ID atypical cell walls & antimicrobial stewardship

epidemic disease

- when the number of cases exceeds expectations
- ex = RSV bronchitis epidemics in young children every winter

antimycobacterials

- isoniazid
- pyrazinamide
- rifampin

isoniazid

- used to treat active TB with other medications or used to treat latent TB on its own
- inhibits the synthesis of mucolic acids in the cell wall of bacteria
- GI upset common
- may cause hepatitis during treatment or later months
- must take on empty stomach

rifampin

- has the ability to diffuse through membranes that block out most other antibacterial agents
- works extremely well agaisnt TB but resistance develops quickly
- must be used in combination with other drugs
- GI upset common
- turn body fluid orange/red.

antimycoplasmas

- macrolides
- tetracyclines
- fluroquinolones

tetracyclines

- doxycycline
- older kids >8 years old & adults

fluroquinolones

- levofloxacin
- ciprofloxacin
- adults only

endospores

- dormant cells highly resistant to harsh environmental conditions
- enables cells to survice harsh environmental conitions for extended periods of time
- only found in clostridioides, clostridium, and bacillus

endospore bacteria treatments

- antibiotics
- vancomysin
- fecal microbiota transplantation

vancomysin

- expensive
- requires other treatments alongside it
- relapse is very common

feccal microbiota transplantation

- cheap
- quick
- effective

endemic disease

- present in the population at relatively constant rate
- ex = gonorrhea

index case

- case that initiates an epidemiological investigation

superbugs

- resistant to several classes of antiboitics
- MRSA
- VRE
- CRE
- XDR-TB
- especially dangerous as health-case associated pathogens

acid-fast bacteria

- mycobacterium
- thick layers of peptidoglycan linked to mycolic acids
- grow extremely slowly
- requires special staining process to identify this bacteria

carbol fusion

- red dye that can penetrate acid-fast cell walls when heated

methylene blue

- counter-stain that provides contrast

pyrazinamide

- only used to treat TB
- converted to pyranzinoic acid inside the cell
- leads to a drop in intracellular pH which inhibits growth
- GI upset
- hepatoxicity
- photosensitivity

wall-less bacteria

- mycoplasma
- no cell wall, can only survice in isotonic environments
-usually very small
- will live inside the host cells for protection and to acquire necessary enzymes & nutients
- cannot use gram staining to identify

macrolides

- azithromycin
- kids and adults

antibioitc resistance

- bacteria naturally produce antibioitcs to help them compete for psace and resources
- occurs naturally in bacteria as a defense
- spontaneous mutations
- horizontal gene transfer

MOA drug resistance - Alter transport of drug into cell

can decrease permeability or transport drug back out of cell

MOA drug resistance - modify drug structure

- enzymes may alter structure
- drug may be degraded

MOA drug resistance - change the drugs cellular target

drug target may be modified by enzymes

human contribution to resistance

- antibioitcs do not cause resistance
- treatment of livestick
- using antibiotics to treat viral infections
- patients who do not fully comply with treatment

empiric antimicrobial therapy

- starts with 2-3 broad-spectrum antibiotics and tapers to narrow-spectrum antibiotics after pathogen is identified

pro of empiric antimicrobial therapy

- increased chance of sucess
- covers polymicrobial infections
- decreases chance of resistance

cons of empiric antimicrobial therapy

- expense
- damage of normal microbiota
- side effects

prohylaxis

administering antibiotics to a patient at high risk of contracting an infeciton

health-care associated infection

- acquired while receiving care at a medical facility
- most common complication for hospitalized patients
- immunocomprimise patients are vulnerable to secondary infection
- high concentration of drug-resistant pathogens in hospital
- invasive procedures provide new routes of infection

catheter-associated urninary tract infections

40% of all HAIs
- most common HAI
- correlates with teh duration of catheter use, nurse technique when emptying urine bag, & catheter insertion in surgical vs. non-surgical site

surgical site infections

- 38% of postoperative infections
- patients at hihger risk for sepsis
- surgical procedures are usually performed using aseptic techniques

health-care provider actions for decreasing the risk for SSIs

- preoperative nasal screening for MRSA colonization
- meticulous hand hygeine before donating sterile PPE
- irrigation of the incision site before closing to remove clots & debris
- insertion of postoperative drains to remove blood that could cause a hematoma
- collection of hand hygeine data on health care workers using everyday technologies

patient-specific actions for redusing the risk of SSIs

- preoperative skin preparation using a 2% CHG towelette for overnight treatment
- preoperative hair removal immediately before surgery using a razor
- neutrophil phagocytic activity enhanced blood glucose levels
- patient education for cleansing and dressing the incision before discharge
- professional postoperative incision care

central line-associated bloodstream infections

- 70% of hospitalized patients with a central line are not in the ICU
- high mortality rate
- 66-68% of CLABSI reduction with implementation of required practices

peripherally inserted central catheter line infections

- specialist wears surgical garb
- chlorhexidine scrub
- ultrasonography used to place line in patient covered in sterile drape

IV associated infections

- phlebitis = inflammation of vein
- usually associated with acidic or alkaline solutions or solutions that have hihg osmolarity
- can also occur from vein trauma during insertion, use of innapropriate IV catheter size for vein, or prolonged use of same IV site

social stringency

- use after using toilet, chnaging a diaper, before food prepartion, or eating
- use simple soap and 20-second handwashing
- removes 50-95% of transient

disinfectant stringency

use in medical settings
- use antimicrobial liquid soap, 60-95% alcohol rub/gel, or chlorhexidine gluconate for 30-60 seconds
- removes 99-99.9% of transient flora and detachable resident flora

surigical stringency

- use before surgical procedures
- use antimicrobial soap with brush scrubbing, hands above elbows to prevent hand recontamination with microbe-laden scrubs for 5 minutes
- removes 99-99.9% of transient flora and detachable resident flora

universal precautions

developed in 1980s to help prevent microbial transmission during rising rates of HBV & HIV transmission

standard precautions

updated standards whihc also include procedures that prevent spread of most infectious diseases in addition to blood-borne pathogens

PPE personal protective equiptment

wear PPE when the nature of the anticipated patient interaction indicates that contact with blood or body fluids may occur and remove and discard PPE before leaving patients room

gloves

should be worn when it can be reaosnably expected that contact with potentially infectious materials will occur

mouth, nose, eye protection

protect mucus membranes of eyes, nose, and mouth during patient-care activities tht are likely to generate splashes or sprays

gowns

should be worn when contact with blood, body fluids, secretions, or excretions is anticipated

PPE for contact with infectious patients

- isolation gown
- gloves

PPE for contact enteric with infectious patients

-gown
- gloves
- must wash hands with soap & water
- clean roon & equipment with bleach

PPE for droplet contact with infectious patients

- isolation gown
- gloves
- surgical/medical mask

PPE for airborne contact with infectious patients

- isolation gown
- gloves
- fit tested N95 respirator
- eye protection
- negative pressure roon with HEPA filtration

screening

- checking patients & providers for colonization with certain bacteria
- key for controlling MRSA infections
- patients swabbed upon admittance
- staff periodically swabbed to check for colonization with MRSA