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RB Y2 CLASP - Sepsis > Microbiology Compilation > Flashcards

Microbiology Compilation Flashcards

1
Q

commensals of the mouth

A
  • strep viridans
  • candida
  • neisseria
  • anaerobes
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2
Q

bowel commensals

A
  • Enterococci
  • Anaerobes: clostridium and bacteroides
  • Coliforms
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3
Q
A

gamma haemolysis

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4
Q
A

alpha haemolysis

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5
Q

name 4 methods for detecting bacteria

A
  • chromogenic media
  • MALDI-TOF
  • PCR
  • whole genome sequencing
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6
Q

non/lactose fermenter enterobacteriaceae

A
  • Lactose fermenters: E. coli, Klebsiella, Enterobacter
  • Non-lactose fermenters: Salmonella, Proteus
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7
Q

what are 3 encapsulated bacteria

A
  • h influenza b
  • pneumococcal
  • neisseria meningitidis

hyposplenism makes host susceptible to infections from encapsualted organisms

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8
Q

name 2 spirochaetes

A

treponema pallidum

borrelia burgodorferi (lyme disease)

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9
Q

what are most false blood cultures due to

A

contamination with skin commensals due to poor technique

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10
Q

how is influenza confirmed

A

nasopahryngeal swab and doing PCR

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11
Q

when is CSF examined

A
  • when there is suspicion of possible meningitis - via lumbar puncture
  • wouldnt normally do this in the clinical setting
  • check child with clotting screen first
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12
Q

indications for urine dipstick

A
  • avoid in the elderly
  • avoid in catheterized patients as it is often colonised
  • not the test of choice in sepsis
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13
Q

indication for urine catheter samples

A
  • do not send unless it is considered to be a source of infection and the patient appears infected
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14
Q

indications for urine culture

A
  • complicated infection
  • male infection
  • recurrent UTI in female
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15
Q

what is the aim of antimicrobial stewardship

A

optimal selection, dosage, and duration of treatment - prudent prescribing

and explaining, reassuring and educating the large group of patients who dont need ABx

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16
Q

4Ds of antimicrobial therapy

A
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17
Q

what does de-escalation involve

A
  • moving from IV to oral - IV therapy must be reviewed every 12-24 hours
  • moving to a narrower spectrum
  • watch microbiology results
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18
Q

indications for IV route

A
  • sepsis
  • oral compromised
  • post surgery
  • ostemyelitis
  • febrile with neutropenia or IS

IV just gives faster systemic absorption

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19
Q

define pharmacodynamics

A

the relationship between infection outcome and drug outcomes

20
Q

define pharmacokinetics

A

effect of body’s processes on the drug

21
Q

minimum inhibitory concentration

A
  • a measure of the potency of the drug against a given pathogen
  • the concentration required to kill 99.9% of organisms within 18-24 hours (tube/well containing pathogen visually clear)
22
Q

what type of dosing gives optimal outcomes

A
  • high dosages for shorter duration
    • longer increases risk for C diff and resistance
  • keeping to recommended dose interval is important in effectiveness
23
Q

what can too high dosing cause

A

harm

resistance

24
Q

outline the start SMART then FOCUS diagram

A
25
Q

action of beta lactams

A

inhibit cell wall biosynthesis by binding to the enzymes that cross link peptidoglycans

26
Q

are beta lactams bacteriostatic or cidal

A

bacteriocidal

27
Q

what is penicillin allergy due to

A

degradation product of beta lactams, true allergy exists in <0.05%

28
Q

aztreonam

A
  • beta lactam
  • can be used in penicillin type 1 allergy
  • active against Gram negative bacteria
  • used in Gentamicin resistance
29
Q

how do bacteria develop resistance to beta lactams

A

synthesise a beta lactamase, this breaks open the beta lactam ring and inactivates the drug

eg MRSA

30
Q

how can beta lactam resistance be overcome

A

ABx are given with a beta lactamase eg clavulanic acid

31
Q

what are ESBL susceptible to

A

carbapenems

32
Q

how can resistance be acquried to an ABx

A
  • Organism specific rate of mutation, some are hypermutators
  • Random mutations that can be induced by antibiotics
  • Bacterial burden – mutation is more likely if there is a higher bacterial load
  • Efflux pumps
33
Q

what sites are harder for ABx to get to

A

in general, tight junctions eg CNS, eyes, prostate

34
Q

gentamicin toxicity

A

kidneys and CNVIII - dizziness and deafness

  • contraindicated in renal problems - can only be given for a max of 24 hours
35
Q

how long in total can gentamicin be given for

A

72 hours

36
Q

which ABx can cause tendonitis

A

quinolones - achilles and extensor knee mechanism?

37
Q

which ABx have anti toxin effects

A

clindamycin and linezolid

38
Q

common adverse effects of ABx

A

nausea and vomiting

39
Q

C Diff causing ABx

A
  • all ABx carry some risk
  • 4 C’s - Ciprofloxacin (fluoroquinolones), Clindamycin, Cephalosporins (Ceftriaxone) and Co-amoxiclav
  • remember levofloxacin
  • kill off the normal gut bacteria and allow the overgrowth of C diff
  • PPIs - reduce the acid produced in the stomach which is normally the first line of defence
40
Q

does treatment time influence the risk of C diff

A

yes - longer treatment

also hospitalization time

IC

41
Q

how long after ABx may C diff occur

A

up to 12 weeks

42
Q

C diff infection

A
  • c diff are gram positive, spore forming, anaerobic rods that produce toxins A and B
  • toxin A in an enterotoxin and toxin B causes bloody diarrhoea
  • these cause an inflammatory response in the large intestine that leads to increased vascular permeability and pseudomembrane formation
43
Q

clinical features of C diff infection

A

range from mild diarrhoea to profuse, watery, haemorrhagic colitis

abdominal pain and vomiting

44
Q

who tends to get C diff infections

A

elderly women

45
Q

investigation of C diff

A

stool toxin

46
Q

management of C diff infection

A

mild: oral metronidazole
severe: oral vancomycin ± IV meronidazole

47
Q

coverage of MRSA

A

vancomycin - gram positive

RB Y2 CLASP - Sepsis (5 decks)

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