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Part 3 – PM3A > (PM3A) Bacterial Infections > Flashcards

(PM3A) Bacterial Infections Flashcards

1
Q

Describe the structure of gram positive bacteria.

A

(1) Simple structure
(2) 50% Peptidoglycan
(3) 40-45% acidic polymer
(4) 5-10% proteins & polysaccharides

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2
Q

Describe the structure of gram negative bacteria.

A

(1) Complex structure
(2) Periplasmic space
(3) Thin peptidoglycan layer
(4) Outer membrane
(5) Complex polysaccharides

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3
Q

Name 2 types of gram positive bacteria. Describe their shape. Can these also be gram negative?

A

(1) Cocci - spherical
(2) Bacilli - rods

Yes, bacilli and cocci can also be gram negative

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4
Q

What are the 2 types of cocci.

A

(1) Staphylococci - clusters

(2) Streptococci - pairs/ chains

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5
Q

How many types of cocci are there?

A

Two.

Staphylo and Strepto

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6
Q

(1) What are the two types of streptococci?

(2) What are the differences?

A

(1) Hemolytic and non-haemolytic

(2) Hemolytic can break down blood cells

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7
Q

What is S. pneumoniae? Is it vaccinated?

A

A hemolytic streptococci (bacteria)

Vaccinated

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8
Q

What are the 4 types of bacilli?

A

(1) Spore-forming
(2) Non-spore-forming
(3) Branching
(4) Acid-fast

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9
Q

What type of bacteria are aerobic and anaerobic bacteria?

A

Spore-forming bacilli

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10
Q

Give an example of a spore-forming anaerobic bacteria.

A

C. tetani

Bacilli

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11
Q

What type of bacteria is C. tetani? Is it vaccinated?

A

Anaerobic spore-forming bacilli

Vaccinated.

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12
Q

What are the different types of non-spore-forming bacilli? Give an example genus for both.

A

(1) Motile - Listeria

(2) Non-motile - Lactobacilli/ Corynebacteria

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13
Q

What is C. diphtheriae? Is it vaccinated?

A

A non-motile non-spore-forming bacilli

Vaccinated

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14
Q

Name an example of an acid-fast bacteria. Give an example of one. Is it vaccinated?

A

Mycobacteria

M. tuberculosis

No longer vaccinated.

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15
Q

What is M. tuberculosis? Is it vaccinated?

A

A mycobacteria.

No longer vaccinated

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16
Q

Describe M. tuberculosis.

A

(1) Mycobacteria
(2) Acid-fast
(3) Bacilli
(4) Gram-positive

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17
Q

Describe C. diphtheriae.

A

(1) Non-motile
(2) Non-spore-forming
(3) Bacilli
(4) Gram-positive

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18
Q

Describe C. tetani.

A

(1) Anaerobic
(2) Spore-forming
(3) Bacilli
(4) Gram-positive

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19
Q

Describe S. pneumoniae.

A

(1) Hemolytic
(2) Streptococci - pairs/ chains
(3) Cocci
(4) Gram-positive

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20
Q

Name two types of gram negative bacteria. Can these also be gram positive?

A

(1) Cocci
(2) Bacilli

Yes, bacilli and cocci can also be gram positive.

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21
Q

What is N. meningitidis? Is it vaccinated?

A

A bacterium of the Neisseria genus.

Vaccinated

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22
Q

What are the 3 types of gram negative bacilli?

A

(1) Coccobacilli
(2) Long-rods
(3) Curved/ spiral rods

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23
Q

(1) What are two coccobacilli that are vaccinated against?

(2) Are they gram positive or gram negative?

A

(1) B. pertussis and H. influenzae

(2) Gram negative

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24
Q

What are the 3 types of long-rod bacilli?

A

(1) Enterobacteria: (non)lactose-fermenting
(2) Bacteroides
(3) Pseudomonas

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25
Q

What are 3 types of curved/ spiral rod bacilli?

A

(1) Campylobacter
(2) Helicobacter
(3) Vibrio

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26
Q

What is the mechanism of action of penicillins?

A

Inhibition of cell wall synthesis

It is a beta lactam

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27
Q

What is the mechanism of action of macrolides?

A

50S protein synthesis inhibition

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28
Q

What is the mechanism of action of tetracyclines?

