Sepsis, Tests and Pneumonia Flashcards
what group of organisms that cause endocarditis are particularly difficult to grow in the lab?
HACEK group organisms
usual source of strep viridans pathogen?
GI tract (mouth)
which organism is not typically a cause of endocarditis: Staphylococcus aureus Enterococcus faecalis Viridans group streptococci Escherichia species HACEK group organisms
escherichia species
2 diseases caused by spiral bacteria?
syphilis lyme disease
coliforms are also known as?
gram -ves
antibiotic cover for coliforms?
gentamicin
antibiotic cover for anaerobes?
metronidazole
antibiotic cover for haemophilus influenzae?
amoxicillin
antiobiotic cover for enterococci?
amoxicillin
gram +ve antibiotic cover?
vancomycin
what antibiotic should you be very wary of prescribing for sepsis?
ciprofloxacin (quinolones)
when are cephalosporins mainly prescribed?
meningitis but rarely
when does sepsis become septic shock?
resuscitation attempts have been made and still not responding
need at least 1 acutely dysfunctional organ
“the presence of a microbe in the human body without an inflammatory response” describes what?
colonisation
bacteraemia always signifies infection: T or F?
F, can have bacteraemia without infection
define sepsis
the dysregulated host response to infection
define septic shock
subset of sepsis with circulatory/cellular/metabolic dysfunction associated with a higher risk of mortality
pathophysiology of sepsis?
- infection
- bacteria from infection enters bloodstream
- blood vessels become leaky
- decreased perfusion and ventilation to organs so they become dysfunctional
name the 4 SIRS criteria
RR >20
HR >90
Tem p >38 or <36
WCC >12000 or <4000mm3
if a patient scores highly on all criteria eg SIRS/qSOFA/NEWS do they have sepsis?
only if they have an infection as well
name sepsis 6 and show how to remember them
BUFALO
Blood cultures (+ other cultures eg urine/swabs)
Urine output
Fluids
Antibiotics IV
Lactate (+ FBC and biochem)
Oxygen (target >94%)
what sepsis criteria is mainly used now?
NEWS >5
name the components of qSOFA
RR >22
sBP <100mmHg
Altered GCS (<14)
what is qSOFA a measure of?
mortality in 28 days
how many SIRS criteria do you need to have to have sepsis?
2 SIRS + signs of infection
how can strep viridans cause infective endocarditis?
lives in mouth
travels in blood if dental surgery
sticks to heart valve
what kind ofendocarditis will strep viridans cause?
native valve
what do phagnocytes act against?
bacteria
fungi
what do t cells act against?
viruses
fungi
protozoa
what do antibodies act against?
bacteria
viruses
what do eosinophils act against?
fungi
protozoa
worms
name the only bug that complement will act against
bacteria
what 2 cell types are responsible for acting against worms
eosinophils
mast cells
T cells do not work against bacteria: T or F
T
a coagulase negative staph is likely to be what?
staph epi
why do gram positive organisms stain purple?
the peptidoglycan layer traps crystal violet dye
what organism is typically pathogenic in alcoholics?
strep pneumoniae
what organism is known to be a strict aerobe
pseudomonas
what can gram negative bacilli be divided into
lactose positive or negative aka easy and difficult organisms
most common subtype of haemophilusi influenzae?
B
name the different microbiological cultures that can be done
blood
stool
urine
tissue
wound
microscopy can be done for what kind of samples?
stool
urine
CSF
sputum
all abscesses cannot be treated by antibiotics T or F
F. small abscesses can
normal flora of the mouth?
strep viridans
neiserria
anaerobes
staphylococci
name a sterile area of the gut
stomach
bile duct
where are anaerobic organisms most likely to be in the GI tract?
lower down eg in bowel
name the flora of the colon
coliforms
anaerobes
enterococcus faecalis
describe the structure and gram stain of coliforms
gram negative bacilli
drug of choice for coliforms?
gentamicin
what should be given if a patient is contraindicated for 1st line Tx for coliforms?
give aztreonam
oral switch antibiotic for coliform sepsis?
co-trimoxazole
antibiotic for oral switch in an anaerobe sepsis?
metronidazole still
antibiotic of choice for enterococci and why
amoxicillin as it is active against gram positive organisms
what antibiotic should be given if there is a contraindication for the 1st line antibiotic for enterococcal sepsis
co-trimozazole
what CURB65 score indicates severe CAP
3-5
outline CURB65
new Confusion
Urea >7
RR >30
sBP <90
65+ years old
should you do blood cultures in pneumonia?
only if it’s really severe
what bacteria would indicate a contaminated blood culture and why?
staph epi
corynebacteria
bacillus species
all skin commensals
problem with a sputum culture?
can contain commensal mouth bacteria
how to tell if the right middle lobe is affected by a pneumonia on CXR?
if there is a whiteout next to the heart on the RHS
what bacteria is likely to cause a classic pneumonia presentation?
strep pneumoniae
what does haem flu grow on?
chocolate agar
antibiotic for haem flu
amoxicillin
doxy if pen allergic
what antibiotic is good for atypical pneumonias?
doxycycline
clarithromycin
complication of Q fever?
culture negative endocarditis
how to confirm an atypical pneumonia?
serology
virus detection
what type of pneumonia should prompt you to do a urine antigen test and why?
legionella as urine legionella antigen is prevalent
what serogroup of legionella causes the most disease?
1
as a rule of thumb, when should you send a urine culture?
if a complicated infection is suspected
