Gram negative Bacteria

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21 Terms

1

Pathogenic features of Gram negatives:

Infections: Intraabdominal, UTI, pneumonia, cellulitis, osteomyelitis, meningitis

Endotoxin- lipopolysaccharide
Enterotoxins- E Coli, Shigella, infectious diarrhea

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2

Enteric gram-negative bacilli

Enterobacterales

  • Escherichia coli

  • Klebsiella pneumoniae

  • Klebsiella oxytoca

  • Klebsiella aerogenes (formerly Enterobacter aerogenes)

  • Proteus mirabilis and vulgaris

  • Serratia marcescens

  • Citrobacter spp.

  • Morganella morganii

  • Salmonella, Shigella, Campylobacter

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3

Enterobacterales

→Enteric gram-negative bacilli
considered part of the normal flora of the gastrointestinal (GI) tract.
→Primary cause of clinically significant gram negative infections

Currently considered a Threat by the CDC

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4

Enterobacterales- Food borne illness

Salmonella, Campylobacter, E Coli, Vibrio

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5

What is the Most common shiga toxin producing E. Coli

Escherichia coli O157:H7

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6

Resistant Enterbacterales Currently considered a Threat by the CDC

Drug resistant salmonella serotype typhi
Carbapenem resistant enterobacteriaceae
Drug resistant resistant campylobacter
Extended Spectrum Beta lactamase (ESBL) producing enterobacteriaceae
Drug resistant shigella 
Drug resistant non typhoidal salmonella

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7

Antibiotic resistance in Gram negatives

  • Mutation in lipopolysaccharide (e.g., polymyxin resistance)

  • Hydrolysis by β-lactamase (plasmid-acquired or overexpressed chromosomal genes)

  • Overexpression of efflux pumps (multidrug resistance)

  • Modified drug target (e.g., quinolones)

  • Antibiotic modification (e.g., aminoglycosides)

  • Porin loss or mutation (reduces antibiotic entry

<ul><li><p><strong>Mutation in lipopolysaccharide</strong> (e.g., polymyxin resistance)</p></li><li><p><strong>Hydrolysis by β-lactamase</strong> (plasmid-acquired or overexpressed chromosomal genes)</p></li><li><p><strong>Overexpression of efflux pumps</strong> (multidrug resistance)</p></li><li><p><strong>Modified drug target</strong> (e.g., quinolones)</p></li><li><p><strong>Antibiotic modification</strong> (e.g., aminoglycosides)</p></li><li><p><strong>Porin loss or mutation</strong> (reduces antibiotic entry</p></li></ul><p></p>
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8

Non enterobacterales

Non-fermentative, Gram negative bacilli

Organisms

  • Pseudomonas aeruginosa

  • Acinetobacter baumannii

  • Stenotrophomonas maltophilia

  • Burkholderia cepacia

  1. Not normal flora

  2. Nosocomial infections

  3. Multi-drug resistant organisms

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9

Pseudomonas aeruginosa Pathogenesis

Acute→Invasive, hospital associated
Chronic→Decreased cytotoxicity, resistance, biofilm and adhesion

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10

Pseudomonas aeruginosa infections

CNS infections, Ear and eye infections, bacteremia, skin burn wounds, localized infections, UTIs, Resp tract infections, musculoskeletal tissue, surgical wounds

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11

Pseudomonas aeruginosa resistance

1)Intrinsic

2)Acquired

3)Adaptive

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12

Acinetobacter baumannii

Very similar to Pseudomonas

Mostly found in hospitals- can last days to week on equipment, infection control is key

Infects immunocompromised host

High crude mortality

Infections: pneumonia, open wounds, lines

SUPER RESISTNAT! URGENT THREAT

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13

Acinetobacter baumannii approved agent

Sulbactam-durlobactam (Xacduro)

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14

When should you cover for pseudomonas

Suspected hospital infection until pathogen identified

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15

Important clincial pear for non enterobacterales

INFECTION CONTROL AND PREVENTION

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16

Gram negative Cocci

Haemophilus Influenzae

Nisseria meningitidis

Neisseria gonorrhoeae

Moraxella

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17

Haemophilus Influenzae

Encapsulates facultative anaerobe

7 serotypes- type b more clinically important


Infections → Mostly children: CAP, meningitis, sinusitis, otitis media , conjunctivitis 

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18

Nisseria meningitidis

  • Requires culture from sterile body fluids like blood, Cerebrospinal Fluid, synovial, pleural, or pericardial fluid for diagnosis

  • Cause of meningitis 

  • Outbreaks in semi closed populations ie childcare centers, colleges, military camps

  • Treatment: B lactams


Treatment required noth higher bacteridicdal antibiotics & high CSF penetration- CEFTRIAXONE

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19

Neisseria gonorrhoeae

Transmission through sex or birth 

Complications: Pelvic inflammatory disease, epididymitis, disseminated gonococcal disease 

Very limited options to treat- Zoliflodacin & Gepotidacin (not yet approved)


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20

Chlamydia trachomatis

Number 1 bacteria STD in the USA

75% women no sx, 50% men no sx 

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21

Gram negative anaerobes

Metronidazole susceptible 


Bacteroides fragilis- Most common and pathogenic,

Lower GI, abdominal ascesses

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