signs and symptoms of infection JH

Question 1

what is an infectious disease?

Answer 1

Infection is the invasion of an organism’s body tissues by disease-causing agents, their multiplication, and the reaction of host tissues to the infectious agents and the
toxins they produce

Question 2

what can infectious disease be caused by?

Answer 2

• Virus
• Bacteria
• Fungus
• Parasites

Question 3

what is an infection that is inactive/ dormant called?

Answer 3

latent infection, e.g. latent tuberculosis

Question 4

what are the general signs and symptoms of infection?

Answer 4

• fatigue
• loss of appetite
• weight loss
• fevers
• night sweats
• chills
• aches and pains

Question 5

how do you determine the severity of an infection?

Answer 5

• heart rate
• respiratory rate
• temperature
• blood tests:
  – Full blood count (white cells raised in response to infection)
  – C-reactive protein – none specific marker of
  infection/inflammation
• Other tests based on symptoms eg. urine dipstick, chest X-ray

Question 6

what are the normal ranges for testing for infection?

Answer 6

• Blood pressure - normal 120/80mmHg
• Heart rate - normal 60-100bpm
• Respiratory rate - normal 12-20rpm
• Temperature - normal 37⁰C
  White cell count - normal 4-11x109/L
• C-reactive protein - normal <5mg/L
• Urine dipstick – is it positive for any components?
• Chest X-ray – are there any areas of consolidation?
• Microscopy, culture and sensitivity

Question 7

what are normal CRP levels? when do they rise?

Answer 7

(5-10 mg/L) start to rise within 2 hrs of
inflammatory event, reaching up to 50,000x normal within 48 hrs.

Question 8

what are some advantages of CRP?

Answer 8

CRP levels are high during bacterial infection (40-200 mg/L),
but significantly lower during viral infection (10-40 mg/L; eg. CRP
influenza: 18-32 mg/L; other viruses: 13-25 mg/L; bacteria: 99-173 mg/L
Provides possible test to distinguish bacterial vs viral infections

Question 9

what are some disadvantages of CRP?

Answer 9

not sufficiently reliable for clinical differentiation of viral and bacterial infections because serum CRP ranges overlap, e.g. viral
infection vs early stage (low bacterial cell number) of bacterial infection.
CRP rises in response to inflammation, but may not be infection

Question 10

when do you want to identify the organism that is causing the infection?

Answer 10

• Carried out in more severe infections or when
  needed to determine most appropriate
  treatment
• In less severe infections – treatment is
  empirical ie. chosen based on most likely
  organism/spectrum of antibiotic – normally
  based on guidelines
• In severe infections – empirical treatment
  is often used to give quick initial therapy

Question 11

how do you identify the organism?

Answer 11

Microbial culture
microscopy
PCR- test for genetic material from specific organism eg virus

Question 12

how should you be vigilant for signs of sepsis?

Answer 12

sweaty skin
disorientation
shivering
high HR
extreme pain
SOB

Question 13

who should you have a lower threshold for concern for sepsis?

Answer 13

Infants
Patients who may have communication challenges
Immunocompromised/long term steroids
Indwelling catheters/lines
Recent surgery/injury
And other higher risk patients

Question 14

what is the sepsis 6?

Answer 14

Within the first hour:
* Oxygen
* Cultures
* IV antibiotics
* Fluid resuscitation
* Blood tests including lactate
* Fluid balance monitoring/urine
output

Question 15

what does an elevated lactate indicate?

Answer 15

• Patients with elevated lactate levels are
  seriously ill and require urgent and effective
  management
• Measuring lactate levels provides useful
  information about the progression of the
  condition and the effectiveness of the
  treatment

Question 16

what is lactate?

Answer 16

metabolite of glucose produced by tissues
in the body under conditions of insufficient oxygen supply. Lactate is normally cleared by the liver and the kidneys, and the blood lactate concentration in unstressed patients is 1-1.5 mmol/L

Question 17

in critically ill patients what happens to the lactate?

Answer 17

lactate is often elevated to above 2 mmol/L, with lactate levels above 4 mmol/L indicating the need for immediate resuscitation and ICU admission

Question 18

what are the risk factors for infection?

Answer 18

– Age
– Comorbidities
– Current treatment
– Nutritional status
– Mechanical barriers
– Lifestyle e.g. travel, occupational risk
– Invasive procedures
– Hospitals
– Care setting

Question 19

who would be an example of an immunocompromised patient?

Answer 19

Caused by a number of conditions, including:
– Congenital
– Asplenia
– HIV
* Or as an adverse effect/complication of treatment, including
– Transplantation
– Chemotherapy
– Steroids

Question 20

how should you avoid infection?

Answer 20

• Healthy lifestyle
• Rest, exercise, good nutrition
• Good hand hygiene
• Avoiding large crowds/individuals with infection
• Good mouthcare
• Not sharing towels etc.
• Wear shoes to protect feet
• Avoiding cleaning waste products e.g. animal/baby
• Have appropriate vaccinations

Question 21

how does antibiotic resistance spread?

Answer 21

spreads through populations of bacteria
when new generations inherit antibiotic resistance genes, and/or when bacteria share or exchange sections of genetic material with other bacteria

Question 22

who are most likely to get better without antibiotic treatment?

Answer 22

People with common colds, sore throat, flu, otitis media and other self-limiting conditions may not know that they are likely to get better without treatment and they may expect to
be prescribed an antimicrobial

Question 23

what is the start smart then focus plan?

Answer 23

• Do not start antimicrobial therapy unless there is clear evidence of infection
• Take a thorough drug allergy history
• Initiate prompt effective antibiotic treatment within one hour of diagnosis (or as soon as possible) in patients with severe sepsis or life-threatening infections
• Avoid inappropriate use of broad-spectrum antibiotics
• Comply with local antimicrobial prescribing guidance
• Document clinical indication, drug name, dose and route on drug chart and in clinical notes
• Include review/stop date or duration
• Obtain cultures prior to commencing therapy where possible (but do not delay therapy)
  Then focus…..
  This means:
• Reviewing the clinical diagnosis and the continuing need for antibiotics at 48-72 hours and documenting a clear plan of action

Question 24

what are the 5 antimicrobial prescribing decisions?

Answer 24

1. Stop antibiotics if there is no evidence of
   infection
2. Switch antibiotics from intravenous to oral
3. Change antibiotics – ideally to a narrower
   spectrum – or broader if required
4. Continue and document next review date or
   stop date
5. Outpatient Parenteral Antibiotic Therapy
   (OPAT)

Question 25

what are the 5 things you should do about infection in primarycare/ community?

Answer 25

1. Give self care or safety netting advice
2. Use clinical scoring tools where
   appropriate e.g. FeverPain
3. Promote vaccinations
4. Clinical check of antibiotic prescriptions
   against guidance
5. Give adherence advice
6. Reinforce good hand hygiene