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Inflammation > Pathogenesis of Sepsis and antibiotics > Flashcards

Pathogenesis of Sepsis and antibiotics Flashcards

1
Q

What is septic shock?

A

Sepsis with acute or refractory hypotension or tissue hypoperfusion despite fluid resuscitation

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2
Q

SIRS temperature?

A

> 38 or <36

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3
Q

SIRS RR?

or SIRS PaCO2?

A

> or equal to 20/min

or < 32 mmHg (normal: 38-42)

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4
Q

SIRS WBC?

A

12,000/ul or over
or 4,000/ul or under
or >10% immature forms

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5
Q

What is sepsis?

A

At least two SIRS criteria caused by an infection (known or suspected)

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6
Q

What is LPS?

A

An endotoxin secreted by gram negative bacteria

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7
Q

What is the most common cause of shock from gram negatives?

A

LPS

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8
Q

What is the most common cause of shock from gram positives?

A

Lipoteichoic acid

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9
Q

Direct cause of shock by microbe?

A

Interaction with the vascular endothelium

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10
Q

Common producers of super antigens?

A 
S. aureus
Streptococcus pyrogenese (group A strep)
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11
Q

What does a superantigen do?

A

Directly attach to MHC class II and TCR causing faster and prolonged response

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12
Q

What effect of sepsis causes tissue hypo-perfusion

A

Increased coagulation, loss of red cell deformability, decrease in BP (leaky vessels)

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13
Q

G -ve causes of shock?

A

E. coli
Meningococci
Pseudomonas
Haemophilus

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14
Q

G +ve causes of shock?

A

Staph aureus
Group A streptococci
Strep pneumoniae
Clostridium spp.

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15
Q

Causes of neonatal shock?

A

Group B streptococci
Listeria
E. coli

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16
Q

What does strep pneumoniae cause?

A

Pneumonia and meningitis

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17
Q

What fungus is common in the immunosuppressed?

A

Aspergilus

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18
Q

Common bacteraemias:

A

S. aureus (+)
Enterococcus (+)
Strep pneumoniae (+)

E. coli (-)
Klebsiella (-)
Pseudomonas (-)

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19
Q

Most common cause of g -ve septicaemia in hospital?

A

UTI with pyelonephritis

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20
Q

Hospital cause of septicaemia?

A

IV catheters and devices

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21
Q

Differentials for septic shock

A 
Burns or trauma
Pancreatitis
PE (resembles pneumonia)
Ruptured AAA, bleed, MI, tamponade
Overdose
Adrenal insufficiency
Anaphylaxis
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22
Q

Management of sepsis?

A 
Fluids
Dopamine
Transfusion (ICU)
Solve precipitating problem
Anti-biotics
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23
Q

Monitor what in sepsis?

A 
ABG
Renal function (U+E's)
CNS
Glasgow coma score (GCS)
LFTs
Myocardial function
24
Q

Sepsis 6:

A

1: Administer high flow O2
2: Blood cultures
3: Broad spectrum anti-biotics
4: IV fluid challenges
5: Measure serum lactate and Hb
6: Measure hourly urine output

25
Q

When do should IV abx have begun?

A

Within the first hour of admission

26
Q

Consider what in neutropenic patients?

A

Combination empiric therapy

27
Q

What is de-escalation?

A

Going from broad spectrum antibiotics to narrow

Carry out once cultures come back

28
Q

Examples of beta-lactams:

A

Penicillins, cephalosporins and carbapenems (ertapenem, meropenem)

29
Q

Glycopeptide Abx:

A

Vancomycin

Teicoplanin

30
Q

What are glycopeptide Abx used for?

A

G +ve
MRSA
Coagulase -ve staphylococcus

31
Q

Bactericidal vs bacteriostatic:

A

Kill vs stop growth

32
Q

-mycin =

A

Macrolide (bacteriostatic)

33
Q

When might a macrolide be used?

A

Penicillin allergy against staph and strep e.g. skin/throat

Atypical pneumonia

34
Q

-cycline

A

Tetracycline (bacteriostatic, broad spec)

35
Q

When might a tetracycline be used?

A

Respiratory and soft tissue atypicals e.g. legionella and mycoplasma

36
Q

Tigecycline is effective against?

A

G +ve
G -ve
Anaerobes

37
Q

Aminoglycosides are used for what?

A

G -ve
Synergy with penicillins against strep and others
Used for serious sepsis

38
Q

Potential complication of macrolide use? (except tobramycin)

A

Nephrotoxicity

CN VII toxicity

39
Q

Penicillins ordered from broad (top) to specific (bottom):

A 
Tazobactam
Co-amoxicillin
Amoxicillin
Penicillin V
PO
40
Q

Function of quinolones?

A

Prevents DNA synthesis

41
Q

-oxacin

A

Quinolone

42
Q

Examples of quinolones:

A

Ciprofloxacin
Levofloxacin
Maxifloxacin

43
Q

Use for trimethoprim?

A

UTI

44
Q

Potential complications of trimethoprim and co-trimoxazole?

A 
Interfere with folate
G +ve side effects
G -ve side effects
Stevens-Johnson syndrome
Bone marrow suppression/aplasia
45
Q

In which situations do abx not help the patient get better quicker?

A

Comylobacter

Acute bacterial sinusitis

46
Q

Treatment for:
CAI and shock
Origin unknown/gut/renal/biliary

A

Co-amoxiclav + gentamicin (+vancomycin if MRSA)
or cefuroxime + metronidazole + gentamicin
or ciprofloxacin + metronidazole + gentamicin

47
Q

Treatment for:
CAI and shock
Origin skin/soft tissue

A

Flucoxacillin + penicillin/amoxicillin +/- gentamicin

consider adding clyndamicin if group A strep or staph. aureus - risk of toxic shock

48
Q

Treatment for:
CAI and shock
Pneumonia

A

co-amoxiclav + doxycycline

or cefuroxime + erythromycin

49
Q

Treatment for:
CAI and shock
Meningococcal disease

A

Penicillin or ceftriaxone

50
Q

Treatment for:
CAI and shock
Malaria

A

Quinine

51
Q

Penicillin allergy (rash only)

A

Consider using penicillin or cephalosporin depending on the allergy

52
Q

Penicillin allergy (severe i.e. anaphylaxis)

A

Ciprofloxacin, vancomycin, eryhthromycin (get advice)

No beta-lactams at all

53
Q

HAI vs CAI

A

For HAI you have to go more broad spectrum

54
Q

Early HAI abx

A

Same as CAI

55
Q

Late HAI abx

A

Broad
Gentamicin + Tazocin
(maybe meropenem or colistin as resistance that bad)

56
Q

MRSA abx:

A

Vancomycin

57
Q

VRE

A

Linezolid

Inflammation (9 decks)

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