W6- Lecture 28- Hospital acquired infections

Question 1

have you done the two activity workbooks

Answer 1

yes-well done

no- please complete them

Question 2

define nosocomial

Answer 2

The medical term for a hospital-acquired infection
Anosocomialinfection is strictly and specifically an infection “not present or incubating prior to admittance to the hospital, but generally occurring 48 hours after admittance.
aka healthcare associated infections

Question 3

what are the three largest healthcare-associated infections

Answer 3

Respiratory infections (including pneumonia and infections of the lower respiratory tract) (22.8%)
Urinary tract infections (17.2%)
Surgical site infections (15.7%)

Question 4

what are the Risk factors for a nosocomial infection

Answer 4

Duration of hospital stay
Indwelling catheters
Mechanical ventilation
Use of total parenteral nutrition
Antibiotic usage
Use of histamine (H2) receptor blockers (owing to relative bacterial overgrowth)
Age—more common in neonates, infants, and the elderly
Immune deficiency

Question 5

define Hospital Acquired Pneumonia (HAP)

Answer 5

Hospital-acquired pneumonia(HAP) ornosocomial pneumoniarefers to anypneumoniacontracted by a patient in ahospitalat least 48–72 hours after being admitted.

Question 6

what are the Common bacteria involved in hospital-acquired pneumonia (HAP)

Answer 6

Pseudomonas aeruginosa
Staphylococcus aureus, including methicillin-susceptible S aureus (MSSA) and methicillin-resistant S aureus (MRSA)
Klebsiella pneumoniae
Escherichia coli
Non-Enterobacteriaceae bacteria such as Serracia marcescens, Stenotrophomonas maltophilia, and Acinetobacter species are less common causes

Question 7

what is a Urinary Tract Infection (UTI)

any associations with catheter ?

Answer 7

A urinary tract infection (UTI) is an infection involving any part of the urinary system, including urethra, bladder, ureters, and kidney

75% of hospital acquired UTI are associated with a catheter

Question 8

what are the Common bacteria involved in hospital-acquired UTI’s

Answer 8

Enteric pathogens (eg,Escherichia coli) are most commonly responsible but also:
Pseudomonasspecies
Enterococcusspecies
Staphylococcus aureus
Coagulase-negative staphylococci
Enterobacterspecies, and yeast also are known to cause infection.
ProteusandPseudomonasspecies are the organisms most commonly associated with biofilm growth on catheters.
Candida, especiallyCandida albicans, is the second-most-common organism that can cause catheter-associated urinary tract infection.

Question 9

what is sepsis

Answer 9

when the body’s response to infection injuresits own tissues and organs. organs to begin to fail
Sepsis can be triggered by any infection, but mostcommonly occurs in response to bacterial infections ofthe lungs, urinary tract, abdominal organs or skin andsoft tissues

Question 10

what other conditions is sepsis normally associated with ?

Answer 10

GI tract – Liver disease, gallbladder disease, colon disease, abscess, intestinal obstruction, and GI instrumentation
GU tract – Pyelonephritis, intra- or perinephric abscess, renal calculi, urinary tract obstruction, acute prostatitis or abscess, renal insufficiency, and GU instrumentation
Pelvis – Peritonitis and pelvic abscess
Lower respiratory tract – Community-acquired pneumonia (with asplenia), empyema, and lung abscess
Vascular system – Infected IV line or prosthetic device
Heart and cardiac vasculature – Acute bacterial endocarditis and myocardial or perivalvular ring abscess

Question 11

what is the Pathophysiology of sepsis

Answer 11

Infection
Excessive cytokine release
Amplification -> capillary dilatation&↑permeability
-> oedema of tissues
Hypotension -> tachycardia
-> reduced urine output
-> reduced cardiac output
-> multi organ failure
Anaerobic respiration-> increase blood lactate
Death or significant morbidity

Question 12

what is the Management of sepsis( The sepsis six)

Answer 12

1. Administer oxygen to maintain Oxygen saturation (SpO2)>94%​
2. Take blood cultures and consider infectivesource​
3. Administer intravenous antibiotics​
4. Considerintravenousfluidresuscitation​
5. Check serial lactates​
6. Commence hourly urine outputmeasurement​

Question 13

what is Meticillin-resistant Staphylococcus aureus (MRSA)

Answer 13

Meticillin-resistant Staphylococcus aureus (MRSA) is a gram-positive bacterium that is genetically different from other strains of Staphylococcus aureus
MRSA is now resistant to all forms of penicillin and cephalosporin

Question 14

which antibiotics do we use to treat MRSA

Answer 14

Vancomycin*
Teicoplanin
Doxycycline
Rifampicin	
Clindamycin
Trimethoprim
Gentamicin
Linezolid
Daptomycin

Question 15

what is Clostridium difficile (C.Diff)

