Bacteria Involved In Surgical Infection

Front 1

Names of BACTERIA

Back 1

01. Staphylococci
02. Clostridia
03. Aerobic Gram-negative bacilli
04. Bacteroide
05. Streptococci

Front 2

Most imp sterptococcus

Back 2

The most important is the β-haemolytic
Streptococcus, which resides in the pharynx of 5–10 per cent of
the population

Front 3

Most pathogenic

Back 3

In the Lancefield A–G carbohydrate antigens
classification, it is the group A Streptococcus, also called
Streptococcus pyogenes, that is the most pathogenic

Front 4

Why strep pyogens most pathogenic?

Back 4

t has the
ability to spread, causing cellulitis, and to cause tissue destruction through the release of enzymes such as streptolysin, streptokinase and streptodornase

Front 5

Streptococcus faecalisis Classification

Back 5

Streptococcus faecalisis an enterococcus in Lancefield group
D

Front 6

Synergy of Strep fecalis with other organisms

Back 6

It is often found in synergy with other organisms, as is the
g-haemolytic Streptococcus and Peptostreptococcus, which is an
anaerobe

Front 7

Imp of strep pyogens and strep fecalis in surgery

Back 7

Both Streptococcus pyogenes and Streptococcus faecalis may be
involved in wound infection after large bowel surgery

Front 8

a-haemolytic Streptococcus viridans imp in surgery

Back 8

a-haemolytic Streptococcus viridans is not associated with wound infections

Front 9

Medicine to be used

Back 9

All the streptococci remain sensitive to
01. penicillin and
02. erythromycin

Front 10

When are cephalosporins used?

Back 10

The cephalosporins are a suitable alternative in
patients who are allergic to penicillin.

Front 11

Staphylococci properties

Back 11

Staphylococci form clumps and are Gram positive

Front 12

Imp streptococci in surgery

Back 12

Streptococcus pyogenes
Streptococcus faecalis
Streptococcus viridans

Front 13

Imp Staphylococci in Surgery

Back 13

Staphylococcus aureusi
Staphylococcus epidermidis(previously Staphylococcus albus),
also known as coagulase-negative staphylococci (CNS

Front 14

Most imo Staphylococcus

Back 14

Staphylococcus aureusis the most important pathogen in this
group

Front 15

Normal occurence

Back 15

and is found in the nasopharynx of up to 15 per cent of
the population

Front 16

What it can cause in wounds

Back 16

It can cause exogenous suppuration in wounds
(and implanted prostheses)

Front 17

Strain Resistant to ab

Back 17

Strains resistant to antibiotics (e.g.
MRSA) can cause epidemics and more severe infection.

Front 18

What should be done in hospital?

Back 18

It is
controversial but, if MRSA infection is found in a hospital, all
doctors, nurses and patients may need to be swabbed so that carriers can be identified and treated

Front 19

How kept low in Europe?

Back 19

In parts of northern Europe,
the prevalence of MRSA infections has been kept at very low levels using ‘search and destroy’ methods, which use these screening techniques and the isolation or treatment of carriers.

Front 20

Patient Access

Back 20

Patients found to be positive on screening may be denied access to hospital

Front 21

MRSA Resistence

Back 21

Some MRSAstrains are now also resistant to vancomycin

Front 22

Local Policies dependence on mam=ngmt

Back 22

Local policies on the management of MRSAdepend
on the prevalence of MRSA, the type of hospital or clinical
specialty and the availability of facilities

Front 23

Necessary Optionns

Back 23

Widespread swabbing,
ward closures, isolation of patients and disinfection of wards all
have to be carefully considered and involve all groups of practitioners. They may be expensive but necessary options.

Front 24

Infection types by staph aureus

Back 24

Infections are usually suppurative and localised (see above
under Abscess)

Front 25

AB used?

Back 25

Most hospital Staphylococcus aureusstrains are
now β-lactamase producers and are resistant to penicillin

Front 26

MRSA Treatment

Back 26

but
most strains (MRSA) remain sensitive to flucloxacillin, vancomycin, aminoglycosides, some cephalosporins and fusidic acid
(used in osteomyelitis)

Front 27

Available Ab

Back 27

There are several novel and innovative
antibiotics becoming available that have high activity against
resistant strains

Front 28

Good oral activity

Back 28

Some have the advantage of good oral activity
(linezolid

Front 29

Wide Spectrum

Back 29

, some have a wide spectrum (tigecycline

Front 30

Have good act in bacteremia

Back 30

have good
activity in bacteraemia (daptomycin

Front 31

Side effects

Back 31

And some have side effects involving marrow, hepatic and
renal toxicity

Front 32

Can they be used?

