Infections from workbooks

Question 1

Infective endocarditis: Most common organism and other organisms responsible

Answer 1

Most common= Staph aureus
Others: (other staph)
            Strep viridans (+other strep)
            Pseudomonas

Question 2

Infective endocarditis: Antibiotic regimens (for native and for prosthetic valves) (blind therapy before culture comes back)

Answer 2

Native: IV amoxicillin +/- IV gentamycin
(Vancomycin + gent if pen allergic)
Prosthetic: Vanc + gent + rifampicin

Question 3

Infective endocarditis: list valves affected in order of how frequently they’re affected (most common first)

Answer 3

Mitral valve.
Aortic valve.
Combined mitral and aortic valve.
Tricuspid valve.
Pulmonary valve - rare

Question 4

Pneumonia- how is severity of community acquired pneumonia assessed?

Answer 4

CURB 65
Confusion
Urea >7
RR>=30
BP systolic <90
Age>=65

Question 5

How does CURB 65 score affect management?

Answer 5

0= manage in community
1= maybe community- look at sats and CXR (use judgement)
>=2 = hospital admission
>4 = get ITU/HDU input- 30% mortality at 30 days

Question 6

Potential systemic complications of community acquired pneumonia

Answer 6

Sepsis
Lung abcess
Pleural effusion
Brain abcess
Pericarditis/myocarditis
Cholestatic jaundice (don't know why, this was written in my workbook)

Question 7

What follow up is needed for someone who had pneumonia?

Answer 7

CXR at 6 weeks

Question 8

Open fracture- common organisms (normal ones, farm ones)

Answer 8

Normal/”non-contaminated”: staph and strep

Farmy ones: clostridia farmy wounds at risk of anaerobic bacteria

Question 9

Open fracture- Leicester antibiotic guidance (which abx, how soon etc)

Answer 9

Within 3 hours:
IV coamoxiclav until surgery (clindamycin if pen allergic)

(additional IV coamox and gent is given at first debridement, then more again on definitive closure)

Question 10

Initial management of open fracture

Answer 10

Remove only gross contamination, photograph it and then cover with saline soaked gauze

Question 11

Septic arthritis/osteomyelitis- empirical antibiotics

Answer 11

IV flucloxacillin (or vanc if pen allergic)

Question 12

Septic arthritis/osteomyelitis- common organisms (in order)

Answer 12

1) staph aureus
2) strep (B haemolytic strep or strep pneumoniae)
3) H influenzae

Question 13

Septic arthritis/osteomyelitis- Once organism is cultured- which antibiotics (lei guidelines)? and for how long

Where do you get the culture from?

Answer 13

Staph aureus- flucloxacillin
Strep- Benzylpenicillin

vanc if pen allergic
Continue for total of 6 weeks- IV initially then oral when stable

Joint aspirate for septic arthritis, blood culture for osteomyelitis

Question 14

Bite injuries- which organisms? human and dog bites

Answer 14

Pasteurella multocida is the most common infection,

Human:Streptococcus spp., Staphylococcus aureus, Eikenella corrodens, and anaerobic bacteria.
(+consider BBV risk)

Dog: strep, staph, pasteurella
(+consider rabies risk)

Question 15

Bite injuries- leicester Abx guidelines

Answer 15

Coamoxiclav for 5 days (for either dog or human)

pen allergic:
dogs: doxycycline and metronidazole
Humans: metronidazole and erythromycin