Bacterial Infections

What does C Diff stand for?

Clostridium difficile

What type of bacteria is C Diff?

Anaerobic, spore forming bacillus (Gram + and Rod Shaped)

In c diff, how long can spores survive for ? Does it need oxygen?

For several months and no, it’s anaerobic.

What’s one of the leading hospital acquired infections?

Clostridium difficile

C Diff route?

Primarily through Fecal oral route

C Diff is the leading cause of what type of infection?

Nosocomial Infections

What does C Diff manifest as ? And what can it lead to?

\
* Manifests as diarrhea (incontinent), but can lead to fatal inflammation of colon ( chronic loose stools and runny stools in the fecal matter)

What is the risk group for C Diff?

- Antibiotic user
- \> 65 y/o
- Residing in room which housed C Diff pt 10-14 days prior

How to prevent C Diff?

* Contact Isolation
* BLEACH wipes >> 2 min air dry rule
* Need to use bleach wipes for whatever equipment you comin contact with the gait belts and such

What is the treatment for C Diff?

Flagyl, vancomycin, probiotics

What type of bacteria is Staphylococcal Infections? Where does it reside?

Anaerobic bacteria that normally reside in skin

Staph infections is a leading cause of what?

Nosocomial and community acquired infections (Endocarditis, prosthetic device infection)

How does a person get a staph infection?

Direct contact transmission \>> not easily removed by scrubbing

What is the most common location for colonization for Staph infection?

Nares

What is Risk Group for Staph Infections?

- Surgical/burn pts
- IDDM
- Neutopenic
- Prosthetics
- Chronic Skin Disease
- RA
- Catheter
- Corticosteroid Rx

How to prevent Staph infection?

Hand washing/education

What is pathogenesis for Staph Infection? And what happens once it invades?

- Usually by traumatic inoculation
- Once invades, secrete membrane damaging enzymes and toxins

What does Staph Infections manifests as?

Local abscesses file w/ pus and bacteria

Staph Infections may lead to what?

* Infections anywhere via bloodstream
* Bones, Joints, Kidney, lung, Heart Valves (endocardinitis-lining of the cardiac is compromised)

Symptoms of Staph Infection:

Fever, chills, pain, swelling over affected area, cellulitis

What is the most common Staph Infection?

Methicillin-Resistant Staphylococcus Aureus (MRSA)

What is treatment for MRSA?

Find antibiotic to fight strain (MRSA-Vancomycin)

What is this ?

Staphylococcus Infection

What is GAS?

Streptococcal Infection - Group A

What is the most common pathogen that affects humans at any age and is an example of GAS?

S. Pyogenes

How is GAS transmitted?

Via contact w/ respiratory droplets

What are Signs and symptoms of GAS?

Dependent upon location of infection

GAS is also known as what?

Strep Throat

What is incubation period for GAS?

1-5 days

What is possible pt presentation if they have GAS?

Fever, sore throat, beefy red pharynx, swollen tonsils and lymph nodes, malaise, abdominal pain

What is treatment for GAS?

Antibiotics to avoid post strep syndromes

What does Post Strep secondary conditions include for Strep Throat?

Rheumatic fever or acute glomerulonephritis-(damaging the filtration system of your kidneys)

How can you get Scarlet Fever ?

When you leave strep throat untreated or wound infections

What does Strep Strain release?

A Pyrogenic Exotoxin = (fever)

What is Scarlet Fever common in?

2-10 y/o

How is Scarlet Fever Transmitted?

By direct inhalation or direct contact with oral secretions

(think about your contact precautions and what you need to wear)

What does a pt with Scarlet Fever present with?

* Fever
* Sore Throat
* Strawberry Tongue
* Rash that looks like Sand paper (it spreads from Chest to Extremities)

What infection is this?

Scarlet fever

What is Impetigo caused by?

Mainly by GAS but also by other strep and staph species

What is Impetigo most common in?

Children 2-5 y/o especially in hot, humid weather

What are the risks for Impetigo?

Close contact, over crowding, poor skin hygiene, minor skin trauma

What is the best defense against Impetigo? And why?

Good Hygiene since colonization usually precedes infection

What does a pt with Impetigo present with?

Small macule \>> Vesicles (pus and encrust)

What may spread Impetigo? And what can it cause?

Scratching and can cause cellulitis/lymphadenitis

Does Impetigo pts with Impetigo have fever or pain?

NOOO Just uncomfortable and itchy

What infection is this?

Impetigo

What causes Erysipelas ?

It’s caused by Streptococcal Bacteria 

What is Erysipelas?

Superficial cellulitis with fever and chills

Where is Erysipelas usually found on?

* Face and legs ( very well defined, you can see it where it starts and stops)

Erysipelas is most common in which gender?

Women

What does Erysipelas look like? And what can form in a couple of days?

- Skin is RED (well demarcated), shiny, and swollen
- Bullae (blisters) may form in couple of days

How is Erysipelas treated?

w/ antibiotics

What infections is this?

