PATHOGEN-INFECTION-ANTIBIOTIC MATCHING

Question 1

Managing patients with infection

Answer 1

Infections
Is there infection? /What/where is the infection? Severity?
Pathogens
What is likely pathogen? Empirical therapy
What is actual pathogen?
What antimicrobials susceptible to? Targeted therapy

Question 2

what to consider when giving antibiotics

Answer 2

empirical and targeted therapy
route, duration (review)
distribution/penetration
cidal/static
resistance
special situations eg liver/renal impairment, obesity, young/elderly, HCAIs,
monitoring
prophylaxis – surgical or long-term (suppression)
Cidals kills the organism but statics just stops them

Question 3

Is it infection? Base this decision off…

Answer 3

Clinical presentation: History and Examination
Obvious source e.g. cellulitis, pneumonia, rash
Tests/investigations: Clinical and microbiological diagnosis Eg CXR, blood tests, swabs, urine/blood cultures
Severity: localised infection/ sepsis/severe sepsis/septic shock

Question 4

Sepsis

Answer 4

presence (probable/definite) of infection with systemic manifestations of infection

Question 5

Severe sepsis

Answer 5

= sepsis-induced tissue hypo perfusion or organ dysfunction.

Question 6

Septic shock

Answer 6

sepsis-induced hypotension persisting despite adequate fluid resuscitation

Question 7

Sepsis epidemiology

Answer 7

High incidence: UK Sepsis Trust 150 000 cases sepsis/year
High mortality: estimates vary 10 – 50%. UK Sepsis Trust 44 000 deaths/year
Increased mortality rates with increasing severity, age and co-morbidities. High financial burden

Question 8

SEPSIS 6

Answer 8

1. Administer high flow oxygen. O
2. Give intravenous fluid challenges. F
3. Give broad spectrum antibiotics. A
4. Take blood cultures. B
5. Measure serum lactate and haemoglobin. L
6. Measure accurate hourly urine output. U

Question 9

Clinical markers of infection

Answer 9

Temperature   
HR, BP, RR, SaO2
Altered mental state 
Rigors, skin changes, urine output
NEWS = National Early Warning Score

Question 10

Biochemical/haematological markers of infection

Answer 10

WCC – neutrophils/lymphocytes
•	Plts and Clotting (DIC)
•	CRP (C reactive protein)
•	Procalcitonin- precursor for calcitonin. Raised in severe systemic bacterial infections. 
•	renal function/liver function = ?MOF
•	Lactate- good marker of sepsis.