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23 Cards in this Set
- Front
- Back
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Patient presents with a history of flank pain, dysuria, febrile - 39deg, HR: 120, BP 90/60. PDx and DDx. |
PDx: Septic shock secondary to a renal source - urosepsis
DDx: pyelonephritis, cystitis, renal calculi, malignancy Pancreatitis, cholecystitis, cholangitis, diverticulitis, appendicitis, bowel obstruction Other causes of shock - Hypovolaemic, cardiogenic |
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What are the common organisms that lead to this presentation?
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Usually if ascending = GN bacilli, or haematogenous = GP cocci
KEEPS K: Klebsiella E: E. Coli (most common) E: Enterobacter (GN) , enterococci (GP) P: Proteus mirabillis, pseudomonas (HAI) S: Staph saprophyticus, Staph Aureus?? or fecalis? |
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What are the virulence factors associated with E. coli infection? |
Fimbriae - allows attachment in cystitis and pyelonephritis
LPS endotoxin - septic shock |
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What are the virulence factors associated with S. Aureus? |
Protein A: Prevents opsonisation
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What investigations would you offer in this case? |
1. Stabilise patient - ABCs + IV access + fluid bolus
Diagnostic: Urine analysis + MCS: causative organism, antibiotic sensitivities, casts Urine dipstick Blood cultures
Others Labs: FBC: left shift, leucocytosis EUC: Pre-renal/post renal failure LFTs: rule out differentials ABG
Imaging - Abdo/pelvic U/S - CT - DMSA scan: scarring |
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What is inside an anaerobe blood culture tube and an aerobic blood culture tube? |
Liquid culture media: Transport media that provides nourishment to microorganisms to encourage growth - Water - Carbon and energy source - Source of nitrogen - Growth factors
Anaerobic tube - Low O2 content as it's been boiled - Nutritional substitutes (vitamin K, haemin) - Reducing agent i.e. 1% glucose (reduces oxidation potential) |
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How would you treat this gram -ve sepsis? |
Severe sepsis: IV treatment while waiting for results
Gent 7mg/kg + amoxycillin 2g IV or 3rd gen ceph if gent is contraindicated
1. Gentamicin 7mg/kg IV for 1 dose, then determine dosing interval based on renal function, maximum 2 more times base on body weight Plus 2. Amoxicillin 2g IV QID
3rd gen cephalosporin if Gent is contraindicated - Ceftriaxone 1g IV daily |
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How do you monitor gentamicin levels? |
Measure peak and trough Peak: 30mins after end of dosing = >8mg/L Trough: just before next dose = <2mg/L |
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What is gentamicin? How does it work? |
Gentamicin is an aminoglycoside, a bacterial protein synthesis inhibitor
MOA: Binds to 30S ribosome -> inhibits protein synthesis |
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What are the side effects of gentamicin? |
SE: Ototoxicity (dose independent) - Vestibular sx: N+V, nystagmus, gait - Cochlear sx: hearing loss, tinnitus
Nephrotoxicity (dose dependent)
Teratogenic
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What is gentamicin used for? |
Empirical treatment for gram negative infections - Pseudomonas - Enterococcus - Endocarditis |
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What is Klebsiella? |
Gram -ve rod Fast lactose fermenter |
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What is E.Coli |
Gram -ve rod Fast lactose fermenter |
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What is Enterococcus? What is an example? |
Strep fecalis Gram positive cocci Catalase negative Gamma haemolytic Grows in bile and salt |
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What is Pseudomonas? |
Gram negative rod Non lactose fermenter Oxidase positive |
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What is proteus mirrabilis? |
Gram negative rod Non lactose fermenter Oxidase negative |
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What is staph aureus? |
Gram positive cocci, occurs in clumps Catalase and coagulase positive |
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What is staph saprophyticus? |
Gram positive cocci, grows in clumps Catalase positive Coagulase negative Novobiocin resistant |
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What is the cut off to diagnose UTI from microscopy? |
10^5 CFU/ml or 10^8 CFU/L for one type of bacteria
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>10^8 WBC |
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What is considered complicated UTI? |
- structural abnormality - functional abnormality - immunocompromised - iatrogenic - upper urinary tract i.e. pyelonephritis - catheter associated |
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What organisms are most associated with hospital acquired UTI? |
Pseudomonas Candida E.Coli |
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How does Pseudomonas cause chronic infection? |
Biofilm formation |
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How do you treat UTI? |
TCAN - Trimethoprim 300mg PO 3 days - Cephalexin 500mg PO BD 5 days - Amoxicillin + clavulanate 500/150mg PO BD 5days - Nitrofurantoin 100mg PO BD 5 days
If pregnant - all but trimethoprim |
