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General Practice YR3 > University day - infection (01/03) > Flashcards

University day - infection (01/03) Flashcards

1
Q

How to choose an antibiotic?

A
  • Active against organism?
  • Reach the site of infection? - BBB, skin, bone
  • Formulation - IV vs oral - difficult swallowing etc?
  • Half life - determines dosing freq
  • Interact with other drugs?
  • Toxicity issues?
  • Monitoring?
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2
Q

When to think sepsis?

A
  • High NEWS score
  • = high risk deterioration
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3
Q

Stratified score for pneumonia

A

CURB 65
* Confusion
* Urea >7mmol/L
* RR 30 or more
* BP <90 S or <60 diastolic
* Age 65 or more

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4
Q

Investigations for pneumonia

A
  • Bloods - FBC, U&Es, clotting, CRP
  • Sputum sample for culture
  • Blood culture
  • Urine sample - legionella and pneumococcal antigen
  • Throat swab for respiratory virus PCR - in viral transport medium
  • Consider atypical investigations - cannot usually culture with sputum
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5
Q

HAP vs CAP

A
  • CAP - acute infection of lung tissue with onset outside of healthcare setting or within 48hrs of admission
  • HAP - onset after 48hrs of admission
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6
Q

Other types of pneumonia

A
  • VAP - pneumonia devloping >48hrs after intubation and mechanical ventilation (get microaspirations, more gram -ve, and like plastic pseudomonas aeruginosa often)
  • Aspiration pneumonia - aspiration of oral and gastric contents into lungs, secondary pneumonia may develop (chemical pneumonitis usually main cause of damage, abx do not always work)
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7
Q

Signs/symptoms of pneumonia

A
  • Cough
  • SOB
  • Pleuritic chest pain
  • Purulent sputum
  • Bronchial breathing
  • Fevers
  • Myalgia
  • Rigors
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8
Q

Likely causative organisms for pneumonia

A
  • Streptococcus pneumonia
  • Haemophilus influenzae
  • Staphylococcus aureus
  • Mycoplasma pneumoniae
  • Legionella pneumophila
  • Chlamydophila pneumoniae
  • Moraxella catterhalis
  • Klebsiella pneumonia - alcohol dependency

Bold = atypical

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9
Q

Treatment for pneumonia

A
  • Amoxicillin - enterally or IV if cannot take orally
  • 2nd line - Doxycycline
  • 3rd line - Clarithromycin
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10
Q

Preventing pneumonia

A
  • Pneumococcal vaccine - some protection against streptococcal pneumoniae (but only some serogroups)
  • Dose given at 12 weeks, 1yr and over 65
  • Prevents pneumococcal sepsis and meningitis too

Other:
* Viral infections can predispose to secondary bacterial infection
* Influenza and COVID vaccine is protective

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11
Q

Features of IECOPD

A
  • Increased SOB
  • Increased sputum purulence
  • Increase amount of sputum
  • Colour change sputum
  • CXR does not show consolidation - this would be pneumonia
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12
Q

IECOPD pathogens

A
  • Virus eg RSV, rhinovirus
  • Bacterial - same as other causes
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13
Q

Treatment IECOPD

A
  • Do not always need abx
  • We usually give amoxicillin if needed
  • If resistance - Co-amoxiclav
  • 2nd line - Doxycycline
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14
Q

Features to check for UTI

A
  • Symptoms suggesting upper UTI
  • Check for sexual infection symptoms
  • Check for FH PCKD/any other urinary tract disease
  • Any chance pregnancy?
  • Any OTC tried?
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15
Q

Common pathogens causing UTI

A
  • Escherichia coli
  • Klebsiella pneumoniae
  • Enterococcus faecalis
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16
Q

Urine dip interpretattion

A
  • Positive for nitrites, leukocytes and blood - UTI likely
  • If nitrite and leukocyte positive - send culture
  • If negative for all - do not send culture
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17
Q

When to send culture?

A
  • Pregnant
  • Older 65
  • Symptoms perisstent or do not resolve with abx
  • Recurrent UTI (2 within 6 months or 3 in 12)
  • Catheter
  • RF for resistance/atypical symptoms
18
Q

Sample collection for culture

A
  • MSU
  • Clean area
  • Pass first bit
  • Hold urine in
  • Then catch mid stream
  • Collect in boric acid containing tube - prevents overgrowth, in unavailable, put in fridge
  • Catheterised - collect from sampling port and not collection bag (has been sat for a long time)
19
Q

Problem with ciprofloxacin

A
  • Floroquinolone = MRHA warning
  • High risk of toxicity and side effects
  • Choose another sensitive abx
20
Q

How long to treat UTI for?

