Sepsis Flashcards
want to give sepsis bundle within what time
one hour
when do you want to do multiple blood culture sets
endocarditis suspected
what fluids for sepsis
500ml of hartmanns/saline over 15-20 mins
if lactate is high consider giving
fluids
non blanching rash can also be
sepsis
mottled skin appearance can suggest
sepsis
what is colonisation
presence of microbe in th ebody WITHOUT an inflammatory response
what is defined as sepsis shock
sepsis and both of persistent HYPOtension (requiring vasopressors to maintain MAP to at least 65) and lactate greater than 2
(despite adequate volume resusitation)
refractory hypotension suggests
septic shock
when do you upgrade to next NEWs level give one example
neutropenic
when should NEWs not be used for pregnancy
if under 16 or in pregnant woman and it may be unreliable in those with spinal cord injury
when should you used scale 2 of oxygen sats on News score
if hypercapnic
vasopressors that can be used in sepsis
Norepinephrine, epinephrine, vasopressin
what are the empiric antibiotics
amoxicilin, gentamicin and metronidazole
skin, soft tissue, lines, devices suggest what bacteria
gram positive cocci
biliary, urinary, gut can suggest what bacteria
gram negative bacilli
what orgainsm can autolyse so on the gram stain the organism is not seen
strep pneumonia
if on gram stain it shows a gram postive cocci in clusters aka staph aureus then what to we do
rapid PCR test
why do we do PCR for staph aureus
tells us if its a staph aureus and whether it has the methicillin resistant gene to make it an MRSA
PCR can be used to
detect specific genes
if gram stain shows a gram positive cocci in pairs or chains aka streptococcal species we can do what
agglutination assay
bad thing about agglutination test
not sensitive as read by humans so subject to error
difference in apha, beta and gamma haemolysis
a- incomplete
b- complete
g- none
after gram stain and rapid test we then set up
culture plates
if big circle in disc diffusion means what
antibitoic is sensitive and working
method that tells us whether the organism is resistant or sensitive
disc diffusion
what can you do to avoid false negatives
take cultures before starting antibiotics
cultures cannot detect dead bacteria. so if culture fails but there is a strong suspicion of infection you can do
PCR or sequencing
very high levels of CRP are associated with what infection
bacterial
gram negative is what colour
pink
why is gram positive purple
thick petidoglycan wall
5 main gram negativce
E.coli, Neisseria meningitis, proteus, klebsiella and Enterobacter (not to be confused with gram pos enterococcus)
the pathogenicity is often associated with the what layer of the gram negative cell
LPS - lipopolysaccharide
e.coli is a
gram neg bacilli/rods
what are coliforms
gram neg rods
extended spectrum beta lactamases cannot give what antibitotics
penicillins, cephalosporins, aztreonam
the bigger the clear circle in culture
the better the antibiotic as there is no bacteria growth
what do you need to minitor daily if start patietn on gentamicin
renal function daily
gram neg coccobacillus
H. influenza
when classed as hospital acquired pneumonia
been in for longer than 48hrs
what bacteria needs chocolate agar as will generally not grow on blood agar
h. influenza
what antibiotic is often given for h. influenza
amoxicillin
what anibiotic is given for atypical pneumonia eg mycoplasma, Coxiella, Chlamydophilia, Legionella
doxycycline
Clarithromycin also works
Levofloxacin if penicilin allergic or Legionella (however c.diff risk as is a fluoquionolone)
fluoroquinolones end in
floxacin
when to not use urinalysis
those over 65 or those with urinary catheters
first line for complicated UTI
amoxicillin and gentamicin
if complicated UTI wg with fever what will not be effective
nitrofurantoin
finding staph epidermidis is only significant if got
prosthetic material
Most e.coli are sensitive to what
co- trimoxazole
what can treat staph epidermidis if got proshetic material
Vancomycin
what bacteria will you make the patient more unwell if you give them IV antiviotics
c. difficile and e.coli
examples of gram NEG COCCI
neisseria meningitidis
clostridium is a gram positive
bacilli
what is the causative organism of Lyme disease
Borrelia burgdorferi
examples of spiral shaped organisms (spiroachaetes)
Borrelia burgdorferi and treponema pallidum
coagulase differentiated from staph aureus and epidermidis. But what differentiates between strep and staph
Catalase
what is catalase positve