A

30S protein synthesis inhibition

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29
Q

Name 5 ways that bacteria may have developed antibiotic resistance.

A

(1) Impermeability to antibiotic
(2) Efflux pumps - to remove antibiotic
(3) Degradation - conversion of antibiotic to inactive form
(4) Change in antibiotic’s target structure
(5) Altered metabolism/ use of an alternative pathway

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30
Q

When does the UK routine immunisation schedule begin and end (age of patient)?

A

8 months –> 70 years

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31
Q

Name 7 ways to reduce antibiotic resistance.

A

(1) Surveillance/ guidance
(2) Antimicrobial stewardship
(3) Increasing awareness
(4) Training/ education
(5) Research into diagnosis + treatment
(6) Drug development
(7) International collaboration

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32
Q

What are the causes of a lower UTI?

A

Commonly bacteria

- Usually E. coli in bladder/ urethra from GIT

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33
Q

What are the risk factors for a lower UTI?

A

(1) Females - urinary system + GIT in close proximity
(2) Sexual activity
(3) Pregnancy
(4) Genetic predisposition
(5) Post-menopausal
(6) Diabetes

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34
Q

What are the symptoms of a lower UTI?

A

(1) Increased urination frequency - polyuria
(2) Burning in urination - dysuria
(3) Cloudy urine
(4) Strong-smelling urine
(5) Lower abdominal discomfort

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35
Q

What is the first line treatment for a lower UTI?

A

For women:

- Nitrofurantoin
- 100 mg M/R 
- BD
- 3 day course (increase duration if pregnant)
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36
Q

What is the second line treatment for a lower UTI?

A

Fosfomycin/ pivmecillinam

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37
Q

What is the most common cause of an infection in the GIT?

A

Faecal-oral transmission

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38
Q

What is the treatment for MOST GIT infections?

A

No treatment - normally self-limiting

Stay hydrated

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39
Q

Name a bacteria that can infect the stomach.

A

H. pylori

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40
Q

What organs comprise the small intestine?

A

(1) Duodenum
(2) Jejunum
(3) Ileum

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41
Q

(1) Where does an H. pylori infection often take place?

(2) What is the treatment for infection with this bacteria?

A

(1) Stomach

(2) PPI + Clarithromycin/ metronidazole + amoxicillin for a duration of 7 days

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42
Q

(1) What is infective endocarditis?

(2) What is its rarity?

A

Bacterial (usually) infection of the heart, often valves

Rare

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43
Q

What are the most common causes of infective endocarditis?

A

(1) Strep

(2) S. aureus

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44
Q

What are the symptoms of infective endocarditis?

A

(1) Fever/ chills
(2) Heart murmurs
(3) Fatigue
(4) Cough
(5) SOB
(6) Headache
(7) Night sweats

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45
Q

What is the treatment for infective endocarditis?

A

If strep:
- A penicillin + gentamicin
If staph:
- A penicillin + flucloxacillin

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46
Q

When is penicillin required for infective endocarditis?

A

Always

In addition to gentamicin/ flucloxacillin

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47
Q

Under what conditions is flucloxacillin required for treatment of infective endocarditis?

A

(1) Staph infection

(2) As well as a penicillin

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48
Q

Under what conditions is gentamicin required for treatment of infective endocarditis?

A

(1) Strep infection

(2) As well as a penicillin

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49
Q

How does treatment for serious infective endocarditis differ from normal treatment?

A

(1) Ampicillin for 2-6 weeks

(2) Surgery if necessary

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50
Q

What is bacterial vaginosis often mistaken for?

A

Thrush

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51
Q

What is the rarity of bacterial vaginosis?

A

Common

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52
Q

What is the cause of bacterial vaginosis?

A

(1) Overgrowth of bacteria in the vagina

(2) Anaerobic bacteria

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53
Q

What are the symptoms of bacterial vaginosis?

A

Discharge:

  • White/ pale grey discharge
  • Milky discharge
  • Fishy-smelling
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54
Q

What is the treatment for bacterial vaginosis?

A
  • Metronidazole
  • Oral
  • 400mg
  • BD
  • 5-7 day treatment
  • Can be a 2g single dose of metronidazole gel
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55
Q

Is itching/ burning/ irritation usually present in bacterial vaginosis?

A

No.

