Chapter 15 Inflammation, Infection, and Antimicrobial Agents PDF

Chapter 15 Inflammation, Infection, and the Use of Antimicrobial Agents  Used to treat or prevent infections caused by Antimicrobial pathologic organisms such as bacteria, fungi, Medications viruses, and parasites Are necessary when host defense...

Chapter 15 Inflammation, Infection, and the Use of Antimicrobial Agents  Used to treat or prevent infections caused by Antimicrobial pathologic organisms such as bacteria, fungi, Medications viruses, and parasites Are necessary when host defense mechanisms are inadequate to ward off infection 2 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #1 Antimicrobial medications are used to treat all microorganisms. 3 Copyright © 2025 Wolters Kluwer. All rights reserved.  False Answer to Question #1 Rationale: Antimicrobial medications are used to prevent or treat infections caused by pathogens. 4 Copyright © 2025 Wolters Kluwer. All rights reserved.  Microorganisms attach to host cell receptors. Microorganisms oInvade tissues and Infections oMultiply oProduce infection Biological adaptations protect microbes from host defense mechanisms and antimicrobials. 5 Copyright © 2025 Wolters Kluwer. All rights reserved.  Bacteria Microorganism Classifications Viruses Fungi Parasites 6 Copyright © 2025 Wolters Kluwer. All rights reserved.  Body areas that are colonized with Normal Microbial microorganisms that protect host Flora #1 oSkin oUpper respiratory tract oColon If normal flora is suppressed via antimicrobial therapy: oPotential pathogens may thrive. 7 Copyright © 2025 Wolters Kluwer. All rights reserved.  Normal flora can cause disease in certain Normal Microbial conditions. Flora #2 oOlder adult patients oDebilitated patients oImmunosuppressed patients 8 Copyright © 2025 Wolters Kluwer. All rights reserved.  Involves the presence of pathogen plus Infectious clinical signs and symptoms of infection Diseases oMicrobes are usually spread by Direct contact with Infected person Contaminated hands, food, water, objects 9 Copyright © 2025 Wolters Kluwer. All rights reserved.  Usually, normal endogenous or environmental Opportunistic flora and nonpathogenic Pathogens oBecome pathogenic under conditions that favor their (over)growth Severe burns, CA, HIV infection Indwelling IV or urinary catheters Antibiotic or corticosteroid therapy oBacterial infections are usually serious and life threatening Caused by drug-resistant microorganisms 10 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #2 Opportunistic infections are likely to occur in patients with impaired defense mechanisms. 11 Copyright © 2025 Wolters Kluwer. All rights reserved.  True Answer to Question #2 Rationale: Opportunistic infections are likely to occur in patients with impaired defense mechanisms, such as those with severe burns, CA, HIV infection, IV or urinary catheters, or antibiotic or corticosteroid drug therapy. 12 Copyright © 2025 Wolters Kluwer. All rights reserved.  Laboratory tests can identify Laboratory oBacteria Identification of Gram stain Pathogens #1 Identifies microscopic appearance Culture Growing microbes in the laboratory 13 Copyright © 2025 Wolters Kluwer. All rights reserved.  Laboratory tests can identify (cont.) Laboratory oSerology Identification of IDs infectious agent via antibody levels Pathogens #2 oPolymerase chain reaction (PCR) Detects the presence of microbial DNA in sampling 14 Copyright © 2025 Wolters Kluwer. All rights reserved.  Increasingly prevalent in human pathogens Antibiotic- Infections caused by resistant pathogens Resistant oRequire more toxic and expensive Microorganisms medications #1 oLead to prolonged illness or hospitalization oIncrease mortality rates 15 Copyright © 2025 Wolters Kluwer. All rights reserved.  Grow, multiply when susceptible organisms Antibiotic- (including normal flora) Resistant oAre suppressed by antimicrobials Microorganisms oNormal host defenses are impaired by #2 Immunosuppressive disorders Immunosuppressive medications oEmerge during or after antimicrobial therapy 16 Copyright © 2025 Wolters Kluwer. All rights reserved.  Mechanisms of development Antibiotic- oBroad-spectrum antibiotics suppresses Resistant normal flora. Microorganisms oResistant organism becomes predominant #3 strain. Cause superinfection oInterruption of/inadequate antimicrobial treatment 17 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #3 Infections often associated with high rates of antimicrobial resistance include lower respiratory tract infections. 18 Copyright © 2025 Wolters Kluwer. All rights reserved.  True Answer to Question #3 Rationale: Infections often associated with high rates of antimicrobial resistance include lower respiratory tract infections and infections associated with cystic fibrosis or osteomyelitis. The infections are often difficult to treat because they tend to reoccur, involve multiple organisms, etc. 19 Copyright © 2025 Wolters Kluwer. All rights reserved.  