Back 32

Their use is justified but needs to be controlled by
tight local policies and guidelines that involve clinical microbiologists

Front 33

Staphylococcus epidermidis Other names

Back 33

Staphylococcus epidermidis(previously Staphylococcus albus),
also known as coagulase-negative staphylococci (CNS

Front 34

Imp in surgery

Back 34

was
regarded as a commensal but is now recognised as a major
threat in prosthetic (vascular and orthopaedic) surgery and in
indwelling vascular catheters

Front 35

Resistence

Back 35

They can be multiply resistant
(MRCNS) to many antibiotics and represent an important
cause of HAI

Front 36

What are clostridial organisms?

Back 36

Clostridial organisms are Gram-positive, obligate anaerobes,
which produce resistant spores

Front 37

Clostridium SP

Back 37

C. perfringens
C. tetani
C. difficile

Front 38

C. perfringens is cause?

Back 38

C. perfringens is
the cause of gas gangrene

Front 39

C. Tetani?

Back 39

C. tetani causes tetanus after
implantation into tissues or a wound

Front 40

C. Difficile

Back 40

C. difficile is the cause of pseudomembranous colitis

Front 41

Onset of Pseudomemb Colitis

Back 41

This is
another HAI, now more common than the incidence of MRSA
bacteraemia, which is caused by the overuse of antibiotics

Front 42

Causative drug to PC

Back 42

The quinolones, such as ciprofloxacin, seem to be most implicated, but the inappropriate sequential use of several antibiotics puts
patients most at risk,

Front 43

Population Affected?

Back 43

particularly in elderly or immunocompromised patients

Front 44

Symptom

Back 44

The key symptom of bloody diarrhoea can
occur in small epidemics through poor hygiene

Front 45

Prognosis

Back 45

In its most
severe form, colitis may lead to perforation and the need
for emergency colectomy, with an associated high mortality

Front 46

Treatmnt C. difficile

Back 46

Treatment involves resuscitation and antibiotic therapy with
metronidazole or vancomycin

Front 47

Investigations

Back 47

01. The fibrinous exudate is typical
and differentiates the colitis from other inflammatory diseases;
02. the laboratory recognition of the toxin is an early accurate
diagnostic test

Front 48

Aerobic Gram-negative bacilli

Back 48

These bacilli are normal inhabitants of the large bowel

Front 49

Anaerobic gm negative bacilli

Back 49

01. E. coli
02. Klebsiella;
03. Proteus.

Front 50

Ecoli Klebsilla Lactose fermentation

Back 50

E. coli
and Klebsiellaspp. are lactose fermenting

Front 51

Proteus lactose fermentation

Back 51

Proteusis non-lactose
fermenting

Front 52

Imp in Surgery

Back 52

Most organisms in this group act in synergy with
Bacteroides to cause SSIs after bowel operations (in particular,
appendicitis, diverticulitis and peritonitis).

Front 53

E coli imp

Back 53

E. coli is a major
cause of the HAI of urinary tract infection

Front 54

UTIs other org

Back 54

although most aerobic Gram-negative bacilli (AGNB) may be involved

Front 55

Procedure?

Back 55

particularly in relation to urinary catheterisation

Front 56

ESBL development Extended spectrum B lactamase

Back 56

There is increasing
concern about the development of ESBLs in many of this group of bacteria

Front 57

Resistence

Back 57

which confer resistance to many antibiotics, particularly cephalosporins

Front 58

Pseudomonas imp in surgical procedures

Back 58

Pseudomonas spp. tend to colonise burns and tracheostomy
wounds, as well as the urinary tract.

Front 59

Eradication in hospital easy?

Back 59

Once Pseudomonashas colonised wards and intensive care units, it may be difficult to eradicate.

Front 60

What should be done in outbreaks?

Back 60

Surveillance of cross-infection is important in outbreaks.

Front 61

Resistence?

Back 61

Hospital strains become resistant to β-lactamase as resistance
can be transferred by plasmids

Front 62

When Ab therapy to be given?

Back 62

Wound infections need antibiotic therapy only when there is progressive or spreading infection with systemic signs.

Front 63

Ab to be used

Back 63

01. The aminoglycosides are effective, but
some cephalosporins and penicillin may not be.
02. Carbazepam

Front 64

Carbazepams

Back 64

Many of the
carbapenems (e.g. meropenem) are useful in severe infections,

Front 65

Quinolones

Back 65

whereas the quinolones have been made ineffective through
their overuse and the development of ESBLs.

Front 66

Ab not to be used

Back 66

Cephalosporins
Penicillins
Quinolones

Front 67

Bacteroides?

Back 67

Bacteroides
Bacteroidesare non-spore-bearing, strict anaerobes that colonise the large bowel, vagina and oropharynx.

Front 68

Imp in sugery

Back 68

Bacteroides fragilisis
the principal organism that acts in synergy with AGNB to
cause SSIs, including intra-abdominal abscesses, after colorectal or gynaecological surgery.

Front 69

Ab to used

Back 69

They are sensitive to the
imidazoles (e.g. metronidazole) and some cephalosporins (e.g.
cefotaxime).