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56
Q

What are the similarities and differences in symptoms between bacterial vaginosis and thrush (candidiasis)?

A

(1) Similarities:
- Increased vaginal discharge
- White discharge
(2) Differences:
- BV discharge can be grey
- Discharge in BV is smooth, thrush is curded
- BV smells fishy, thrush no odour
- Thrush itches + burns, BV does not

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57
Q

Which skin layer(s) does acne affect?

A

Epidermis - hair follicle

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58
Q

Which skin layer(s) does impetigo affect?

A

Epidermis

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59
Q

Which skin layer(s) does cellulitis affect?

A

(1) Dermis

(2) Subcutaneous fat

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60
Q

What infections affect the epidermis?

A

(1) Acne - hair follicle

(2) Impetigo

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61
Q

What infections affect the dermis?

A

Cellulitis

62
Q

What infections affect the subcutaneous fat?

A

Cellulitis

63
Q

What causes an impetigo infection?

A

Infection with S. aureus/ S. pyogenes in breaks in the skin

64
Q

What are the symptoms of impetigo?

A

(1) Sores - red spots/ blisters

(2) Swollen glands

65
Q

What is the treatment for impetigo? How does this vary for localised/ systemic?

A

(1) Good hygiene
(2) Localised area:
- Topical fusidic acid for 5 days
- Topical mupirocin 2% for 5 days if MRSA
(3) Systemic:
- Oral flucloxacillin 250-500mg QDS for 7 days
- Clarithromycin 250-500mg BD for 7 days (if allergic)

66
Q

What is cellulitis?

A

Inflammation of the skin and subcutaneous tissues (fat)

67
Q

What are the symptoms of cellulitis?

A

(1) Red
(2) Hot
(3) Swelling/ inflammation
(4) Painful

68
Q

What causes cellulitis?

A

(1) S. pyogenes - most common

(2) S. aureus - in damaged skin

69
Q

What is the treatment for mild cellulitis?

A
  • Flucloxacillin (clarithromycin if penicillin allergy)
  • 500mg
  • QDS
  • 7 days
70
Q

What is the treatment for gram negative cellulitis?

A

Broad-spectrum antibiotic - e.g. amoxicillin

71
Q

What causes bacterial conjunctivitis?

A

(1) S. aureus
(2) H. influenzae
(3) S. pneumoniae

72
Q

What are the symptoms of bacterial conjunctivitis?

A

(1) Thick + yellow discharge (mucopurulent)
(2) Gritty feeling in eye
(3) Pink/ red eye

73
Q

What is the first line treatment for bacterial conjunctivitis?

A

(1) Self-care

(2) Bathe + Clean

74
Q

What is the second line treatment for bacterial conjunctivitis?

A

(1) OTC Topical Antibiotics
- Chloramphenicol 0.5% drops
- Chloramphenicol 1% ointment
(2) Self-care

75
Q

What are the two potential treatments for bacterial conjunctivitis? When are they used.

A

Chloramphenicol 0.5% drops or 1% ointment

As second line treatment

76
Q

What is the self-care advice for bacterial conjunctivitis?

A

(1) Bathe eyes
(2) Lubricate eyes
(3) Prevent spread

77
Q

What is otitis externa? What is it known as more colloquially?

A

Infection of the outer ear

Swimmer’s ear

78
Q

What are the causes of otitis externa?

A

Mainly bacterial

  • S. aureus
  • P. aeruginosa

Can also be fungal

79
Q

What are the symptoms of otitis externa?

A

(1) Pain
(2) Itchiness
(3) Discharge
(4) Temporary/ slight hearing loss
(5) Feeling of pressure

80
Q

What is the treatment for otitis externa?

A

(1) Self-care
- Pain relief
- Localised heat
(2) Clotrimazole if fungal
(3) If bacterial:
- Topical acetic acid 2%
- Topical antibiotic - neomycin
- Corticosteroid - betamethasone

81
Q

What is otitis media? What is its rarity?

A

Infection of the middle region of the ear

Most common cause of ear pain in children

82
Q

What is the cause of otitis media infection?

A

(1) Usually viral
(2) Can be bacterial:
- S. pneumoniae
- H. influenzae

83
Q

What are the symptoms of otitis media?