staphylococcus
what is catalase negative
strep
examples of alpha haemolytic strep
viridans and pneumonia
what is given for staph aureus if allergic to fluclox or MRSA species
Iv vancomycin
example of beta haemolytic strep
pyogenes
where is strep pyogenes found
skin and soft tissue infection
what organisms cause subacute endocarditis
viridans and enterococci
what are significant pathogens in urinary tract infection
enterococci
streptoccus are commensal in the GI tract eg viridans lives in the — and enterocci lives in the
mouth, bowel
what drug are widely used for streptococcus
penicllins
green discolouration is what haemolysis
alpha
alpha haemolysis can suggest
strep viridans or pneumoniae
beta haemolysis - cplete clearing and what colour
bright yellow
beta organisms -
strep pyogenes
gamma haemolysis organisms
enteroccoi
alpha haemoltic strep in suspected endocarditis are suggestive of viridans or pneumoniae but which one is it
viridans - as much more common cause of endocardiits
dukes criteria
likelihood of endocardiits
classification of streptoccocus using
lancefield antigen
pyogenes infections associated with
pharyngitis or skin infections
bacteria associated with pregnancy and neonates
strep agalactiae
gram positive bacilli includes
listeria, colstridium
common gram pos
strep, staph listeria, clostridium
drug of choice for enterococcus
amoxicillin
vancomycin if allergic
alpha haemolytic
viridans and pneumoniae
clostridium perfringens
soft tissue infection
more difficult for antibiotics to get into what areas as they have tight junctions
CNS, eyes and prostate
sepsis usually requires antibitoics given how
IV
what can measure the minimum inhibitory conc of antibiotics
broth dilution
when is wound swaps only really recommednded
if open wound with significant exudate
strep pyogenes is sensitive to
penicllin
pseudomomas aeruginosa is well known to colonise chronic wounds. How do you manage it
nothing just stick with original treatment
what antibiotic is usually given for a skin infection
flucloxacillin
c. difficle is a
bacilli
rf for c. difficile
gastric acid suppression
what antibiotic are not effective against C. difficile
IV
additional test for c. diff
PCR stool
why cannot use hand gel and got to use soap and water for c.diff
spores are resistant to alcohol gel
bloody diarrhoea top of the differential is
shiga toxin producing e.coli
what is a key concern from shiga toxin producing e.coli
haemolytic uraemic sydnrome
haemolytic uraemic syndrome triad
haemolytic anaemia, thrombocytopenia, aki
diagnosis of shiga toxin producing e.coli
selective culture and shiga toxin testing of stool
management of shiga toxin producing e.coli
supprtive -fluids.
Avoid antibiotics as increased risk of haemolytic uraemic syndrome
ideally how do you want to take blood cultures in endocarditis
3 sets 6 hrs apart
however if sepsis- minimum 2 sets over first hour
if got implantable cardiac electric device usualy organism is
staph especially staph aureus
what staph aureus is most common in ICED infection(cardiac device)
Methycillin sensitive staph aureus ( not resistant)!
in ICED can be staph auerus or epidermidis. epidermidis has Mec gene which is MRSA so what do you give
IV vancomycin first lien
if septic arthritis is confimed what is mandatory
washout
most common pathogens for CAP -comm acquired pneum
step pneum and h. infleunza
curb 65 is what (CAP)
new confusion
urea over 7
resp rate over 30
bp <90/60
age over 65
curb score -0-2
amoxicillin and doxycycline in allergy
what antibiotic for mild curb if penicillin allergic and need IV
clarithromycin
curb65 of 3 or more
Co - amoxiclav plus doxycycline
allergy - levofloxacin
what antibiotic is used in severe disease for gram neg cover
co-amoxiclav
additional investigation if legionella
urinary antigen
what should be offered to all pts with pneumonia
HIV testing
what is done 6 weeks after penumonia
CXR - to ensure resolution and no underlying malignancy is at risk
most common organism for peripheral venous cannula that may have been from surgery
staph aureus
staph aureus bacteraemia mx
48 hourly cultures until negative
Thansthoracic echo in all
Minimum 2 weeks IV fluxclo therapy traditionally recommended. if allergic then Iv vancomycin
when can you assume someone is neutropenic in cases of potential neutropenic sepsis
if had chemo within the past 3 weeks
mx of neutropenic + sepsis and news score is less than 6
Piperacillin/ tazobactam
mx of neutropenic septic SHOCK or news over 7
