Chemoprophylaxis and Surgical Prophylaxis Overview
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Chemoprophylaxis and Surgical Prophylaxis Overview

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Questions and Answers

What is a primary source of exogenous hospital-acquired infections?

  • Patients' own flora
  • Normal skin commensals
  • Contaminated fluids (correct)
  • Invasive devices

    • Which statement best describes endogenous hospital-acquired infections?

  • They are caused by hospital staff.
  • They arise from environmental contamination.
  • They result from airborne pathogens.
  • They occur when a patient's own flora invade their tissues. (correct)

    • What is an example of a factor that contributes to bacterial resistance in healthcare settings?

  • Effective sterilization of instruments
  • Invasive devices (correct)
  • Clean hospital environments
  • Frequent handwashing

    • Which of the following is a potential vehicle for the transmission of pathogens in a hospital?

    <p>Contaminated air</p> Signup and view all the answers

    How can staff members contribute to nosocomial infections?

    <p>By being carriers of infections without symptoms.</p> Signup and view all the answers

    Which of the following areas is NOT considered a source of environmental contamination in hospitals?

    <p>Clean surgical instruments</p> Signup and view all the answers

    What factor may lead to transmission of pathogens between patients and hospital staff?

    <p>Inadequate hand hygiene practices</p> Signup and view all the answers

    Which type of catheter is most commonly associated with hospital-acquired urinary infections?

    <p>Urinary catheters</p> Signup and view all the answers

    What is a primary factor that leads to the failure of prophylaxis against infections?

    <p>Presence of multiple pathogens without targeted action</p> Signup and view all the answers

    What characteristic should an antibiotic for surgical prophylaxis possess?

    <p>It should be active against common surgical wound pathogens</p> Signup and view all the answers

    Which scenario would likely necessitate nonsurgical prophylaxis?

    <p>An immunocompromised individual at risk of infection</p> Signup and view all the answers

    Why should broad-spectrum antibiotics be reserved for specific cases in surgical prophylaxis?

    <p>They can lead to increased rates of resistance and superinfection</p> Signup and view all the answers

    What defines a nosocomial infection?

    <p>Infections that manifest 48 hours or more after hospital admission</p> Signup and view all the answers

    What is the shortest effective course recommended for antimicrobial surgical prophylaxis?

    <p>A single dose at the time of incision</p> Signup and view all the answers

    Which of the following factors contributes to an increased risk of hospital-acquired infections?

    <p>Patient's underlying diseases making them more susceptible</p> Signup and view all the answers

    Which of the following agents is NOT relevant to antimicrobial prophylaxis?

    <p>Antimicrobial agents ineffective against pathogens</p> Signup and view all the answers

    What is one of the significant consequences of nosocomial infections?

    <p>Increased emotional stress of the patient</p> Signup and view all the answers

    Which of the following is NOT a preventive measure against nosocomial infection?

    <p>Using razors to shave the operation site</p> Signup and view all the answers

    What is a potential outcome of increased morbidity and mortality ratios due to nosocomial infections?

    <p>Potentially increased patient mortality</p> Signup and view all the answers

    How can drug resistance in bacteria develop?

    <p>By horizontal transfer of resistance traits</p> Signup and view all the answers

    What is one of the recommended practices for minimizing nosocomial infections?

    <p>Using barrier isolation materials</p> Signup and view all the answers

    Which of the following antibiotics is classified as a cell wall synthesis inhibitor?

    <p>Vancomycin</p> Signup and view all the answers

    Which of the following statements about antibiotic resistance is true?

    <p>Gram-negative bacteria are generally resistant to vancomycin</p> Signup and view all the answers

    Which mechanism is NOT a way through which drug resistance can be acquired?

    <p>Autotransformation</p> Signup and view all the answers

    Which generation of cephalosporins includes Cefepime?

    <p>Fourth Generation</p> Signup and view all the answers

    Which of the following is NOT considered a beta-lactamase inhibitor?

