MRSA + C.Difficile

Question 1

Bacterium is MRSA

Answer 1

Staphylococcus aureus

- mecA gene - alters penicillin binding proteins

Question 2

Which drugs are resistant to MRSA

Answer 2

Beta-lactams + fluoroquinolones

- variable resistant with fusidate, macrolides, clindamycin and trimethoprim.

Question 3

Reduce spread of MRSA

Answer 3

Infection control – Hand Hygiene, Isolation, Decontamination
Antimicrobial Stewardship
Screening and Decolonisation

Question 4

Antimicrobial Stewardship

Answer 4

Limiting to appropriate antibiotic use part of the battle

Question 5

Screening and Decolonisation

Answer 5

All inpatients screened (nasal and perineum).
Carriers are isolated and decolonised
- MRSA can cross infect
- Mupirocin 2% nasal cream to both nostrils TDS for 5 days
- All over body wash daily with appropriate
antibacterial wash 5 days, including hair twice.
e.g. Chlorhexidine 4%, Octenisan, Skinsan etc.

Question 6

Bacterium is Clostridum difficile

Answer 6

Gram-positive spore-forming rods

Inhibited by normal gut flora

Question 7

C.diff cycle

Answer 7

Stomach kills vegetative bacteria
Spores travel to intestine and germinate. With altered gut flora (Abx), colonisation toxin production and disease.
Excreted to cause further environmental contamination

Question 8

C.diff symptoms

Answer 8

Diarrhoea
Diarrhoea Type 6-7
Mucus.
Offensive smell 
Raised CRP/WCC
Pyrexia
Toxic confusional state in elderly

Question 9

Manage C.Diff

Answer 9

Stool sample for toxin
Patient isolation
Perfect hand hygiene (soap and water)
Stool chart and daily monitoring of stools
Stop offending antibiotics
Review drugs that may cause diarrhoea (PPIs, Laxatives etc.)
Avoid loperamide and if possible opioids.

Question 10

Antibiotics to treat C.diff

Answer 10

Metronidazole + oral vancomycin/fidoxomicin

Question 11

Antibiotic treatment of pneumonia

Answer 11

Glycopeptide/linezolid

Question 12

Antibiotic treatment of cellulitis/SSTI simple

Answer 12

Tetracycline/cotrimoxazole/if sensitive clindamycin

Question 13

Antibiotic treatment for SSTI complicated

Answer 13

Glycopeptide/linezolid/daptomycin/televancin/ if sensitive clindamycin

Question 14

Antibiotic treatment for UTI simple

Answer 14

Tetracycline/ if sensitive trimethoprim/nitrofurantoin