Piperacillin/tazobactam and gentamicin
why do cf patients need longer duration of treatment
biofilm forms
CMV you get
visual changes
what is raised in pneumocystis jiroveci
LDH
most common aspergillus
A. fumigatus
what lab testing for malaria
blood smears
malaria can occur up to how long post travel
up to 1 year
plasmodium falciparum
malaria
enteric fever can present as
fever and abdo pain - typhoid
dengue has what 3 symptoms
fever, athralgia and leukopenia
mx for dengue is
supportive care
ebola is a
viral haemorrhagic fever
risk of c. diff remains up to how long after an antibiotic course
12 weeks
4 C antibitoics
co - amoxiclav
clindamycin
ciprofloxacin (and other quinolones)
cephalosporins eg ceftriaxone
what should only be used as a last resort
fluoroquinolones
what can identify bacteria in 6hrs
MALDI TOF
gram neg associated with
GI tract
gram pos associated with
skin and mucous membranes
vancomycin side effect
red person syndrome
nitrofurantoin can cause
peripheral neuropathy
what drug is an enzyme inducer
rifampicin
what antibiotic interacts with alcohol
metronidazole
macrolides and quinolones can prolong the
QT interval
side effects common to antibiotics in general
Gi disturbance and skin rash
capillary leakage in sepsis can result in
oedema, diarrhoea and vomiting
sepsis defined by
News score greater than 5 and infection
mottled skin and non blanchign rash can suggest
sepsis
septic shock is when
persisten hypotension despite adequate fluid
sepsis 6 bundle should be given within how long from recognition
1 hr
what oxygen mask for critically unwell eg in sepsis
non re breathe
most common source of sepsis
chest
antibiotics for cellulitus
fluclox and if allergic then doxycycline
what fluids are first line for resuscitation
crystalloids
examples of crystalloids
hartmanns, plasmalyte and sodium chloride
caution regarding what with lots of hartmanns
potassium overload
what can help guide fluid therapy and help guide ICU referral if needed
lactate and Urine output
target output for UO in sepsis
0.5ml/kg/hr
do get the urine output of a patient you need to do what
catheterise the patient
bioavailabilty of the antibiotic refers to
absorption
what is - the fraction of the administered drug that reaches the systemic circulation in the unchanged form
bioavailability
gentamicin is in what class of antibiotics
aminoglycosides
rougly how long does it take for lab results to come back eg how long might they be on empirical antibitiotics
48-72hrs
treating what can give antibiotics in the abscence of a positive culture
cellulitis as the most common causative organisms are strep and staph
what antibiotics are useless in ESBLs
penicillins , cephalosporins, aztreonam
older people often have asymptomatic bacteriuria but it does not indicate
infection
what urine does not mean infection
dark or foul smelling - may just be a sign of dehydration
how long after giving antibiotics for sepsus should you review to see if can stop or switch therapy
48-72hrs
what is the drug of choice for sepsis with coliforms
gentamicin
complicatef UTI in priamry care
co amoxiclav or co-trimoxazole
whereas secondary care - amox and gent then step down to co trimoxzole
examples of anaerobes
clostridium and bacteriodes
antibiotic of choice for sepsis with anaerobes
metronidzole
drug of choice for sepsis and enterococci in GI tract
amoxicillin
neutropenic sepsis mx
piperacillin/ tazobactam
mx for neutropenic sepsis with septic shock
piperacillin/tazobactam and gentamicin
mx of bacterial meningitis
ceftriaxone and dexamethasone
if listeria cover required in bacterial meningitis then
stop dexamethasone and add amoxicillin
what that is not a bacteria will stain methyl purple
candida
vibrio shape looks like what
curved c shape
diplococci grow in
pairs
example of a gram pos diplococci
strep pneumoniae
another example of a gram pos cocci in chians
strep pyogenes
strep pyogenes infection can present as
tonsilitis, scarlet fever
strep pneumoniae and viridans show what haemolysis
alpha
staph epidermidis shows what haemolysis
gamma
strep pyogenes shows what haemolysis
beta
neisseria and h. infleunxa are both gram negative what is slight difference
n- diplococci
h- coccabacilli
example of spirochetes
treponema pallidum and borrelia burgdorferi
bacteria that dont gram stain
myobacteria tuberculosis hence why you need to do ziehl neelson stain
difference between strep penumoniae and strep pyogenes
pyogenes is in chains and pneumoniae is diplococci
gram positive clusters can also be
staph epidermidis