Answer 15

Spore-forming anaerobic Gram positive bacillus bacterium
Spores facilitate the organism’s survival in conditions of adversity (resistant to heat, drying, stomach acids, alcohol and some chemicals)
Produces exotoxins A and B
Toxins cause inflammation of the intestinal wall resulting in spectrum of disease:
Antibiotic associated diarrhoea (AAD)
Antibiotic associated colitis (AAC)
Pseudomembranous colitis (PMC)
Fulminant colitis

Question 16

Risk factors for infection of Clostridium difficile (C.Diff)

Answer 16

Any antibiotic can induce Clostridium difficile associated diarrhoea (CDAD)
Antibiotics alter normal gut flora allowing C. difficile to flourish and produce toxins
CDAD can occur up to 2 months after exposure to antibiotics

Question 17

which antibiotics are low risk for causing Clostridium difficile associated diarrhoea risk

Answer 17

Low risk(narrow spectrum antibiotics)
Trimethoprim
Nitrofurantoin
Metronidazole
Gentamicin 

Intermediate
Penicillins
Co-amoxiclav
Macrolides 
Tetracyclines
Pipericillin/tazobactam
Glycopeptides
Meropenem

High risk
Cefalosporins
Ciprofloxacin
Clindamycin

IV
Multiple courses
Prolonged
Combinations

Question 18

risk factors for CDI (aside from AntiBiotics )

Answer 18

≥65 years
Previous C.difficile infection
Recent hospitalisation (exposure to environmental spores / close contact with infected others )
Previous antibiotic exposure
Extensive / severe co-morbidity
Immunocompromised (malignancy, HIV, chemotherapy, etc.)
Long term prescription of proton-pump inhibitors (PPIs) eg omeprazole

Question 19

what is the Treatment for CDI (c.diff infection)

Answer 19

Asymptomatic carriers require no treatment
Symptomatic patients:
15 – 25% respond to conservative treatment
If possible STOP antibiotics - allows re-establishment of normal colonic micro flora and reduces risk of relapse
Supportive therapy (observe for sepsis, rehydrate, toileting, etc.)
Dietician referral – aim for balanced, nutritional oral intake with good fibre content

Question 20

what is Glycopeptide Resistant Enterococci (GRE)

Answer 20

Enterococcus species frequently found in bowel of normal, healthy individuals
Only a few species have potential to cause infections in humans
May cause a range of illnesses including:
Urinary tract infections,
Bacteraemia
Wound infections
Glycopeptide antibiotics include Vancomycin and Teicoplanin
2 most common species ofGREare E. faecalis and E. faecium

Question 21

risk factors for Glycopeptide Resistant Enterococci (GRE)infection

Answer 21

GREoccur mainly in hospital patients, such as those:
Who are immunocompromised
Having had previous treatment with other antibiotics (particularly cephalosporins and glycopeptides)
On prolonged hospital stay
In specialist critical units

Question 22

what are the Vancomycin Resistant Enterococci treatment options

different for the 2 different species

Answer 22

Enterococcus faecalis – amoxicillin

Enterococcus faecium – resistant to amoxicillin
Other options:
Linezolid
Daptomycin

Question 23

what are Extended-spectrum beta-lactamases (ESBLs)

Answer 23

Extended-Spectrum Beta-Lactamases (ESBLs) are enzymes that can be produced by bacteria making them resistant to cefalosporins.
widely detected among Escherichia coli ( E. coli) bacteria
These ESBL-producing E. coli are resistant to penicillins and cephalosporins and are found most often in urinary tract infections (UTI’s)

Question 24

what are Extended-spectrum beta-lactamases (ESBLs)

1) resistance to
2) susceptible to ?

Answer 24

1)Usually confer resistance to:
First-, second- and third-generation cephalosporins(e.g. cefalexin, cefuroxime, ceftriaxone)
Amoxicillin and co-amoxiclav and aztreonam
Plasmids also contain resistance genes to:
Ciprofloxacin
Trimethoprim

2)Usually confer resistance to:
First-, second- and third-generation cephalosporins(e.g. cefalexin, cefuroxime, ceftriaxone)
Amoxicillin and co-amoxiclav and aztreonam
Plasmids also contain resistance genes to:
Ciprofloxacin
Trimethoprim

Question 25

what are theTreatment options for ESBLs & AmpC

Answer 25

Aminoglycoside
Carbapenem
Ciprofloxacin
Trimethoprim
Nitrofurantoin
Tigecycline
Temocillin

Question 26

So, what can we do to reduce hospital acquired infections?!

Answer 26

Antimicrobial Stewardship (AMS)
Launchedin 2011and updated in2015
1)Hospitals”Start smart: then focus”for antibioticprescribing
2)antibioticsurgical prophylaxis
its a framework for clinical review and procedures to help limit these infections
e.g type of antibiotics , duration , is a catheter used , and keep reviewing decision