2009PHM Infection Revision (student copy) PDF

Bacteria • Single-cell microorganisms, usually a few micrometers in length that normally exist together in millions. • Come in three main shapes (morphology) • Cocci (spheres) • Bacilli (rods) • Spirilla (spirals) • No nucleus • Ribosomes are the only internal organelles • Rapid reproduction • Bin...

Bacteria • Single-cell microorganisms, usually a few micrometers in length that normally exist together in millions. • Come in three main shapes (morphology) • Cocci (spheres) • Bacilli (rods) • Spirilla (spirals) • No nucleus • Ribosomes are the only internal organelles • Rapid reproduction • Binary fission • Recombination School of Pharmacy Aerobes and Anaerobes Gram stain School of Pharmacy Penicillins Penicillins Corynebacterium jeikeium Gram-negative Enterococcus faecalis Acinetobacter spp. Enterococcus faecium piperacillin with tazobactam amoxicillin with clavulanic acid flucloxacillin, dicloxacillin Gram-positive phenoxymethylpenicillin Organism Broad spectrum procaine benzylpenicillin benzylpenicillin piperacillin with tazobactam amoxicillin with clavulanic acid amoxicillin, ampicillin flucloxacillin, dicloxacillin Narrow spectrum amoxicillin, ampicillin Broad spectrum phenoxymethylpenicillin Organism procaine benzylpenicillin benzylpenicillin Narrow spectrum Aeromonas spp. Listeria spp. Burkholderia cepacia Staphylococcus aureus Burkholderia pseudomallei Staphylococcus aureus (MRSA)3 Staphylococcus epidermidis 2 2 2 2 Campylobacter jejuni and coli Citrobacter freundii 1 Staphylococcus saprophyticus Enterobacter spp. 1 Streptococcus - group A, B, C, G Escherichia coli Staphylococcus lugdunensis v v Streptococcus anginosus Haemophilus influenzae Streptococcus pneumoniae Klebsiella spp. Viridans streptococcus group Moraxella catarrhalis Anaerobes Actinomyces Morganella spp. Bacteroides fragilis group Neisseria gonorrhoeae 2 Clostridioides difficile Neisseria meningitidis v Clostridium perfringens Pasteurella multocida Cutibacterium (Propionibacterium) acnes Proteus mirabilis Fusobacteria spp. Proteus vulgaris Peptostreptococcus spp. Providencia spp. Prevotella melaninogenica Pseudomonas aeruginosa Miscellaneous 1 v,1 v,1 v Salmonella spp. Chlamydophila, Chlamydia spp. Serratia spp. Legionella spp. 1 Shigella spp. Mycobacterium tuberculosis Stenotrophomonas maltophilia Mycoplasma pneumoniae Nocardia spp. v 1 v Yersinia spp. v tested are susceptible to that antibiotic). Cephalosporins Cephalosporins Enterococcus faecalis 3 2 Aeromonas spp. Listeria spp. Burkholderia cepacia Staphylococcus aureus 1 v v 2 5 Staphylococcus saprophyticus Citrobacter freundii 1 1 1 Enterobacter spp. 1 1 1 1 1 1 Escherichia coli Streptococcus - group A, B, C, G Streptococcus anginosus Haemophilus influenzae Streptococcus pneumoniae Klebsiella spp. 6 v v Moraxella catarrhalis Anaerobes Morganella spp. Actinomyces Neisseria gonorrhoeae Bacteroides fragilis group Neisseria meningitidis Clostridioides difficile Pasteurella multocida Clostridium perfringens Proteus mirabilis Cutibacterium (Propionibacterium) acnes Proteus vulgaris 1 1 1 1 1 1 1 v 1 Fusobacteria spp. 2 Providencia spp. Peptostreptococcus spp. 2 Pseudomonas aeruginosa Prevotella melaninogenica Salmonella spp. Miscellaneous Serratia spp. Chlamydophila, Chlamydia spp. Shigella spp. Legionella spp. Stenotrophomonas maltophilia Mycobacterium avium complex Yersinia spp. Mycobacterium tuberculosis 1 Mycoplasma pneumoniae 2 v,7 v 3 4 v v use of broad-spectrum cephalosporins may result