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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

25
action of beta lactams
inhibit cell wall biosynthesis by binding to the enzymes that cross link peptidoglycans
26
are beta lactams bacteriostatic or cidal
bacteriocidal
27
what is penicillin allergy due to
degradation product of beta lactams, true allergy exists in \<0.05%
28
aztreonam
* beta lactam * can be used in penicillin type 1 allergy * active against Gram negative bacteria * used in Gentamicin resistance
29
how do bacteria develop resistance to beta lactams
synthesise a beta lactamase, this breaks open the beta lactam ring and inactivates the drug eg MRSA
30
how can beta lactam resistance be overcome
ABx are given with a beta lactamase eg clavulanic acid
31
what are ESBL susceptible to
carbapenems
32
how can resistance be acquried to an ABx
* 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
what sites are harder for ABx to get to
in general, tight junctions eg CNS, eyes, prostate
34
gentamicin toxicity
kidneys and CNVIII - dizziness and deafness - contraindicated in renal problems - can only be given for a max of 24 hours
35
how long in total can gentamicin be given for
72 hours
36
which ABx can cause tendonitis
quinolones - achilles and extensor knee mechanism?
37
which ABx have anti toxin effects
clindamycin and linezolid
38
common adverse effects of ABx
nausea and vomiting
39
C Diff causing ABx
* 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
does treatment time influence the risk of C diff
yes - longer treatment also hospitalization time IC
41
how long after ABx may C diff occur
up to 12 weeks
42
C diff infection
* 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
clinical features of C diff infection
range from mild diarrhoea to profuse, watery, haemorrhagic colitis abdominal pain and vomiting
44
who tends to get C diff infections
elderly women
45
investigation of C diff
stool toxin
46
management of C diff infection
mild: oral metronidazole severe: oral vancomycin ± IV meronidazole
47
coverage of MRSA
vancomycin - gram positive

RB Y2 CLASP - Sepsis (5 decks)

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