A

(1) Ear ache
(2) Fever
(3) Vomiting
(4) Fatigue
(5) Slight hearing loss

84
Q

What are the similarities and differences between the symptoms of otitis externa and otitis media?

A

(1) Similiarities:
- Pain/ ear ache
- Slight hearing loss
(2) Differences:
- externa is itchy, with discharge + feeling of pressure
- media gives fatigue, fever + vomiting

85
Q

What is the treatment for otitis media?

A

(1) Self-care
- Pain relief
(2) If severe
- Antibiotics (amoxicillin)

86
Q

What is the cause of a sore throat?

A

(1) Usually viral
(2) Can be bacterial
ø Strep throat - caused by airborne droplets

87
Q

What are the symptoms of a sore throat?

A

(1) Pharyngitis - throat inflammation

(2) Tonsillitis - tonsil inflammation

88
Q

What is the treatment for a sore throat?

A

(1) Self-care
ø Salt gargle
ø Increased fluids
ø Painkillers
(2) Phenoxymethylpenicillin - severe bacterial infections
- Covers group A streptococcus (GAS)

89
Q

What is septic arthritis?

A

Infection of the joints

90
Q

What is the treatment for septic arthritis?

A

Flucloxacillin for 4-6 weeks

91
Q

What is osteomyelitis?

A

Infection of the bone marrow

92
Q

What is the treatment for osteomyelitis?

A

(1) Flucloxacillin for 6 weeks

(2) Sometimes + fusidic acid/ rifampicin for first 2 weeks

93
Q

What is the role of the pancreas?

A

Blood glucose regulation

94
Q

What is bacterial meningitis?

A

Infection of the central nervous system

95
Q

What is the cause of bacterial meningitis? How does this differ for old/ young patients?

A

(1) Older children/ adults:
- S. pneumoniae
- N. meningitidis
(2) Young children:
ø H. influenzae

96
Q

What are the symptoms of bacterial meningitis?

A

(1) Headache
(2) Stiff neck
(3) Fever
(4) Non-blanching rash - meningococcal (N. meningitidis)
(5) Photophobia
(6) Altered consciousness

97
Q

What is the treatment for bacterial meningitis?

A

(1) If meningococcal (N. meningitidis):
- Parenteral benzylpenicillin
(2) In hospital:
ø IV ceftriaxone/ cefotaxime
(3) Can also use corticosteroid - dexamethasone

98
Q

What are the preventative measures for bacterial meningitis?

A

Vaccination

99
Q

What does the bacterial meningitis vaccination include?

A

(1) HiB
(2) MenB
(3) MenC
(4) MenACWY

100
Q

What is sepsis? What does it do to the body?

A

(1) An inflammatory immune response to infection

(2) Damages tissues and organs

101
Q

What are the molecules that damage the body’s tissues and organs in sepsis called?

A

(1) Endotoxins

(2) Exotoxins

102
Q

How do the 3 types of endo/ exotoxins damage the body’s tissues and organs?

A

Type 1 - Disrupt host cell (without entry)

Type 2 - Destroy host cell membranes to invade and interrupt host defence

Type 3 - Disrupt host cell defence to allow dissemination of infection

103
Q

What are the underlying infections that can cause sepsis?

A

(1) Usually bacterial
ø Gram+ (Staph)
ø Gram- (E. coli)
(2) Less commonly fungal/ viral

104
Q

What are the most common infection sites leading to sepsis?

A

(1) Lungs (50%)
(2) Urinary tract (20-25%)
(3) Abdominal (15-20%)
(4) Skin/ soft tissue (10-15%)

105
Q

What are the symptoms of sepsis?

A

(1) Fever/ low body temperature
(2) Elevated HR
(3) Elevated RR
(4) Low BP
(5) Confusion
(6) Pale blotchy skin & non-blanching rash
(7) Significantly reduced urination

106
Q

What is the treatment for sepsis?

A

(1) Antibiotics PRN
(2) IV fluids PRN
(3) Oxygen PRN

107
Q

What is a nosocomial infection?

A

Healthcare associated infection

HCAIs

108
Q

What is an HCAI and what is another name for it?

A

Healthcare associated infection

Nosocomial infection

109
Q

What is Clostridium difficile?

A

Gram positive, anaerobic, spore-forming rod

110
Q

What is another name for Clostridium difficile?