in emergence of resistance and treatment failure susceptible in vitro, insufficient or limited clinical data ceftriaxone used with amoxicillin for synergistic effect ceftolozane with tazobactam ceftazidime with avibactam ceftazidime 1 Campylobacter jejuni and coli Staphylococcus lugdunensis 1 1 Burkholderia pseudomallei Staphylococcus aureus (MRSA)4 Nocardia spp. ceftaroline Acinetobacter spp. Enterococcus faecium Viridans streptococcus group cefepime Gram-negative Corynebacterium jeikeium Staphylococcus epidermidis cefotaxime, ceftriaxone Gram-positive Broad spectrum cefoxitin Organism cefaclor, cefuroxime Moderate spectrum cefalexin, cefazolin ceftolozane with tazobactam ceftazidime with avibactam ceftazidime ceftaroline cefepime cefotaxime, ceftriaxone Broad spectrum cefoxitin cefalexin, cefazolin Organism cefaclor, cefuroxime Moderate spectrum The following table provides a general guide to clinical antimicrobial susceptibilities. The table is intended to assist empirical selection of antimicrobials in the absence of laboratory confirmation of susceptibility; it is not a substitute for management advice from clinical microbiologists or infectious diseases specialists. Consider these data in conjunction with the clinical condition of the patient, site of infection, knowledge of local susceptibility patterns (which may vary) and evidence-based guidelines. Use the narrowest spectrum antibiotic that is effective to limit the development of antimicrobial resistance. When in doubt seek specialist advice. The designation of susceptibility used in the table is 75% (an organism is deemed susceptible if at least 3 out of 4 cultures tested are susceptible to that antibiotic). Enterococcus faecalis 2 Enterococcus faecium 2 Listeria spp. 2 Staphylococcus aureus 2 Staphylococcus aureus (MRSA)4 2 v,3 Burkholderia pseudomallei 5 5 Staphylococcus lugdunensis 5 5 5 v v Campylobacter jejuni and coli v v Citrobacter freundii Enterobacter spp. Staphylococcus saprophyticus Escherichia coli Streptococcus - group A, B, C, G 2,6 Streptococcus anginosus 2 Streptococcus pneumoniae 2 3 3 3 3 3 3 Anaerobes Bacteroides fragilis group Haemophilus influenzae Klebsiella spp. Moraxella catarrhalis Morganella spp. Neisseria gonorrhoeae Actinomyces 3 3 Pasteurella multocida Clostridium perfringens Proteus mirabilis Cutibacterium (Propionibacterium) acnes Proteus vulgaris Fusobacteria spp. Peptostreptococcus spp. Prevotella melaninogenica Providencia spp. Pseudomonas aeruginosa Salmonella spp. Miscellaneous Serratia spp. Chlamydophila, Chlamydia spp. Shigella spp. Legionella spp. Stenotrophomonas maltophilia Mycobacterium avium complex Yersinia spp. Mycobacterium tuberculosis 1 Mycoplasma pneumoniae 2 Nocardia spp. 4 5 in combination with azithromycin used for synergistic effect with beta-lactam antibacterial some strains may not be susceptible MRSA: implies resistance to all beta-lactams 1 Neisseria meningitidis Clostridioides difficile 3 3 4 5 6 in combination with azithromycin used for synergistic effect with beta-lactam antibacterial some strains may not be susceptible MRSA: implies resistance to all beta-lactams can be used if susceptible to beta-lactam antibacterial use with beta-lactam antibacterial for Group B streptococcus only Legend lincomycin Lincosamides clindamycin teicoplanin vancomycin Glycopeptides meropenem imipenem ertapenem Aeromonas spp. v,3 Burkholderia cepacia 5 2 tobramycin Acinetobacter spp. Staphylococcus epidermidis 1 Carbapenems Gram-negative Corynebacterium jeikeium