    <p>Daptomycin</p> Signup and view all the answers

    What is a significant impact of inappropriate use of preoperative antibiotics?

    <p>Increased likelihood of antibiotic resistance</p> Signup and view all the answers

    Which penicillin is specifically noted for its resistance to beta-lactamase enzymes?

    <p>Oxacillin</p> Signup and view all the answers

    Identify the agent that is a monobactam antibiotic.

    <p>Aztreonam</p> Signup and view all the answers

    Which mechanism contributes to drug resistance through decreased accumulation in bacteria?

    <p>Efflux mechanisms</p> Signup and view all the answers

    Which antibiotic is primarily affected by enzymatic inactivation through the production of beta-lactamases?

    <p>Penicillin</p> Signup and view all the answers

    What specific alteration leads to resistance in Neisseria gonorrhoeae against penicillin?

    <p>Presence of plasmid-mediated penicillinase</p> Signup and view all the answers

    Which class of antibiotics is noted for primarily suffering from altered target mechanisms leading to resistance?

    <p>Fluoroquinolones</p> Signup and view all the answers

    What is a common reason for bacterial resistance to cephalosporins?

    <p>Production of beta-lactamases</p> Signup and view all the answers

    Which antibiotic exhibits resistance due to the alteration of porin channels in resistant organisms?

    <p>Fluoroquinolones</p> Signup and view all the answers

    Which mechanism does not lead to drug resistance through decreased drug penetration?

    <p>Increased membrane fluidity</p> Signup and view all the answers

    What mechanism is a primary factor contributing to resistance against tetracycline?

    <p>Efflux pumps expelling the drug</p> Signup and view all the answers

    Study Notes

    Chemoprophylaxis

    • Using a single, effective, nontoxic drug for prevention of infection by a specific microorganism is commonly successful.
    • Chemoprophylaxis is frequently ineffective in preventing colonization or infection by multiple microorganisms in a patient's surroundings.
    • Using antibiotics discriminately is crucial to avoid bacterial resistance and superinfection.
    • Benefits of prophylactic antibiotic use must outweigh potential risks.

    Surgical Prophylaxis

    • Surgical wound infections are a major cause of nosocomial infections.
    • The chosen antibiotic should be effective against common surgical wound pathogens, avoiding unnecessarily broad-spectrum coverage.
    • Antibiotic efficacy should be proven in clinical trials.
    • Antibiotic concentration needs to exceed the minimum inhibitory concentration (MIC) of suspected pathogens at the time of incision.
    • The shortest possible course, ideally single-dose, of the most effective and least toxic antibiotic should be used.
    • Newer broad-spectrum antibiotics should be reserved for treating resistant infections.
    • The least expensive agent should be used if all other factors are equal.

    Nonsurgical Prophylaxis

    • Indicated for individuals with high risk of temporary exposure to virulent pathogens and patients with underlying diseases increasing their susceptibility to infection (e.g., immunocompromised hosts).
    • Most effective when targeting organisms predictably susceptible to antimicrobial agents.

    Nosocomial Infection

    • Infections occurring 48 hours or more after hospital admission or within 30 days after discharge are considered nosocomial.
    • Also called Hospital Acquired Infections (HAI).
    • Four factors contribute to the rise of nosocomial infections:
      • Microbial agents
      • Patient susceptibility
      • Presence of microorganisms in the hospital environment
      • Environmental factors

    Factors Predisposing to HAI

    • Microbial agents: Bacteria, viruses, fungi, parasites are common sources.
    • Patient susceptibility: Compromised immune systems (e.g., immunocompromised patients, individuals with chronic diseases, those undergoing chemotherapy) increase susceptibility.
    • Presence of microorganisms in the hospital environment: Hospitals are rich in microorganisms due to high density of sick individuals and frequent use of invasive procedures.
    • Environmental factors: Transmission of pathogens from staff to patients and among patients.
      • Bacterial resistance - Increased prevalence of resistant strains makes infections more difficult to treat.
      • Transmission of pathogens between staff and patients - Direct contact, airborne particles, and contaminated surfaces contribute.