A

Clostridioides difficile

111
Q

What is Clostridioides difficile?

A

Clostridium difficile

Gram positive, anaerobic, spore-forming rod

112
Q

What is a CDI?

A

Clostridium (clostridioides) difficile infection

113
Q

What is the effect of broad-spectrum antibiotics on CDIs?

A

Increases the infection

Proportional to the duration of exposure to the antibiotic

114
Q

Which two conditions is a CDI significantly implicated in?

A

(1) AAD - Antibiotic-associated diarrhoea

(2) AAC - Antibiotic-associated colitis

115
Q

What is the difference in mortality rate when a CDI is present?

A

8%

116
Q

What are the common symptoms of a CDI?

What are the rare symptoms of a CDI?

A

(1) Mild-moderate diarrhoea
(2) Mild-severe abdominal cramping/ pain
(3) Yellow-white plaques on the intestinal mucosa (only if SEVERE)

RARE:

(1) Fulminant life-threatening colitis (severe + sudden)
(2) Low-severe fever
(3) Dehydration

117
Q

(1) What are the different categories for CDI severity?

(2) How is the severity determined?

A

(1) MILD:
ø Normal WCC
ø <3 loose stools in a day
ø 5-7 on Bristol Stool Chart

(2) MODERATE:
ø Increased WCC - >15x10^9/ L
ø 3-5 loose stools in a day

(3) SEVERE:
ø Increased WCC - >15x10^9/ L
ø Acutely increased serum creatinine (+>50%)
ø Temperature >38.5ºC
ø Evidence of severe colitis
ø Stools are no longer relevant in determining severity

(4) LIFE-THREATENING:
ø Hypotension
ø Partial-complete ileus (obstruction of the ileum)
ø Toxic megacolon (rapid widening of the colon)
ø CT evidence of severe disease

118
Q

What are common risk factors for CDIs?

A

(1) Increased age
(2) Proximity to infected patients - e.g. hospital staff
(3) Nasogastric tube
(4) Gastric surgery
(5) PPIs
(6) Increased hospital stay
(7) Underlying disease - e.g. IBS
(8) Chemotherapy
(9) Increased exposure to antibiotics
(10) Courses of multiple antibiotics

119
Q

What antibiotic can cause a CDI?

A

Any antibiotic

Traditionally: clindamycin

120
Q

Define ‘pathogenicity’.

A

The process of causing a disease

121
Q

Why can antibiotic therapy increase risk of CDI?

A

Can affect the healthy flora of the colon

122
Q

What is the pathogenicity of C. diff?

A

(1) Antibiotic therapy affecting healthy colon flora
(2) Toxicogenic stains producing A + B toxins
ø Some strains also produce binary toxin (CDT)

123
Q

What causes diarrhoea in CDIs?

A

Toxins

124
Q

What causes fluid secretion and intestinal inflammation in CDIs?

A

Toxin A

125
Q

What does toxin A do in C. diff infections?

A

(1) Causes fluid secretion
(2) Causes intestinal inflammation
(3) Activates cytokine release

126
Q

What activates cytokine release in CDIs?

A

Toxin A & Toxin B

127
Q

What is the trend of a CDI when binary toxins (CDT) is present?

A

Increased severity

128
Q

What are the stages of progression of a CDI?

A

(1) Uncolonised
(2) Asymptomatic colonisation
(3) Toxin production
(4) CDI

129
Q

How is a CDI diagnosed based on clinical symptoms and risk factors?

A

(1) Diarrhoea
(2) ABx exposure
(3) History - can lead to recurrent CDI

130
Q

How is a CDI differentially diagnosed?

A

(1) Cytotoxic assay
(2) Toxigenic culture
(3) ELISA for toxins A + B
(4) PCR for toxin genes
- Presence of the gene does NOT mean presence of the toxin

131
Q

How is a suspected CDI managed?

A

(1) Cessation of offending antibiotic
(2) Symptomatic treatment
ø Fluid + electrolyte replacement
ø NOT antidiarrhoeals
(3) Specific ABx therapy usually indicated

132
Q

What is the first line therapy for treatment of a mild-moderate CDI?