Viridans streptococcus group Organism gentamicin Gram-positive Aminoglycosides amikacin lincomycin clindamycin Lincosamides teicoplanin vancomycin imipenem ertapenem Glycopeptides meropenem Carbapenems tobramycin amikacin Organism gentamicin Aminoglycosides tested are susceptible to that antibiotic). Gram-negative Acinetobacter spp. v Aeromonas spp. 2 Citrobacter freundii Enterobacter spp. v Escherichia coli Enterococcus faecalis Klebsiella spp. v trimethoprim with sulfamethoxazole trimethoprim 1 Staphylococcus aureus (MRSA)3 1 Staphylococcus lugdunensis Streptococcus - group A, B, C, G v Streptococcus anginosus Streptococcus pneumoniae Viridans streptococcus group Neisseria gonorrhoeae Anaerobes Neisseria meningitidis Actinomyces Pasteurella multocida Bacteroides fragilis group Proteus mirabilis Clostridioides difficile Proteus vulgaris v Providencia spp. Pseudomonas aeruginosa v Salmonella spp. Serratia spp. Clostridium perfringens Cutibacterium (Propionibacterium) acnes Fusobacteria spp. Peptostreptococcus spp. v Prevotella melaninogenica Shigella spp. Miscellaneous Stenotrophomonas maltophilia Chlamydophila, Chlamydia spp. 5 Yersinia spp. Legionella spp. 5 1 Mycobacterium avium complex 5 Mycobacterium tuberculosis 5 Mycoplasma pneumoniae 5 urinary isolates only use with another antibacterial MRSA: implies resistance to all beta-lactams most community-acquired MRSA are susceptible susceptible in vitro, insufficient or limited clinical data Nocardia spp. 1 urinary isolates only 4 v Staphylococcus epidermidis Morganella spp. 5 tigecycline Staphylococcus aureus Moraxella catarrhalis 4 sodium fusidate v Staphylococcus saprophyticus Haemophilus influenzae 3 nitrofurantoin1 Corynebacterium jeikeium Listeria spp. 2 Campylobacter jejuni and coli 2 metronidazole linezolid fosfomycin daptomycin aztreonam Gram-positive Enterococcus faecium Burkholderia cepacia Burkholderia pseudomallei v Organism minocycline trimethoprim with sulfamethoxazole trimethoprim tigecycline sodium fusidate nitrofurantoin1 metronidazole linezolid fosfomycin daptomycin aztreonam minocycline doxycycline Organism doxycycline Tetracyclines Other antibacterials Tetracyclines Other antibacterials MOA School of Pharmacy Systemic fungal infections • Who get’s systemic fungal infections? • What to use first for systemic infections? • What to use first in serious illness? Malaria ERC P.falciparum P.vivax P.ovale P.malariae Latent disease Rx Herpesvirus Infections • Herpesviruses are DNA viruses • Herpes simplex virus (HSV) • Varicella-zoster virus (VZV) • Cytomegalovirus (CMV) School of Pharmacy Hepatitis (A,B,C) A Contraction method Vaccine PEP Treatment B C School of Pharmacy HIV • HAART • NRTI/NNRTI • NRTI/NNRTI • INSTI Post exposure prophylaxis Hep B (PEP) School of Pharmacy INDIVIDUALS WITH EVIDENCE OF PREVIOUS IMMUNITY TO HEPATITIS B (HBSAB POSITIVE) WILL REQUIRE NO FURTHER FOLLOW-UP. NON-IMMUNE INDIVIDUALS REQUIRE IMMUNISATION AND FOLLOW-UP (TO 6 MONTHS). IF THE INDIVIDUAL IS NON-IMMUNE AND THE SOURCE IS KNOWN TO HAVE CHRONIC HEPATITIS B (HBSAG POSITIVE) THEN A SINGLE DOSE OF HBIG SHOULD BE ADMINISTERED WITHIN 72 HOURS OF THE EXPOSURE AND HEPATITIS B IMMUNISATION COMMENCED. Assessment of the risk of HIV transmission • The risk of HIV transmission through a single exposure is determined by: • The nature of the exposure with its estimated risk/exposure • The risk that the source is HIV positive, if their status is unknown • Factors associated with the source and exposed individuals. School of Pharmacy