Other Flashcards
How do you Dx infection / organism
Blood culture Urine culture Stool culture Sputum culture Wound swab
What should you put on form for micro
Duration of Sx Clinical info Allergies Other drugs Pregnant or breast Renal function Previous Ax tried What test you want
How long do you treat UTI in young women
3 days
How long exacerbation COPD
7 days
Minor wound
Short
Septic arthritis
Long
What is a true penicillin allergy
Anaphylaxis
Urticarial or rash immediately after
When would you give penicillin if severe infection
If complain of GI upset or rash >72 hours
B-lactam >vancomycin if don’t have true allergy
Can you have co-amoxiclav if penicillin allergic
No
What is a major RF for infection
DM
What is important in the history
Travel Sexual Food Contact up to 2 weeks Antibiotics Trauma Occupation Animal / pet history Immunosuppression - DM / HIV / drugs / steroid IVDA
When do you consider sexual
New UTI
HIV seroconversion
Septic arthritis - gonorrhoea
Reiter’s - chlamydia
Trauma
Bites Athlete foot Itchy skin Lymphoedema Ulcers
How do you investigate
Blood culture
Swab open wound
ASOT - strep
What are indications for culture
High or low temp Tachycardia Raised WCC Tachypnoea Altered mental state Hyperglycaemia but no DM Evidence of infection
When may infection / sepsis be muted
DM Elderly Young Immunocompromised Prosthesis - may only have pain
What do prosthesis tend to be infected with
Low grade pathogen
S.epidermis
Enterococci
Yeast
What is common in IVDA
Hep C
S.aureus
Group A strep
What infections common
Bone
Abscess
Infected DVT / PE
Endocarditis - tricuspid
How do you look for abscess
CT
How do you treat
IV fluclox
Clindamycin better strep
Longer if infected clot of abscess
How do you diagnose virus
Antigen detection - PCR
Serology - IgG or IgM
NAAT
Why don’t you do culture
Takes too long
Needs transported in viral medium
When do you do microscopy
Film - malaria
Faeces - ova / cysts / parasites
Gram and ZN stain - bacteria/ TB
Rare for virus
What is antigen detection
ELISA - hep B surface Rota Adenovirus HIV Syphillis
What do you do for respiratory virus
Immunoflurosence of NPA
What is NAAT
Nucleic acid amplification
PCR if virus
What is serology
IgM and IgG
Ab detection
When is it of little use
Immunocompromised
Virology
Will only detect tests you ask for
Serology
Antigen detection
NAAT
What does gram stain do
Info about type of organism
Do on blood culture
What can infection be mimicked by
Autoimmune
Drugs
Haem malignancy
How does S.aureus bacteraemia present
Skin / bone / joint infection Cellutlits Joint infection Pneumonia Abscess Metastatic
Metastatic presentation S.aureus
Vertebral OM
Endocarditis
Discitis
What does S.aureus prroduce
Enterotoxin - gastroenteritis
TSS1
How do you investigate
Blood culture
TTE for all bacteraemia
Other investigation
CT / MRI if discitis
Joint aspiration
CXR
Why do you repeat culture
Show infection under control
In case its a contaminant
How do you Rx
IV fluclox
How long for
Minimal 14 dyas
Longer if deep seated
DO NOT discharge on OPAT
What causes MRSA
B lactase production
How do you treat MRSA
Vancomycin but resistance arising, doxycycline or clindamycin
Teicoplanin
Linezolid = 2nd line
What. is S.epididermis
Skin commensal
Common contaminant of blood culture
Low pathogeneicty but if foreign body e.g. central line or IE can have high
Difficult to Rx with Ax
What should you screen for in all surgical patients
MRSA
How do you screen and when
Nasal swab + any skin lesion
Elective admission
Emergency admission
When do you eradicate MRSA and how
If +ve
Nasal mupricon
Skin chlorhexidine
What does strep. Pneumonia cause
Pneumonia
Otitis meda
Meningitis
Sensitive to pen
What does strep viridian’s cause
IE
Normal flora of oral / throat
If isolate from culture - think endocaridits
What does strep pyogenes cause
Throat / tonsilltiis / pharyngitis Cellulitis/ necrotising fasciitis Rheumatic fever Post strep GN Scarlet fever Sensitive to benzypen
What does group B strep cause
Neonatal sepsis / meningitis
Common commensal of female genital tract
Ax if high risk in pregnancy
What is non-haemolytic
Enterococcus
GI tract
UTI / intra-abdominal abscess
How do you Rx
Amoxiccilin
May need vancomycin