Erysipelas

What is Streptococcal Cellulitis?

Inflammation of skin and subcutaneous tissues

Where is Streptococcal Cellulitis usually at?

Wound site, but entire site not always noted

Where can Streptococcal Cellulitis reoccur at?

In extremities w/ impaired lymph drainage

How does Lymphangitis present? (Streptococcal Cellulitis)

Red linear streak from affected area toward tender, swollen lymph nodes

What infection is this?

Streptococcal Cellulitis

What is Streptococcal Necrotizing Fasciitis (NF)?

Serious, rapidly progressive infection along fascial planes

In Streptococcal Necrotizing Fasciitis (NF), is it painful and what can you lose?

Yes it is very painful and you can lose skin tissue

What is Type 1 NF?

- Polymicorbial infection - p/o complication

What is Type 2 NF?

Distal break in skin or transient bacteremia

Pt presentation of NF? (4) steps, what happens initially and then what does the skin become?

● Initially, pain and fever present while skin looks healthy
● Infection rapidly spreads \> edema and tenderness
● Thrombosis of blood vessels \> dark red and indurated
● Ultimately, skin becomes ischemic (black and friable)

S/S of NF? (4)

- Hypotension
- Nausea
- Vomiting
- Delirium

Does NF have a high mortality rate? And why?

* Yes, because of:
* Toxic Shock
* Kidney and Liver Failure
* Pulmonary Infiltrates

What is treatment for NF?

* Aggressive debridement w/ IV antibiotics

What is needed in order to determine antibiotic choice?And what does does it need? (NF)

- Culture and gram staining
- May need serial debridement

What infection is this ?

Streptococcal Necrotizing Fasciitis (NF)

What infection is this?

Streptococcal Necrotizing Fasciitis (NF)

What is Streptococcus Pneumoniae a cause of? (4)

- PNA
- Sepsis
- Otitis Media
- Meningitis

How is Streptococcus Pneumoniae transmitted?

Direct contact or inhalation of respiratory secretions

Streptococcus Pneumoniae is the most common cause of what?

- Community-Acuired PNA
- Death by preventable bacterial diseases by vaccination

Streptococcus Pneumoniae vaccine is recommended for what population?

- \> 65 y/o
- Individuals w/ chronic diseases or compromised immunity

Streptococcus Pneumoniae pt presentation (7)

- fever
- pleuritis with pain
- dyspnea
- productive cough
- purulent sputum
- elderly with delerium
- slight cough

What are complications of Streptococcus Pneumoniae?

- Empymea
- Bacteremia
- Sepsis
- Meningitis

What is required to select appropriate antibiotic for Streptococcus Pneumoniae?

Culture fluid and Gram Staining

What is Gas Gangrene? And what is it caused by?

- Rare, painful
- Caused by Anaerobic Bacteria (Clostridial Myonecrosis)

What happens to the muscles and subcutaneous tissues with Gangrene?

Muscles and subcutaneous tissues fill with gas and exudate

What does gangrene usually follow after?

Follows trauma or surgery

What can happen in a couple of hours with gangrene?

It spreads rapidly so death can follow within hours

Gangrene growth is uncommon in what?

Healthy human tissue UNLESS devitalized tissue w/ severe trauma present

Where is Gangrene usually found?

deep wounds

What gasses are produced subcutaneously when pt has Gangrene?

CO2 and H Gasses

Gangrene Incubation period?

< 3 days after injury

What are Signs and symptoms of Gangrene?

- Cool skin
- Pallor/Cyanosis
- Sudden/Sever Pain
- Sudden edema
- Loss of Extremity pulses

What happens to the skin of Gangrene pt?

* Skin darkens because of cutaneous necrosis and hemorrhage
* Thick discharge w/ foul odor

In gas gangrene, whats it called when you palpate the skin from gas bubbles?

Crepitation

What’s the key prevention to avoid Gangrene?

Cleaning Wounds

How can you treat gas gangrene?

surgical debridement and antibiotics

What infection is this?

Gas gangrene

What type of bacteria is Pseudomonas?

Pseudomonas aeruginosa-opportunistic bacteria

What does Pseudomonas cause?

PNA, wound infections, UTI, Sepsis

Where does Pseudomonas thrive in?

Moist environment surfaces

Is Pseudomonas antibiotic resistant?

YESS which is why it’s tough to treat

Pseudomonas aggressive growth often leads to what?

Sepsis in population with low immunity

How does a person contract Pseudomonas?

Contact transmission

What are the 3 ways to prevent Pseudomonas transmission?

- Proper hand hygiene
- Proper cleaning of equipment
- Strict Sterils techniques w/ wounds

What does Pseudomonas produce?

Variety of proteins which helps to evade host's immune response

Pseudomonas damages what?

- Epithelial cells uncovering binding sites or P. Aeruginosa

What does Pseudomonas produce for protection?

Proteoglycan