Managing a patient presenting with suspected infection Flashcards
what are the 3 steps for diagnosing an infection?
-Does patient have an infection or is it something else
-Is it: bacterial, viral, fungal or parasitic
-Which specific infection does the patient have: pneumonia, UTI, TB
To determine a diagnosis what must be carried out:
-History taking
-Clinical examination - relevant to symptoms
-Investigation / Tests - determine type of pathogen or rule out diagnosis
What to ask a patient about a medical and medication history?
-Do you take any prescribed medicine
-What are the name/s of the drug/s
-What is it for
-How often do you take the medication
-When was it started
-Do you take any thing otc
-Do you use any ear drops, eye drops inhalers, patches, injection, creams, gels, ointments, suppositories
-Do you have any allergies, if so what is experienced
-Occupational history
-Recreational use
-smoking
-alcohol
What are the generic symptoms of an infection?
-Fever
-Chills
-Headache
-Fatigue
-Malaise
-Muscle aches
-Joint aches
-Swollen lymph nodes
What are the symptoms of a respiratory infection? (upper tract infection)
-Sneezing
-Runny nose
-Nasal congestion
-Nasal discharge
-Scratchy or sore throat
-Pain when swallowing
-Coughing
-Sinus pain
What are the symptoms of a UTI?
-Back or flank pain (area above the buttock)
-Pelvic pressure
-Lower abdominal discomfort
-Pain or burning when urinating
-A persistent urge to urinate
-Difficulty urinating
-Urethral discharge
-Cloudy urine
-Blood in urine
What information is required to be considered when taking history?
Food and drink
Occupational history
Needle use
Travel history
Animal contact
Sexual history
What information is required to be considered when taking history?
Food and drink
Occupational history
Needle use
Travel history
Animal contact
Sexual history
What is the key test for infections?
Microbiology testing
What is microbiology testing?
Method detecting the presence of microorganisms present in the body
What testing would be required for: meningitis, c.dif, UTI.
Meningitis- CSF
C.Diff - Stool
UTI -Urine
What types of infections are there?
Bacterial
Viral
Parasitic
Fungal
Why do you need to have an ideas of what the infection is likely to be?
- Treatment must be started before taking sample and wait for results. This will give an idea of cause for initial treatment.
2.
How long does it take for results to get back?
wait 24 hours to
identify organism and further 24 hours for sensitivities (this can be weeks for fungal
infections).
Why should the patient be treated ASAP?
will affect prognosis to delay treatment
How are bacteria and yeast cultured?
They are cultured in a similar
way by encouraging growth on a medium and identifying organism under a microscope
What parasite is common in the uk
Giardia and Cryptosporidium
what is Giardia
Diarrhoeal disease caused by a parasite. It is generally not a serious
disease, but is fairly common in the UK. It is often acquired from contaminated water.
what is Cryptosporidium
microscopic parasite that causes the diarrheal disease
How is Giardia and Cryptosporidium tested?
Enzyme-linked immunosorbent assay
(ELISA)
What is the ELISA test?
used to detect and quantify substances: antibodies, antigens, proteins and glycoproteins, parasites in biological samples.
How are tropical parasites identified?
Identified using a microscope. This looks for parasite and/or eggs.
What testing is used for viruses?
polymerase chain reaction (PCR)
What is the disadvantage of PCRs?
They only test for one type of virus
What social history increases the chances of Legionnaires’ disease?
air conditioning systems
humidifiers
spa pools and hot tubs
What is the aim of ‘start smart then focus’?
improve safety and quality of patient care and to contribute significantly to reductions in emergence and spread of AMR
why can’t treatment be delayed?
increase morbidity, mortality,
cause hospitalisation, or prolong a hospital stay
what is empirical treatment
Treatment given based on experience, without precise knowledge of the cause or nature of a disorder. EG: broad spectrum antibiotics while the results of bacterial culture and other tests are awaited
What are the DIS of empirical treatment
-Based on signs and
symptoms patient has and what we know to be the typical pathogens that cause the infection think the patient has.
-may be wrong in diagnosis
-patient may have an infection
caused by an atypical pathogen
Give examples of broad spectrum antibiotics
azithromycin, amoxicillin, tetracycline
what do you need to know when selecting a empirical treatment?
-Location of the primary infection
-Typical pathogens which cause the infection
-Which antimicrobials (or combination of antimicrobials) have a spectrum of activity that covers these typical pathogens
-Local resistance patterns
what does bacteriostatic mean?
prevents bacteria growth
what does bactericidal mean?
substance which kills bacteria
give examples of bactericidal antibiotic
“BANG Q RP.”
Beta-lactams
Aminoglycosides
Nitroimidazoles (metronidazole)*
Glycopeptides (vancomycin)
Quinolones*
Rifampicin
Polymyxins (colistin)
“BANG Q R.I.P.”
give examples of bacteriostatic antibiotic
MS. COLT
Macrolides
Sulfonamides*
Chloramphenicol
Oxazolidinones
Lincosamides (clindamycin)
Tetracyclines
Why is flucloxacillin use for skin infections?
flucloxacillin is active against Staphylococcus aureus and skin infections are often caused by Staphylococcus aureus
What must antibiotic formularies ensure?
information on: drug, dose, frequency and course length
Be evidence based
Be reviewed regularly
what are the five antimicrobial prescribing decisions?
-Stop
-Switch
-Change
-Continue
-OPAT
On a culture sensitivity report what does ‘S’ mean?
Antibiotic bacteria is sensitive to.
On a culture sensitivity report what does ‘R’ mean?
Antibiotic bacteria is resistant to.
DIS of using more than one antimicrobial
-Increase costs
-Increase risk of adverse side effects
-Increase risk of interactions
-Increases risk of superinfections
ADV of using more than one antimicrobial
-Provide more enough broad spectrum
-Cover for unknown or mixed infections
-Immunocompromised may need to
combine antimicrobials to reach the microorganism at multiple sites to compensate for body’s
natural immune defences not being able to generate a normal immune response
What does a synergistic drugs do?
EG: penicillins and gentamicin for the treatment of infective
endocarditis.
penicillin-induced cell wall damage increases permeability of enterococci to aminoglycosides, so
the penicillin effectively facilitates access of the gentamicin to its target site.
What does an antagonistic drug do?
acts against and blocks an action.
EG:
tetracyclines antagonise the effects of penicillins, and erythromycin and clindamycin both bind to
same subunit of bacterial ribosomes so will compete with each other for binding sites and not provide any additional effect.
