S4 L2 - Antimicrobial Stewardship and Meningitis, Encephalitis, Peritonitis, Ascites, DIC

Question 1

Consequences of Antimicrobial resistance

Answer 1

• Treatment failure
• Prophylaxis failure
• Economic costs

Question 2

Range of Antimicobial Resistance
- 3

Answer 2

MDR - Multi-drug resistant
XDR - Exentensely-drug resistant
PDR - Pan-drug resistant

Question 3

• *Definition of Anti-microbial Resistance**
• Definition
• Aims of Antimicrobial stewards

Answer 3

Definition:
Coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy, and route of administration.

Aims:
• appropriate use of antimicrobials
• optimal clinical outcomes
• minimize toxicity and other adverse events
• reduce the costs of health care for infections
• limit the selection for antimicrobial resistant strains

Question 4

Stewardship Interventions

Answer 4

Question 5

• *Meningitis**
• What is this?
• What are the meninges?
• Role of the meninges?
• What is CSF?
• Where is it?
• Role of CSF?
• Which cells produce CSF?

Answer 5

What is this?
Meningitis is the inflammation of the meninges, that surround the brain and spinal cord
What are the meninges?
Meninges - the three connective tissue layers in the CNS: PAD (inside out - pia meter is closest to the brain, arachnoid, dura meter).
Role of the meninges?
Protect the brain and spinal cord from injury and infection
What is CSF? Where is it?
In the subarachnoid space (between the Pia meter and arachnoid layer), surrounds the spinal cord and ventricles/
Role of CSF?
Maintain constant intracranial pressure
Which cells produce CSF?
Produced by the choroid plexus (in the lining of the ventricles), plasma filtered in the blood by epithelial cells, to produce CSF

Question 6

• *Meningitis (cont.)**
• Pathogen
• Patient
• Mechanism of infection
• Infection symptoms of viral and bacterial meningitis
• Management
• Outcome
• Prevention

Answer 6

Question 7

Result of CSF
Appreance, white cell count, usual cell types, proteins, glucose
- Normal
- Bacterial meningitis
- Tuberculosis meningitis
- Fungal meningitis
- Viral meningitis

• How to investigate CSF

Answer 7

Question 8

What are these:
Encephalitis

Peritonitis

Ascites

Sepsis - antibiotics to use

Answer 8

Encephalitis – inflammation of the brain itself

Peritonitis – inflammation of the peritoneum (usually due to bacterial or fungal infection, peritoneal cavity is meant to be sterile)

Ascites – If excess fluid fills the peritoneal cavity, can lead to ascites

Sepsis – few points
Antibiotic given, when no sign of meningitis and severe gram positive sepsis suspected– Co-amoxiclav, if allergic give Meropenem
Severe gram-negative sepsis is suspected – Gentamicin

Question 9

• *DIC**
• What does this stand for?
• Causative organism
• What happens?
• Signs and symptoms

Answer 9