Infection

Question 1

Why is important to differentiate between hospital and community acquired infection?

Answer 1

Different infecting organisms

Different antibiotic resistance patterns

Marker for outbreaks/epidemiology

Marker of poor infection control in hospitals (hospitals can be fined if too much hospital-acquired infection)

Question 2

What infections have more resistance hospital acquired or community, why?

Answer 2

Hospital infections have more resistance due to beta lactamases

Question 3

Cell wall inhibitor antibiotics?

Answer 3

Beta lactams:

• Penicillins - amoxicillin, flucloxacillin
• cephalosporins - cefuroxime, ceftriaxone, ceftazidime
• Carbapenems - meropenem, ertapenem, imipenem

Glycopeptides:
- Vancomycin

Question 4

Possible issues with using narrower spectrum antibiotics?

Answer 4

Can lead to C diff infection.

Question 5

In hospital infections what antibiotic groups are not indicated due to beta lactamases?

Answer 5

Penecillins

Cephalosporins

Question 6

Issues with vancomycin?

Answer 6

Has to be given IV
Risk of renal impairment
Therapeutic levels need to be monitored

Question 7

What will vancomycin not work against?

Answer 7

Gram negatives

vanco-resistant enterococci

Question 8

Protein inhibitor antibiotics

Answer 8

• Tetracyclines (bacteriostatic) – doxycycline, tetracycline
• Macrolides (bacteriocidal) – clarithromycin, erythromycin
• Aminoglycosides (bacteriostatic) - gentamicin

Question 9

How can C diff progress?

Answer 9

• Mild diarrhoea
• Pseudomembranous colitis
• Toxic megacolon
• Colonic perforation
• death

Question 10

How do you test for C diff infection?

Answer 10

Stool test

Question 11

Most common causes of C diff infection?

Answer 11

• Cephalosporins
• Ciprofloxacin
• Clindamycin
• Co-amoxiclav

Question 12

Risks associated with tetracyclines?

Answer 12

Risk of photosensitivity

Risk of teeth staining in

Question 13

Risks associated with macrolides?

Answer 13

Risk of cardiac complications
Interact with statins
GI upset

Question 14

Risks associated with aminoglycosides?

Answer 14

Renal toxicity

Ototoxicity

Question 15

DNA synthesis inhibitor antibiotics?

Answer 15

• Quinolones (bacteriocidal) – ciprofloxacin, moxifloxacin, levofloxacin
• Nitroimidazoles (bacteriocidal at higher doses) – metronidazole
• Nitrofurans e.g. nitrofurontoin

Question 16

Risks of Quinolones?

Answer 16

QT prolongation
reduced seizure threshold
achilles tendon rupture
C diff infection

Question 17

Risks of metronidazole?

Answer 17

GI upset, peripheral neuropathy

Question 18

Management of C diff infection?

Answer 18

• Stopping offending antibiotic
• Isolation
• Fluid rehydration
• Avoid anti-motility drugs e.g. loperamide
• Consider stopping PPIs
• Metronidazole/vancomycin

Question 19

Norovirus diagnosis?

Answer 19

Stool PCR

Question 20

Treatment of norovirus?

Answer 20

ORT, paracetamol antiemetics

Question 21

Treatment of MRSA?

Answer 21

IV vancomycin

Question 22

What groups should routine HIV testing be carried out in?

Answer 22

• MSM
• IVDU
• Pregnant women
• Anyone with another STI/a partner with an STI
• Anyone from a country with a high HIV prevalence

Question 23

What is Pneumocystis pneumonia (PCP) how do you treat?

Answer 23

Most common Opportunistic infection in UK in immunosuppressed patients.

Treat with co-trimoxazole (&steroids)

Question 24

What is toxoplasmosis, how is it treated?

Answer 24

protozoan parasite - uncooked food

Can cause SOL in brain, ost infection is fairly asymptomatic

Treated with sulfadiazine (antibiotoc) and pyrimethamine (anti protozaol)

Question 25

What is Kaposi's sarcoma? Treatment?

Answer 25

AIDS associated cancer Dark/red pigmented lesion from a vascular tumour of spindle cells Driven by co-infection with HHV-8 Treat with anti-retrovirals and chemo

Question 26

Examples of antiretrovirals?

Answer 26

AZT/ zidovudine – a nucleotride reverse transcriptase inhibitor (NRTI) Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) - Nevaripine Protease inhibitors (PIs) Indinavir

Question 27

Treatment regimens for HIV?

Answer 27

* 2 NRTIs and a NNRTI * 2 NRTIs and a PI * 2 NRTIs and an integrase inhibitor e.g. raltegravir

Question 28

Four modes of action of antibiotics?

Answer 28

Cell wall inhibitor Inhibit protein synthesis Inhibit DNA synthesis Inhibit RNA synthesis

Question 29

RNA synthesis inhibitor antibiotics?

Answer 29

Rifamycins

Question 30

Rifamycin limitations/SEs?

Answer 30

Stains bodily fluids orange hepatotoxicity Drug interactions

Question 31

Common hospital acquired infections?

Answer 31

C. diff MRSA Norovirus

Question 32

What types of antibiotics is MRSA resistant to?

Answer 32

Beta lactams

Question 33

Major associated conditions with HIV?

Answer 33

``` Seroconversion illness Pneumocystis jirroveci pneumonia Toxoplasmosis Kaposis sarcoma Tuberculosis ```

Question 34

Levels of CD4 associated with PCP?

Answer 34

Lower than 200

Question 35

Predicted total life expectancy of HIV if caught early?

Answer 35

65 years+

Question 36

Common cause of pneumonia and meningitis in the community?

Answer 36

Strep pneumonia

Question 37

Use of monoclonal antibodies against C diff?

Answer 37

Reduce recurrence