infections Flashcards
Current and emerging anti-microbial resistance - causative organisms from TRUS-guided biopsy
Escherichia coli (E. coli) -90%
Klebsiella pneumoniae
Pseudomonas aeruginosa
Enterococcus species.
A contributing factor for the progression of resistance development is the increase in plasmid-mediated extended spectrum β-lactamases (ESBL) within the community. in 2008, a study independently identified a new clonal outbreak, what is this?
Serogroup O25b, sequence type 131 (ST131)
Risk factors for TRUS biopsy - fluoroquinolone-resistant bacteria
- Prior floroquinolone exposure
- exposure to any antibiotic prior to biopsy
- travel to Southern Asia is associated with the greatest chance of colonisation by resistant organisms, with India highlighted as the country travellers were most likely to acquire endogenous resistant bacteria
- diabetic patients are significantly more likely to harbour fluoroquinolone-resistant bacteria
- Hospital employees and family members
possible additives to Flouroquinolone for prophylactic therapy for TRUS
- Aminoglycoside agent
2. carbapenem antibiotics
alternative method of prostate biopsy and disadvantages
transperineal
disadvantages: the requirement for a general anaesthetic
the longer period of time needed to perform the procedure
the prerequisite for specialised equipment.
Patient from Vietnam, for TRUS BIOPSY: what to do
Perform a transperineal biopsy instead, using IV cephazolin only -
Replace his standard fluoroquinolone prophylaxis with a carbapenem antibiotic -
Take a rectal swab and give antibiotic prophylaxis according to the results
__ produced by E. coli convey resistance to most β-lactam antibiotics increasing bacterial resistance.
ESBL
three important questions to consider in treating candiduria
- Does the patient have any predisposing factors that increase their risk of an ascending candidal renal infection or disseminated candidiasis?
- Symptomatic?
- Unstable?
The main predisposing factors for Candiduria are:
1 Diabetes mellitus, particularly those with high glycosuria (including patients on sodium-glucose co-transporter-2 (SGLT2) inhibitors)
2 Renal transplantation
3 Extremes of age (neonates and end of life)
4 Female sex
5 Instrumentation of the urinary tract
6 Concomitant bacteriuria
7 Genitourinary structural abnormalities
8 Broad-spectrum antibiotics
9 Diminished renal function and metabolic abnormalities
10 Immunosuppression, including chemotherapy. However, renal transplantation does not increase the risk of developing candidaemia from candiduria
The most common species causing fungal UTIs is ___ accounting ___% of all candiduria infection
C. albicans, 70
_____ is occasionally found in urine in neonates and is associated with systemic infection in this population.
C. parapsilosis
The following Candida are typically resistant to fluconazole:
C. glabrata
C. krusei.
Management of asymptomatic patients with candida growth in urine cs
Consider first : the presence of predisposing factors and
how stable or immunocompetent is the patient
As Candida biofilms are innately resistant to all antifungals, asymptomatic catheterised patients should not be treated with antifungals.
Solution: The catheter should be removed and the clearance of Candida from urine followed up.
mainstay of therapy for candidal UTIs
Fluconazole is the mainstay of therapy for candidal UTIs due to its good activity against most Candida species and its excellent pharmacokinetics: as a highly water-soluble drug it is primarily excreted into the urine as an active drug.
Therefore, it often has activity also against isolates with reduced fluconazole susceptibility, including C. glabrata.
Other azoles that could serve as alternative choices for fluconazole-resistant isolates are not useful for cystitis because of minimal excretion of the active compound into the urine.
To avoid overtreatment of suspected systemic candiduria infection, this test can be done
Beta-d-glucan test
