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34 Cards in this Set
- Front
- Back
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Kleb microbiology |
Gram negative aerobic bacilli (GNR) Enterobacteriacae family Mucoid colonies with polysaccharide capsule (virulence factor that inhibits phagocytosis)
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Kleb pathogens |
Pneumonia, oxytoca, rhinoscleromatis, granulomatis |
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Kleb culture medium |
MacConkeys agar (contaminated specimens) non-selective media (sterile specimens) |
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Most Kleb produce beta-lactamses: |
Constituitive (usually made at low levels) Resistance against: ampicillin, amoxicillin |
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ESBLs Kleb |
Plasmid-mediated MDR (TEM or SHV types) Detected by in vitro resistance to ceftazidime and aztreonam |
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Kleb Pneumo carbapenamases (KPCs) |
Broadest resistance Detected via modified Hodge test: test for inactivation of carbapenems |
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Clinical diseases |
PNA and UTI in immunocompetent hosts
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PNA Kleb |
K. pneumonia: Friedlander's disease Alcoholic or diabetic patients Currant jelly sputum abscess/cavity Bowed fissue sign on CXR |
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Nosocomail Kleb infections |
PNA, sepsis, intra-abdominal (biliary tract and peritonitis), meningitis, surgical wound infection |
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Risk factors for ESBL and KPC |
Recent hosp. Residence in LTC Recent ABX use Immunocompromised Invasive devices |
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Treatment for KPC |
colitisin or tigecycline |
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Proteus microbiology |
Aerobic gram negative bacilli (GNR) Urease-splitting rod Swarms on moist agar (many flagella) Enterobacteria family |
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Proteus pathogens |
P. mirabilis (indole negative): 90% infections P. vulgaris/penneri (indole positive) Mirabilis resistant to tetracycline/tigecycline |
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Clinical proteus infections |
10% uncomplicated UTIs Wounds, bactermia, nosocomial PNA struvite stone formation: splits urea raising urinary pH to >8: nidus for chronic renal infection/obstruction |
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Proteus inherently resistant to |
nitrofurantoin tetracycline 10-20% resistant to ampicillin and 1st cephalosporins |
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Sites of proteus infection |
GU: UTI/pyelo Abdomen: intra-ab infection SKin: burn, SSI Other: nosocomial PNA, bacteremia, line sepsis, prosthetics, rare endocarditis |
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Most nosomical proteus infections are due to |
indole positive strains not mirabilis |
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Consider evaluation for struvite stones if |
alkaline urine is detected! |
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Ecoli microbiology |
Gram negative rod Enterobaceteria family 90% are lactose fermenters EIEC strains typically lactose negative 99% indole positive Human strains are 1. Commensal bowel flora 2. Intestinal pathogenic (enteric/diarrheic) 3. Extra-intestinal pathogenic |
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When to culture stool for E coli |
Only if chronic diarrhea or if O157:H7 is suspected (culture all bloody diarrhea) use sorbitol-macconkey or Shiga EIA |
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E coli clinical Dx |
Most common cause UTI, neonatal meningitis, and travelers diarrhea |
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E coli O157:H7 |
10% nonbloody diarrhea 90% hemorrhagic colitis 10% hemolytic uremic syndrome |
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Enterotoxigenic E coli (ETEC) |
Major cause of travelers diarrhea |
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Enteroinvasive E Coli (EIEC) |
Blood diarrhea Very simialr to Shigellosis utilize adhesin proteins to bind to and enter intestinal cell No toxins but damage intestinal wall through mechanical destruction fecal leukocytes + abdominal pain |
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Enteropathogenic E Coli (EPEC) |
watery infant diarrhea |
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Enteroaggregative E Coli (EAEC) |
Food borne, enteric pathogen Acute/persistent diarrhea Cipro or rifampin shown to dec. duration |
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Shiga-toxin producing E Coli (STEC) |
Serotype O157:H7 Zoonotic, food, or water borne Leading cause of HUS Diarrhea may be bloody |
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HUS Triad and Tx |
Hemolytic anemia Thrombocytopenia Renal failure Possible seizures
DO NOT USE ANTIBIOTICS or anti-motility agents!
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Community-acquired E Coli increasingly resistant to |
Cipro (15%), ampicillin (30-45%) |
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E Coli UTI |
Urine culture not needed for uncomplicated
Urinalysis should be done |
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Serritia microbiology |
aerobic gram neg rod of enterobacteria fam Only S marcesens is routine in humans |
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Clinical serratia |
Nosocomial infections (resp or GU tracts with GI less common) Heroin using addicts |
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Serratia inherently resistant to |
ampicillin macrolides 1G cephs |
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Serratia most likely a cause of |
hosp-acquired UTI, PNA, or bacteremia IVDU: prone to endocarditis or osteomyelitis |
