Looks like no one added any tags here yet for you.
What is the reagent in the optochin test?
Ethylhydrocupreine hydrochloride
What is the optochin test?
Differentiates between streptococcus veridans and streptococcus pneumonia
Uses an optochin disc
What is the quelling test?
It can demonstrate capsules in an organism
Which tests are used to identify Streptococcus pneumoniae?
Quelling test, optochin test, bile solubility, latex agglutination/counterimmunoelectrophoresis
What species can sometimes give a false positive for coagulase?
Enterococcus
What is the most common cause of SBE?
Streptococcus viridans
Quantitative vs qualitative
Quantitative: Numerical measurement
Qualitative: Quality, not numerical value
Is Kirby-Bauer qualitative or quantitative?
Qualitative
What is the kirby-bauer test?
Qualitative test
Agar disc diffusion
Uses mueller hinton agar with a 3-5 mm depth in 100 or 150 mm plates
Stored at 4 C, pH 7.2-7.4
Divalent Ca2+ and cationic Mg2+ present affect the results of aminoglycosides, polymixinns, tetracyclines against Pseudomonas
4% NaCl enhances the ability to detect MRSA
Is MIC quantitative or qualitative?
Quantitative
What are dilution tests?
Quantitative
Give a more accurate measure of the probable in vivo effect of a drug
Results are expressed as the minimal concentration to inhibit (MIC) or to kill (MBC) the test strain
Why would a dilution test be done?
Blood cultures: Endocarditis and septicemia
Patients who fail to respond to adequate therapy
Patients who relapse while undergoing therapy
Pediatric cases of meningitis and septicemia
What is the antimicrobial gradient strip method, E-Test (Epsilometer)?
Quantitative MIC on agar containing a gradient of antimicrobial agent applied
0.5 McFarland and streak to agar twice within 15 minutes of adjusting turbidity
Do NOT incubate with CO2
What is the main test for beta-lactamase?
Chromogenic cephalosporin
What is the D-Test?
Inducible clindamycin resistance
Macrolide resistance in Staph and Strep are conferred by the erm gene which results in resistance to erythromycin and either inducible or constitutive resistance to clindamycin
What is the turbidity standard?
0.5 McFarland
Extended Specrum B-lactamase (ESBL)
Spontaneous mutations which result in novel B-lactamases can inactivate extended-spectrum cephalosporins, penicillins, and aztreonam
AmpC B-lactamase
Members of Enterobacteriaceae produce plasmid-mediated or chromosomal AmpC B-lactamase which confers resistance to cephamycins
Carbapenemase B-lactamase (CRE)
Members of Enterobacteriaceae that produce carbapenemase are often resistant to one or more of the carbapenems
Acinobacter is a major CRE organism
Resistance is to carbapenems, penicillins, cephalosporins, and aztreonam
Metallo-B-lactamase
New Delhi strain
Pseudamonas was the original organism, but now there are enterobacterialis
Bacteriacidal activity of serum
Testing the antibiotic that’s in the patient’s serum to see if it’s at the level they need to treat that organism
Known as the Schlichter test
Do NOT use plasma
What is synergism?
Effect of a combination is GREATER than the sum of the effect of each agent tested independently
What is additive or indifferent?
Effect of a combination is EQUAL to the sum of the effects of each agent or is no greater than that of the more active drug
What is antagonism?
Effect of a combination is less than the effect of the more active agent
What are the clinical uses of combination therapy?
Endocarditis caused by Enterococcus
Tuberculosis
Checkerboard/chessboard titration
Two drugs are diluted as for MIC determinations and then combined in sets consisting of each concentration of one drug against serial dilutions of the other
What is therapeutic drug monitoring?
Serum levels of antimicrobial agents
Don’t want the antimicrobial levels in the patient to get too high or low
Serum samples are drawn at certain times to monitor antibiotic levels
What is pharmacodynamics?
The absorption/presence of antibiotic in different tissues and sites
What is pharmacokinetics?
Concentration of drug in certain areas
What are the inhibitors of cell wall synthesis?
B-lactams: Penicillin, cephalosporins
Carbapenems: Imipenem
Glycopeptides: Vancomycin
Monobactams: Aztreonam
What are the inhibitors of cell membrane functions?
Most are against gram positive
Gram positives: Lipopeptides: Daptomycin
Gram negatives: Polymixins
Fungi: Amphotericin B
What are the inhibitors of protein synthesis?
Gram-positive and negative
Aminoglycosides
SPS counteracts aminoglycosides in some blood cultures
Tetracycline
Macrolides
What are the inhibitors of nucleic acid? (DNA and RNA)
Gram positive and negative
Quinolones
Fluoroquinolones
Most inhibit DNA
Rifampin: RNA
Nitrofurantoin: Urinary tract only
Nitromidazoles
What are the inhibitors of folic acid synthesis?