A
  • Non pregnant women - 3 days
  • Men or women with urological abnormalities, pregnancy, diabetes, immunosupression or catheter long term - 7 days
  • Pyeonephritis - 10 days if ising beta lactams, 7 days for fluroquinolones
21
Q

Abx used for UTI

A
  • Trimethoprim
  • Nitrofurantoin
  • Fosfomycin
  • Co-amoxiclav - if pyelo
22
Q

Most likely pahogens cellulitis

A
  • Staphylococcus aureus
  • Streptococcus pyogenes (Group A)
  • Group C and G streptococcus (Streptococcus dysgalactiae)

All gram +ve skin commensals

23
Q

Staphylococcus epidermidis and cellulutis?

A
  • If central venous catheters, portocath etc then often occurs
  • Very slow growthing
  • Can cause bacteraemia
  • But not often cause of cellulitis
  • Is usually cause of IE in prosthetic valve - at point of implantation
  • Causes several weeks later, low virulance (but within 2 months)
  • Also joint replacement
24
Q

Causative organism for catheter infection

A

Pseudomonas

25
Q

Group patient at risk of cellulitis

A
  • Any breakage of skin so eg scrape injury
  • Severe eczema
  • Iatrogenic eg cannula
26
Q

Preventing cellulitis

A
  • Check sites daily
  • Non-touch aseptic technique
  • Maintain skin integrity eg in eczema
27
Q

Treatment for cellulitis

A
  • Flucloxacillin oral if localised and systemically well
  • 2nd line - Doxycycline
  • IV fluclox if unwell/spread (vancomycin IV if allergic)
28
Q

Investigations for meningococcal sepsis

A
  • Bloods
  • Blood culture
  • Assess for increased ICP
  • As long as no signs, lumbar puncture
29
Q

CSF interpretation

A
  • Bacterial - cloudy, elevated WBC, primarily polymorphic neutrophils, elevated protein, low glucose, elevated opening pressure
  • Viral - clear, elevated WBC (less than bacterial), primarily lymphocytes, elevated protein (less than bacterial), normal glucose (>60% serum), normal or elevated opening pressure

NEED serum glucose to be done at same time
Also do microscopy, gram stain and culture and PCR (only if needed for PCR)

30
Q

Causes of meningitis

A
  • Neisseria meningitidis
  • Streptococcus pneuminiae
  • Listeria monocytogenes - older or immunocompromised adults (also pregnant)
  • Streptococcus pyogenes
  • TB
  • E-coli - esp infants
31
Q

Treatment meningitis

A
  • Ceftriaxone (meropenem if allergic penicillin)
  • IV dexamethasone before abx or within first 12 hours of first abx dose (for strep pneumoniae), stop if not pneumococcas

Age 60 years and older
* Cefrtiazone and Amoxicillin (for listeria)
* Meropenem if allergic
* IV dexamethasone (same again), stop if not pneumococcas

32
Q

Meningitis notifiable?

A

YES
* Household contacts may need prophylaxis

33
Q

Preventing meningitis

A
  • Pneumoccal vaccine
  • Men ACWY vaccine
34
Q

Management of pneumoperitoneum

A
  • Surgery - laparotomy for source control, washout needed
  • Need abx for any residual infection as peritoneal caviry usually sterile
  • Supportive care - IV fluids, ITU?
35
Q

Likely organisms of peritonitis

A
  • Enterobacterales
  • Streptococci
  • Anaerobes
  • Enterococci

Need broad spectrum as gram -ve and +ve

36
Q

Abx for perforated bowel

A
  • Co-amoxiclav
  • Ciprofloxacin/cefuroxime/ceftazidime + Metronidazole
  • Tazocin
  • Meropenem
37
Q

Infection in surgery cause

A

From own patient or due to external infection

38
Q

Timing for surgical site infections

A
  • Up to 30 days
  • Extends up to 1 year if prosthesis is inserted
39
Q

Surgical wound classification

A

CHECK THIS

40
Q

Pre op infection prevention

A
  • Shower patients
  • Nasal decolonisation
  • Hair removal not recommended - clippers not razors
  • Scrubs for theatre
  • Removal of nails/jewellery
  • Abx prophylaxis for some procedures
41
Q
A

General Practice YR3 (31 decks)

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