INFECTIONS AND ANTIBIOTICS

PATHOGENIC POTENTIAL OF MICROBES

EXALTATION PATHOGENIC SYNERGY

ASEPSIS

SURGICAL RITUAL STERILIZATION * Wet heat * Dry heat * Irradiation * Special sterilizing chemicals, liquid or gases DISINFECTION

SURGICAL INFECTION

Infection,bacteremia&septicaemia Microbiological diagnosis of infection Wound infection Peritionitis Pelvic inflammatory disease Burns Pressure sores Sepsis, shock & SIRS

WOUND INFECTION

FACTORS PREDISPOSING TO INFECTION * contamination * foreign material * virulence enhancing effect of some materials,such as soil,calcium and iron .salts * delay in primary intention * Pathogenic synergy * Dentalized tissue * oedema / pressure / constriction * impaired blood supply * extravasation of tissue fluids& blood * host factors lowering resistance TISSUE OXYGENATION SYMPTOMS & SIGNS OF INFECTION POST-OPERATIVE WOUND INFECTION

ANAEROBIC INFECTION

TETANUS GAS GANGRENE/OTHER CLOSTRIDIAL INFECTIONS PROGRESSIVE BACTERIAL GANGRENE&NECROTIZING FASCITIS OTHER ANAEROBIC INFECTIONS

HOSPITALACQUIRED(NOSOCOMIAL)INFECTIONS

SITES OF COLONIZATION HAND-BORNE OR SURFACEMEDIATED CHALLENGES AIRBORNE CHALLENGES INGESTED CHALLENGES INOCULATED CHALLENGES HAZARDS ASSOCIATED WITH INTENSIVE CARE

ANTIMICROBIAL MANAGEMENT OF WOUND INFECTIONS

ORGANISM Methicillin-sensitive Methicillin-resistant Coagulase-negetive Streptococcus pneumoniae Streptococcus pyogenes Streptococcus Bacteroides species Escherichia Coli -Sepsis - UTI Haemophilus influenza Klebsiella Proteus Pseudomonas aeruginosa Clostridia

FIRST CHOICE Flucloxacillin Vancomysin Vancomysin Benzylpeniocillin Benzylpenicillin Amoxicillin Metronidazole Cefuroxime or gentamicin

ALTERNATIVE Eryhthromycin,cefuroxime Clindamycin Telcoplanin,Linezolid Telcoplanin Erythromycin,Cefuroxime Ceftriaxone Erythromycin,clindamycin Gentamycin with Penicillin or Amoxicillin,Vancomysin Co-amoxiclav,Clindamycin Erythromycin

Ceftriaxone,ceftazidime, Ciprofloxacin Trimethoprim or Amoxicillin Coamoxiclav,Cefuroxime Cefotaxime,ceftazidine Norfloxacin Amoxicillin Co-amoxiclav,cefroxime Ceftriaxone,trimethoprim Chloramphenicol Cefuroxime or gentamicin Cefotaxime,ceftazidime, Ciprofloxacin,meropenem Cefuroxime or gentamicin Ceftriaxone,ceftazidime, Ciprofloxacin Ceftazidime with genatmicin Tazocin or Ciprofloxacin Benzylpenicillin,metronidazole Clindamycin, Erythromycin

PRINCIPLES OF GOVERNING THE CHOICE AND USE OF ANTIBIOTICS

INITIAL THERAPHY FOR ACUTE INFECTIONS Type of infection Antimicrobial Chest Infection -----------------Uncomplicated Amoxicillin,erythromycin Community-acquired pneumonia Cefuroxime+erythromycin Hospital-acquired/post operative Ceftazidime/ciprofloxacin+metronidazole Aspiration pneumonia Coamoxiclav or amoxicillin+metronidazole Atypical or legionella likey erythromycin or tetracycline UTI ---Lower infection Trimethoprim/amoxicillin/cephalexin/nitrofurantoin Acute pyelonephritis Cefuroxime/Ceftriaxone/ciprofloxacin/gentamycin Wound Infection -------------------Abdominal and Pelvic Metronidazole with 2nd or 3rd generation Cephalosporin or Benzyl Penicillin Genatmycin If Staph.Aureus suspected Fluxacillin or Cefuroximeor Erythromycin; Vancomycin for MRSA orCombination Theraphy As guided by sesnstivities Amputation and gas gangrene Benzyl Penicillin,Metronidazole Septicaemia and Septic Shock Bezyl Penicillin+Metronidazole and Genatamicin/ Ciprofloxacin Severe Pseudomonas infections Ceftazidime or piperacillin with Gentamicin for Candida Sepsis Synergy;ciprofloxin.amphotericin B; Alternative fluconazole

PROPHYLACTIC USE OF ANTIBIOTICS

SKULL FRACTURES & MENINGITIS TETANUS GAS GANGRENE PREVENTION OF ENDOCARDITIS CLEAN SURGERY GASTROINTESTINAL&GENITOURINARY SURGERY TREATMENT OF COMPOUND LIOMB FRACTURES PROSTHETIC IMPLANTS

MANAGEMENT OF IMMUNOSUPPRESSED PATIENTS(including those who had splenectomy)

PROPHYLAXIS TREATMENT ( A combination of Aminoglycoside with an antipseudomonal Penicillin or Cephalosporin is recommended for immunosuppressed patient )

INFECTION & ANTIBIOTICS

Clinical Scenarios

A 53 year old woman develops a swing pyrexia five days after an eventful cholecystectomy. On examination the wound appears inflammed, and there is oozing of pus from the upper end. Gram stain of the pus reveals Gram-positive cocci in cluster, with pus cells present

a)What is the likely organism? b)What antibiotic is likely to be helpful? c)What other intervention may be necessary?

A 70 year old man who is awaiting surgery for an enlarged prostate is admitted from home having been found collapsed by neighbours. He is confused and unable to give a history. Examination reveals only mild suprapubic tenderness, other systems are clear. He is pyrexial and hypotensive.

What is the likely diagnosis? What is the likely organism? What other intervention might be necessary?

A 65 year old man is transferred to ITU for ventilation after a difficult hemicolectomy. After three days of ventilation, he develops a low-grade pyrexia, rising white cell count and increased oxygen requirement.He had received treatment with amoxycillin for his chronic bronchitis before admission, and had prophylaxis with a second generation cephalosporin and metronidazole preoperatively. A tracheal aspirate shows moderate number of pus cells and Gram-negative bacilli. What is the likely organism?

What antibiotic would be most suitable for treatment?