates of carriage of resistant bacteria in recipients –> longer durations and multiple courses –> increased resistance rates

40
Q

What is the smallest change necessary to give rise to antimicrobial resistance in a bacteria?

A

Single nucleotide

41
Q

Can legionella pneumophilia cause inward transmission after infecting a human host from the environment?

A

No

42
Q

What are the 5 objectives of antimicrobial stewardship?

A 
Appropriate use of antimicrobials
Optimal clinical outcomes
Minimise toxicity and adverse events
Decrease costs of healthcare for infections
Limit selection for microbial strains
43
Q

How are the 5 objectives of antimicrobial stewardship achieved?

A

Use of an MDT
Surveillance of process
Surveillance of outcome
Measures of interventions

44
Q

Give some examples of persuasive interventions in antimicrobial stewardship.

A 
Education
Consensus of best practice
Opinion leaders
Reminders
Audit feedback
45
Q

Give some examples of restrictive intervention in antimicrobial stewardship.

A

Restricted susceptibility reporting
Formulary restriction
Validation codes
Automatic stop orders

46
Q

Give some examples of structural interventions in antimicrobial stewardship.

A

Computerised records
Rapid lab tests
Quality monitoring

47
Q

Which type of intervention in antimicrobial stewardship is slower to take effect but long-term is as effective as restrictive interventions?

A

Persuasive

48
Q

What process measures can be used in antimicrobial stewardship?

A

Look at trends in antibacterial use and consider defined daily doses per 1000 bed days, classes and appropriateness over time +/- other institutions

49
Q

What outcome measures can be used in antimicrobial stewardship?

A

Pt outcomes
Emergence of resistance
C.diff infection rate

50
Q

What is needed for successful antimicrobial stewardship?

A

Long term confirmed and appropriate resources supported by leadership w/delegated leadership for challenge integrated into organised pt safety and QoL care

51
Q

Give an example of an effective antimicrobial stewardship case.

A

Cephalosporins control on CDI in Leicester:
Introduced restoration codes first (quantitative restriction) followed by physical removal of cephalosporins from wards (qualitative restriction) –> marked decrease in total C.diff cases

Semester 3 (50 decks)

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