Lecture 2 - Signs, symptoms and Monitoring of Infection

Question 1

What are bacterial infections caused by?

Answer 1

Bacteria

Question 2

What are viral infections caused by?

Answer 2

Viruses

Question 3

What are fungal infections caused by?

Answer 3

Fungus

Question 4

What are antibacterial agents not effective against?

Answer 4

viral or fungal infections

Question 5

What helps guide best treatment?

Answer 5

determining the most likely cause of the infection

Question 6

What to consider for diagnosis?

Answer 6

actual or presumes
best guess of diagnosis
clinical judgement
cultures available

Question 7

Source?

Answer 7

likely organism

bacterial, viral, fungal

Question 8

Why do we need cultures?

Answer 8

To tailor therapy to suit the patient and the infection

Question 9

Signs and symptoms of an infection?

Answer 9

redness/changes in skin colour

pain

heat

swelling

loss of function

Question 10

Clinical assessment of a patient?

Answer 10

temperature

tachycardia

tachypnoea (breathing rate)

white cell count

hypotension

hyperglycaemia

swollen lymph nodes

Question 11

What is a high/low temperature?

Answer 11

High = 38 degrees +

Low = 36 degrees or lower

Question 12

Normal white cell count?

Answer 12

between 4 and 11

Question 13

Tachypnoea?

Answer 13

breathing rate more than 20 breaths per minute

Question 14

What are clinical signs related to specific infections?

Answer 14

increased sputum volume/increased sputum purulence

pus/exudates

rashes

cough

pain on urination

nasal congestion

sore throat

Question 15

SIRS criteria?

Answer 15

temperature <36 or >38

Pulse > 90bpm

respiratory rate > 20 breaths per minute

white cell count <4 or >11

Question 16

Sepsis ?

Answer 16

One SIRS criteria + documented infection

Question 17

What is a documented infection?

Answer 17

a host response to the presence of microorganisms or tissue invasion by microorganisms

Question 18

Signs of a documented infection?

Answer 18

cellulitis

purulent sputum

X ray changes in the lung

redness

swelling

heat

Question 19

Patient factors to consider?

Answer 19

age

other conditions/illness

nutritional status

compromised immune system

medications

Question 20

Exogenous source of infection?

Answer 20

via host or from environment e.g. food, water, soil, coughing and sneezing

Question 21

Endogenous source of infection?

Answer 21

normal flora from another part of the body e.g. skin pathogens, gut pathogens

Question 22

What does the clinical diagnosis give?

Answer 22

‘best guess’

patients often treated for this as cultures can take days - weeks to come back from lab

Question 23

What is taken before treatment?

Answer 23

samples from the site of infection e.g. blood cultures

Question 24

Why must a sample be taken before treatment?

Answer 24

the bacterial level will lower after the patient has started treatment

Question 25

What is done after sampling?

Answer 25

emperic/best guess treatment

most times you can’t wait for the outcome of cultures to start treatment

Question 26

What happens when you get the culture and sensitivity results?

Answer 26

you can continue or modify the treatment

Question 27

Blood cultures?

Answer 27

taken from different sites

must be taken while the patient is pyrexial

Question 28

Sputum samples?

Answer 28

must get a good sample

Question 29

Urine sample?

Answer 29

needs to be a mid stream sample as urine is usually sterile so need a good sampe

Question 30

Swabs?

Answer 30

wounds, eyes, nose, throat

Question 31

Other samples?

Answer 31

pus

bone samples

surgical samples

nail clippings

Question 32

Bacteriological assessment?

Answer 32

agar plates

stains e.g. gram stain and zeihl-neelsen

confirmatory tests - oxidase/catalase

selective media

viral cultures

PCR

ELISA tests

Question 33

What is sensitivity testing?

Answer 33

tests for sensitivity or resistance to a selection of potential treatments

Question 34

What does sensitivity testing help?

Answer 34

guide the continuing therapy for treating the patient

national and local sensitivity patterns

guides the development of local formularies

Question 35

What is the modified early warning system (MEWS)?

Answer 35

used in hospital to monitor the patient

the patient is given a score depending on the assessment

score of 4+ then the ward doctor is informed

score of 0 means no infection

Question 36

SEWS?

Answer 36

surgical early warning system

modified for the surgical ward

score or 4 or more means contact doctor for review

score of 6 or more means urgent review needed

Question 37

What are CRP and ESR?

Answer 37

c-reactive protein and erythrocyte sedimentation rate

they are non-specific markers of inflammation

Question 38

What can CRP be used for?

Answer 38

to monitor how well a patient is reacting to antibacterial therapy

Question 39

What is CURB-65?

Answer 39

assessment of pneumonia, a predictor of the outcome

Question 40

CURB-65 scores?

Answer 40

the risk of death at 30 days increases as the score increases

0 = 0.6%
1 = 2.7%
3 = 14%
4 or 5 = 27.8%

Question 41

CURB-65 score of 0?

Answer 41

low risk of death and do not normally require hospitilisation

Question 42

CURB-65 score of 1 or 2?

Answer 42

increased risk of death, particularly score of 2

hospital referral and assessment should be considered

Question 43

CURB-65 score of 3 or more?

Answer 43

high risk of death and require urgent hospital admission

Question 44

What needs to be taken into account when deciding on home treatment?

Answer 44

the patients social circumstances and wishes

Question 45

What are used for monitoring?

Answer 45

all diagnostic parameters

Question 46

What does the frequency of monitoring depend on?

Answer 46

the severity of the infection

Question 47

What does monitoring guide?

Answer 47

when to change route of therapy

when to stop therapy

when to change therapy