Week 12 Nosocomial Infections & Antimicrobial Resistance Flashcards
1
Q
Nosocomial Infections
A
- Infection occurring in a patient during process of care in healthcare facility
- No present/incubating at time of admission
- Generally develop 48-72h after admission
2
Q
Pathophysiologic Factors
A
- Decreased host defence
- Colonization by pathogenic bacteria/viruses
- Both must be present to some degree for infection to result
3
Q
Bacterial Colonization
A
- Strongly associated with hospital stays
- Frequent impaired host defences
- Presence of invasive decides
- Admin of long-term/repeated courses of antibiotics
4
Q
Impact
A
- Increased morbidity & mortality
- Associated with drug-resistant microorganisms
- Prolong hospital stays
- Additional costs
- Death
5
Q
Causes
A
- Bacteria, fungi, viruses entering the body
- Exogenous colonization - cross-transmission
- Direct contact - hands, contaminated equipment, infusions
6
Q
Predisposing Factors
A
- Increased risk of colonization
- Decreased host defence
7
Q
Underlying Health Impairment
A
- Chronic lung disease
- Immune status
- Age
- Poor nutrition
- Chronic debilitation
8
Q
Common Infections
A
- UTI (catheters)
- Pneumonia
- Surgical wound
- Skin
9
Q
Causative Organisms
A
- E.coli - UTIs
- Staphylococcus aureus & streptococcus - respiratory
- Norovirus & c. diff - V/D
- Hep B, C, HIV - blood
10
Q
C. Diff
A
- Can be commensal bacterium of normal microbiota
- Microbiota overgrowth - long-term antibiotic use
- Endospores - long term survival
- Produce toxins A&B
11
Q
C. Diff Toxins
A
- Inactivate small GTP-binding proteins
- Actin condensation & cell rounding - cell death
12
Q
C Diff Infectious Process
A
- Focal necrosis
- Ulceration with exudate
- Can progress to pseudomembranous colitis - inflammation of colon
- Contains death epithelial cells & leukocytes
13
Q
C. Diff Risk Populations
A
- Immunocompromised
- Extended stay in healthcare settings
- Older
- Recently taken antibiotics
- Recent GI procedures
- Use proton pump inhibitors (reduce stomach acid)
14
Q
C. Diff Treatment
A
- Stop antibiotic use & provide supportive therapies
- Metronidazole preferred antibiotic
- Vancomycin - when metronidazole ineffective/under age of 10/pregnant
- No cohorting as per hospital policy
15
Q
Antibiotic Use
A
- Antibiotics use only for bacterial infections
- Not effective for viral/fungal infections
- Antiviral meds for viruses (flu)
- Antifungals for fungus
16
Q
Med Interactions
A
- Macrolide antibiotics can interact with statins (cholesterol)
- Rifampin (oral contraceptive effectiveness)
- Metronidazole (alcohol)
17
Q
Bacteriostatic
A
- Inhibits bacteria from reproducing
- Does not kill bacteria
18
Q
Bactericidal
A
Actively kills bacteria
19
Q
Antibiotic Mechanisms of Action
A
- Inhibit cell wall synthesis/function
- Inhibit nucleic acid synthesis/function
- Inhibit protein synthesis
20
Q
Antibiotic Classes
A
- Aminoglycosides
- Cephalosporines
- Tetracyclines
- Penicillins
- Sulfonamides
- Fluoroquinolones
- Macrolides
- Carbapenems
- Lincosamides
- Glycopeptides
21
Q
Culture & Sensitivity
A
- Identifies bacteria causing infection - culture
- Identifies antibiotic that will treat infection - sensitivity
22
Q
Antibiotic Biograms
A
Summarizes susceptibility of bacterial isolates to different antibiotics
23
Q
Antimicrobial Resistance
A
- Microbes develop ability to resist drug effects
- More difficult to treat infections
24
Q
Common Resistant Bacterias
A
- MRSA
- VISA
- VRE
- Streptococcus pneumoniae
- Enterobacter ESBL
- Acinetobacter
- Pseudomonas aeruginosa
- MDR-TB
25
Risk Factors for Infection with Drug-Resistant Bacteria
- Antimicrobial therapy preceding 90 days
- Current hospitalization for 5+ days
- High frequency of antibiotic resistance in community/unit
- Immunosuppression
26
Antimicrobial Stewardship
- Judicious use of antimicrobials
- Limit development of antimicrobial resistant organisms
- Selection, dosing, duration, route of admin
27
MRSA
- Resistant to many commonly used antibiotics
- Spreads easily
- Skin infections, pneumonia, blood stream infections
28
MRSA Testing
- Sterile sample from nose & perianal area
- PCR used for quicker results
- Routinely screened in all admitted patients
29
VRE
- Developed vancomycin resistance
- Easily spread in healthcare environments
30
VRE Testing
- Collecting samples from where enterococci commonly found - rectum/stool
- Identify strains of enterococci & testing resistance to vancomycin
- PCR for rapid testing
31
C. Diff Testing
- Stool culture - presence of toxins
- ELISA or PCR testing
- Guide in choosing effective treatment
32
Hospital Acquired Infections (HAIs)
- Serious health complications
- Prolonged hospital stays
- Increased healthcare costs
- HAND HYGIENE