A 
(1) 
ø Metronidazole
ø 400 mg
ø TDS
ø Oral
ø 10-14 day duration

(2) Switch to 500mg TDS IV if oral FAILS
(3) Switch to VANCOMYCIN if treatment FAILS

133
Q

What is the first line therapy for treatment of a severe CDI?

A 
(1) 
   ø Vancomycin
   ø 125-500 mg
   ø QDS
   ø 10-14 days

(2) ORAL vancomycin is ineffective as it is poorly absorbed

134
Q

Which antibiotic is potentially superior to vancomycin for preventing recurrent CDI?

A

Fidaxomicin

135
Q

What is the rarity of recurrent CDI?

A

Up to 1/3 cases

136
Q

How does treatment differ for recurrent CDI?

A

(1) Same treatment as before

(2) Often switched to oral vancomycin or fidaxomicin

137
Q

What treatment is gaining importance as a possible treatment for recurrent CDI?

A

Faecal transplantation

138
Q

What treatment can be administered in recurrent CDI, in addition to antibiotic therapy? Give an example.

A

(1) Monoclonal antibodies
(2) Selective against toxin B
(3) Bezlotoxumab

139
Q

How are CDI controlled in hospitals?

A

(1) Good infection control - thorough hand washing
(2) Cohorting/ isolation of infected patients
(3) PPE
(4) Increased monitoring
(5) Improved education on ABx use

140
Q

What is antimicrobial stewardship?

A

(1) Reduction in inappropriate ABx use
(2) Improvement in susceptibility profiles of hospital pathogens
(3) Better selection, dosing, route of administration, and therapy duration of ABx

To REDUCE ABx resistance

141
Q

Why is antimicrobial stewardship important?

A

Drug resistant pathogens have an impact on care

142
Q

What are the 7 antimicrobial stewardship strategies?

A

(1) Formulary restriction
(2) Review/ audit + feedback
(3) Education + guidelines
(4) Streamlining/ de-escalation
(5) IV -> Oral
(6) Antibiotic cycling
(7) Supplementary strategies

143
Q

What is the formulary restriction in antimicrobial stewardship? What are the pros and cons?

A
  • Restricted dispensing for certain ABx
  • AMS team must be contacted by prescriber

+
ø Direct control of ABx
ø Cost-effective
ø Ensures appropriate therapy

-
ø Loss of autonomy for prescribers
ø Time-consuming

144
Q

What is review/ audit + feedback in antimicrobial stewardship? What are the pros and cons?

A
  • Daily review of ABx appropriateness
  • Steward (pharmacist) gives feedback to prescriber

+
ø Maintained prescriber autonomy
ø Individual education

-
ø Compliance is only voluntary
ø Increases workload of pharmacist
ø Reactive, rather than proactive

145
Q

What are education/ guidelines in antimicrobial stewardship? What are the pros and cons?

A
  • Can be issued by NHS or government
  • Education of clinicians

+
ø Maintained prescriber autonomy
ø May alter behaviour patterns

-
ø Mostly ineffective by itself

146
Q

What are streamlining/ de-escalation in antimicrobial stewardship? What are the pros and cons?

A
  • Use of results-based therapy
  • Use of patient-specific rather than broad-spectrum

+
ø Avoids long-term broad-spectrum ABx
ø Reduces resistance risk

-
ø Increased pharmacist workload
ø Sample-processing time

147
Q

What is the IV to Oral switch in antimicrobial stewardship? What are the pros and cons?

A
  • Use of oral ABx in hospital
  • Many oral ABx have good absorption + bioavailability

+
ø Avoids entry site infections
ø Cost savings

-
ø Compliance

148
Q

What is antibiotic cycling in antimicrobial stewardship? What are the pros and cons?

A
  • Avoids resistance to any single antibiotic
  • Aims to slow resistance

+
ø May reduce drug resistance by changing selective pressure

-
ø Adherence
ø Effectiveness lacks evidence

149
Q

What are the supplemental strategies in antimicrobial stewardship?

A

(1) Decrease ABx usage
(2) Mathematical modelling
(3) Combination of the other 6 strategies

150
Q

What are the goals of the UK 20-year vision for antimicrobial resistance?

A

(1) Half gram-negative healthcare-associated infections
(2) Reduce drug-resistant infections by 20% by 2025
(3) Reduce ABx use by 15% by 2024

Part 3 – PM3A (28 decks)

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