Sulfa drugs
Gram positive and many gram negative
Sulfonamides
What are the non-genetic causes of antibiotic resistance?
Enzymatic destruction
Enzymatic modification
Altered target (receptors)
Decreased uptake
Target overproduction
Efflux
Loss of target structure
What are the genetic causes of antibiotic resistance?
Intrinsic
Acquired resistance (Transfer)
What are beta-lactams?
Beta lactamase is produced by the organism. It hydrolyzes the beta lactam ring
What is penicillin?
Beta lactam
Not effective against gram negative rods
Soft tissue and body fluid have the highest concentrations
What is cephalosporin?
Beta lactam
Similar tro penicillin, better withstands the action of B-lactamase
Concentrated in soft tissue, poor concentration of CNS
Not absorbed well from GI tract
Treatment for urinary and respiratory infection, but not major systemic infections
Some nephrotoxicity
What are the other beta-lactams?
Carbapens: Broadest spectrum of all antimicrobial agents. Referred to as penems
Monobactams: Aztreonam is the only one. Broad spectrum. For gram negatives
What antibiotic cannot be used during pregnancy or used on infants?
Tetracyclines. It destroys the enamel of teeth and causes bone damage. Can cause green teeth
What are the urinary tract drugs?
Nitrofurantoin, nalidixic acid, phosphomycin is urinary tract ONLY
Fosfomycin is for E. coli and enterococcus
What antibiotic causes ota and renal toxicity?
Aminoglycosides
What is Kawasaki disease?
Mucocutaneous lymph node syndrome
Toxin is from Staph aureus
Found in children 5 and under
What is toxic shock syndrom?
Patient is acutely ill, febrile, toxemia
Hypotension, DIC (Disseminated intravascular coagulation)
Toxin causes the infection
Morphology of micrococcaceae
Spherical, gram positive cocci arranged singly, in pairs, clusters of 4 or 8 organisms
Catalase positive
Possess cytochrome enzymes which give a positive catalase
Non-motile, some pigmented
At what temperature is motility and pigment produced best at?
25 C
Staphylococcus aureus
Most important organism in this group
Can be found in any specimen
Responsible for a lot of skin infecetions and abscesses
Furuncles produce sinus tractsm colony grows to other sites and are harder to treat
Antibiotic resistant Staphylococcus are responsible for hospital acquired infection
Staph toxin can cause food poisoning
Metastatic lesions in lung, bone, kidney of 2/3 patients with bacteremia may develop endocarditis
How can an infection caused by Staph aureus be differentiated from Clostridium perfringes and salmonella?
Lack of fever and short duration
Scalded skin syndrome
Also known as Ritter’s disease
Generally in newborns, picked up from mom
Toxin causes skin to be very red
Staphylococcus lugdunensis
Can cause similar clinical issues as Staph aureus
Can be typical flora, but also can be a pathogen
Always significant in endocarditis following cardiac or open chest surgery
Significant with stitch abscesses
Colonies exhibit a white pigment
Staphylococcus saprophyticus
Opportunistic. Second most common cause of UTI
10^4 is the significant colony count
Seen sometimes in innear ear infections
What is the significant colony count of a UTI caused by Staphylococcus saprophyticus?
10^4
T/F: All Staphylococcus are salt tolerant
True
Staphylococcus hemolyticus
Causes hemolysis on blood
Very resistant to antibiotics
Primary culture of staphylococcus
Blood agar and thioglycollate are intially inoculated
Inoculate at 35 C
White, golden, yellow or cream colored colonies
Colonies appear after 24 hours on blood agar
What gene dermines if Staph aureus is going to me MRSA or not?
Mech A gene
What test separates Staphylococcus and Streptococcus?
Catalase test
Non-hemolytic (Gamma)
Applies to enterococcus more than anything else
No lysis of red blood cells around the colony
Alpha hemolysis
Green color surrounding the organism due to biliverdin (methemoglobin) released as RBC hemolysis is accomplished
Most grow better under CO2
Alpha prime hemolysis
Colonnies producing a zone of alpha hemolysis
Narrow zone encircles the colony with a zone of complete or beta hemolysis
Beta hemolysis
Total lysis of RBC’s around colony
Clear zone surrounnds the colony
Streptolysin O (SLO) is oxygen ____
labile
Streptolysin S (SLS) is oxygen ____
stable
Group A post-streptococcal diseases
Acute glomerulonephritis
Rheumatic fever
Scarlet fever
Impetigo
Toxic shock syndrome
Necrotizing fascitis
What antibiotic is highly concentrated in the biliary tree (liver)?
Penicillin
What antibiotic can cause aplastic anemia?
Chloramphenicol