Lecture 10

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Medical Laboratory Science
Jenny Rhodes

MELS223 Lecture 10 09/08/13 Hospital-acquired infection  Infections not0 present and without evidence of incubation at the time of admission to a healthcare setting  - Onset 48 hours after admission or within 30 days of discharge  Nosocomial infections Who- rates of infection will increase because:  Crowded hospital conditions  Increasing number of people with compromised immune systems  New organisms  Increasing antimicrobial resistance  Perception that infection unavoidable Pathogenesis of hospital acquired infections – chain of infection!  Require susceptible host – age, underlying disease, drugs, diabetes  Virulent organism – antimicrobial resistance (70% of cases)  Portal of entry – anatomic barriers breached. Catheters, lines, ET rubes  Source of microbes (endogenous, exogenous-cross infection)  Transmission Sites of common HAI infection  Urinary Tract Infection  Lower respiratory tract infection; pneumonia  Surgical site infection  Bloodstream infection HAI: UTI  UTI = most common form of HAI  >80% infection associated with catheters  ~100% of patients develop bacteriuria after 30d catheter use  Infections often asymptomatic – reservoir of infection. Antimicrobial resistant gram negatives  Source or uropathogens: o Endogenous – catheter insertion o Retrograde movement up the urethra o Patient’s own faecal flora  Growth in biofilm = increased antimicrobial resistance -E.coli (30-50%) -Proteus, Klebsiella, Enterobacter (~10%) - Enterococci (10-20%) -Staph. Epidermidis (10-20%) -Pseudomonas (10%) - Candida (5%) Treatment/prevention = remove catheter  Amoxycillin, trimethoprim (drug resistance may occur)  Aseptic technique during insertion  Silver coated catheters HAI Pneumonia - Lower respiratory tract infection o Infection of alveoli and associated tissues o Inflammatory exudate and fluid in alveoli - Onset at least >48 hours after admission - 2 ndmost common HAI (13-18% of all HAI) Risk factors: intubation  ICU, Antimicrobials, Chronic lung disease/smoking  Old, immunosuppression Aetiology : gram negatives from faecal flora (aspiration of gastric contents)  Enterobacteriacae (Klebsiella, E.coli), Pseudomonas (equipment)  Staph. Aureas (20%). MRSA  Strep. Pneumoniae (~10%)  Haemophilus (5%)  Legionella/Acinetobacter (environmental)  Candida (yeast) Treatment  Empiric due to risk/potential for resistance to 1 choice drugs  Drugs can be altered once sensitivities determined  Needs to cover Pseudomonas, E.coli, Klbsiella and MRSA  Anti-pseudomonal penicillin (piperacillin) or aminoglycoside  3rd or 4thgeneration cephalosporin o Broad spectrum activity  MRSA – vancomycin or linezolid (new, expensive) Surgical Site Infections rd  3 most common  Endogenous sour
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