    Sources of Hospital-Acquired Infections

    • Contaminated hospital environment: Instruments, fluids (e.g., IV fluids), food, air, medications.
    • Patient flora - Skin, gastrointestinal, genitourinary, respiratory tract
    • Invasive devices - Urinary catheters, vascular catheters, endotracheal tubes, wounds, endoscopes
    • Medical Personnel - Colonized or infected staff members can act as carriers.

    Sources of Nosocomial Infection

    • Endogenous - Patients' own flora can invade tissues during surgical operations or instrumental manipulations. This can involve normal commensals from the skin, respiratory, gastrointestinal, and genitourinary tracts.
    • Exogenous - Infections originate from other patients, staff, or the hospital environment.
      • Environmental sources: Inanimate objects, air, water, food.
      • Cross-infection: Transmission from other patients or hospital staff (suffering from infections or asymptomatic carriers).

    Problems of Nosocomial Infections

    • Increased suffering for patients.
    • Prolonged hospital stays.
    • Significant increase in healthcare costs.

    Consequences of Nosocomial Infections

    • Potential for death.
    • Increased emotional stress for patients.
    • Increased morbidity and mortality ratios.
    • Excess costs associated with extended hospital stays.
    • Transmission to discharged patients or visitors.
    • Increased antibiotic resistance.

    Prevention of Nosocomial Infections

    • Avoid shaving the operation site with a razor.
    • Disinfection of the skin at the incision site.
    • Appropriate use of preoperative antibiotics when indicated (starting immediately before surgery and continuing for 24 hours after).
    • General hygienic measures: Handwashing, proper hygiene practices.
    • Use of barrier isolation materials: Gloves, gowns, masks.
    • Routine decontamination of respiratory equipment: Regular disinfection.
    • Annual influenza immunization for patients and staff.

    Drug Resistance

    • Bacteria are considered resistant when they are no longer sensitive to the maximum level of an antibiotic to which they were previously sensitive.
    • Some organisms are inherently resistant to specific antibiotics (e.g., gram-negative bacteria and vancomycin).
    • Resistance to a particular drug can develop in one species and spread to others.

    Mechanisms of Drug Resistance

    • Altered targets: The antibiotic's target site is changed, preventing its binding and action.
    • Decreased accumulation: Reduced uptake of the antibiotic by the bacterial cell.
      • Permeability: Changes in the bacterial membrane reduce antibiotic entry.
      • Efflux: The antibiotic is actively pumped out of the cell.
    • Enzymatic inactivation: An enzyme produced by the bacteria inactivates the antibiotic.

    Classification of Antibiotics

    • Cell wall synthesis inhibitors
    • Protein synthesis inhibitors
    • DNA synthesis inhibitors
    • RNA synthesis inhibitors
    • Folic acid synthesis inhibitors
    • Membrane disruptors

    Cell Wall Synthesis Inhibitors

    • Beta-lactams: Penicillins, cephalosporins, carbapenems, monobactams
      • Penicillins: Amoxicillin, ampicillin, dicloxacillin, indanyl carbenicillin, methicillin, nafcillin, oxacillin, penicillin G, penicillin V, piperacillin, ticarcillin.
      • Cephalosporins: Cefadroxil, cefazolin, cefprozile, cefdinir, cefepime, cefixime, cefuroxime, cefotaxime, cefoxitin, ceftazidime, ceftibuten, ceftizoxime, ceftriaxone.
      • Monobactams: Aztreonam.
    • Beta-lactamase inhibitors: Clavulanate acid, sulbactam, tazobactam.
    • Others: Bacitracin, vancomycin, daptomycin.

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    Lecture 7: Introduction to Antimicrobial Drugs PDF

    Description

    This quiz covers the principles of chemoprophylaxis and surgical prophylaxis in preventing infections. It highlights the importance of using effective antibiotics selectively and understanding their role in managing surgical wound infections. Test your knowledge on the criteria for antibiotic selection and strategies for minimizing resistance.

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