Production of enzymes that inactivate Microbial medications Mechanisms of Modification of antibiotic target sites Resistance Production of alternate enzyme to bypass antibiotic activity Changing cell wall permeability Acquiring/increasing ability to pump medications out of the cell Modification of antibiotic binding target 20 Copyright © 2025 Wolters Kluwer. All rights reserved.  Intact skin and mucous membranes Host Defense Various anti-infective secretions Mechanisms Mechanical movements oCoughing, swallowing, peristalsis Phagocytic cells Immune processes Inflammatory processes 21 Copyright © 2025 Wolters Kluwer. All rights reserved.  Breaks in skin and mucous membranes Host Defense oTrauma, inflammation, open lesions Mechanism oInsertion of prosthetic devices, tubes, Impairments #1 catheters Impaired blood supply Neutropenia, other blood disorders Malnutrition 22 Copyright © 2025 Wolters Kluwer. All rights reserved.  Poor personal hygiene Host Defense Suppression of normal flora via antimicrobials Mechanism Suppression of immune system, inflammatory Impairments #2 response Diabetes mellitus, other chronic diseases Advanced age 23 Copyright © 2025 Wolters Kluwer. All rights reserved.  Terms Characteristics of oAnti-infective and antimicrobial include Antimicrobial Antibacterials Drugs #1 Antivirals Antifungals oAntibacterial and antibiotic (ATB) Medications used in bacterial infections 24 Copyright © 2025 Wolters Kluwer. All rights reserved.  Terms (cont.) Characteristics of oBroad spectrum Antimicrobial oNarrow spectrum Drugs #2 oBactericidal oBacteriostatic 25 Copyright © 2025 Wolters Kluwer. All rights reserved.  Acts on specific target in pathogen Antimicrobial oInhibition of bacterial wall synthesis Mechanisms of oInhibition of protein synthesis or production Action #1 of abnormal bacterial proteins oDisruption of microbial cell membranes oInhibition of reproduction of organisms oInhibition of cell metabolism and growth 26 Copyright © 2025 Wolters Kluwer. All rights reserved. Antimicrobial Mechanisms of Action #2 27 Copyright © 2025 Wolters Kluwer. All rights reserved.  Goal of treatment Principles of oEradicate causative microorganism Antimicrobial oReturn host to full physiologic function Therapy Rational use of antimicrobials oMost frequently used medications worldwide oMuch overuse, misuse, abuse leading to   adverse drug effects, healthcare costs, drug-resistant infections 28 Copyright © 2025 Wolters Kluwer. All rights reserved.  Cost Antimicrobial oUse older, more cost-effective drug if it Therapy Use meets criteria for selection Guidelines #1 Combination therapy of antimicrobials to treat oInfections caused by multiple microbes oHospital-acquired infections oSerious infections 29 Copyright © 2025 Wolters Kluwer. All rights reserved.  Administration Antimicrobial oOrally or IV for systemic infections Therapy Use oDependent on patient condition Guidelines #2 Location, severity of infection Ability to take oral medications oAvailable medication dosage forms 30 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #4 A community-acquired infection is contracted while one is within a healthcare facility. 31 Copyright © 2025 Wolters Kluwer. All rights reserved.  False Answer to Question #4 Rationale: Hospital-acquired infections are acquired while within a healthcare setting and may be more severe and difficult to manage because they often result from drug-resistant microbes and occur in those who are immunocompromised. 32 Copyright © 2025 Wolters Kluwer. All rights reserved.  Duration of therapy Antimicrobial oVaries, depending on reason for use Therapy Use Single dose (prophylactically) Guidelines #3 7 to 10 days or until the patient has been afebrile and asymptomatic for 48 to 72 hours Acute infection 33 Copyright © 2025 Wolters Kluwer. All rights reserved.  Perioperatively Antimicrobials in Children Special Older adults Populations Abnormal kidney function Hepatic impairment Critical illness Home care 34 Copyright © 2025 Wolters Kluwer. All rights reserved.  Avoid using antibacterial drugs to treat viral Guidelines to infections. Promote Give antibacterial drugs only for significant Appropriate bacterial infections or when there is an Antimicrobial established indication for prophylaxis. Drug Use #1 Use a narrow-spectrum antibacterial drug instead of a broad-spectrum drug, whenever possible. Collect specimens for culture and Gram stain before giving the first dose of an antibiotic 35 Copyright © 2025 Wolters Kluwer. All rights reserved.  Minimize antimicrobial drug therapy for fever Guidelines to unless other clinical manifestations or Promote laboratory data indicate infection. Appropriate Follow CDC recommendations for prevention Antimicrobial and treatment of infections. Drug Use #2 Consult infectious disease/infection control specialists about local patterns of drug- resistant organisms and treatment of complicated infections. 36 Copyright © 2025 Wolters Kluwer. All rights reserved.