Infections

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Infections

  1. 1. INFECTIONS AND ANTIBIOTICS dr shabeel pn www.hi-dentfinishingschool.blogspot.com
  2. 2. PATHOGENIC POTENTIAL OF MICROBES <ul><li>EXALTATION </li></ul><ul><li>PATHOGENIC SYNERGY </li></ul>
  3. 3. ASEPSIS <ul><li>SURGICAL RITUAL </li></ul><ul><li>STERILIZATION </li></ul><ul><li>* Wet heat </li></ul><ul><li>* Dry heat </li></ul><ul><li>* Irradiation </li></ul><ul><li>* Special sterilizing chemicals, liquid or gases </li></ul><ul><li>DISINFECTION </li></ul>
  4. 4. SURGICAL INFECTION <ul><li>Infection,bacteremia&septicaemia </li></ul><ul><li>Microbiological diagnosis of infection </li></ul><ul><li>Wound infection </li></ul><ul><li>Peritionitis </li></ul><ul><li>Pelvic inflammatory disease </li></ul><ul><li>Burns </li></ul><ul><li>Pressure sores </li></ul><ul><li>Sepsis, shock & SIRS </li></ul>
  5. 5. WOUND INFECTION <ul><li>FACTORS PREDISPOSING TO INFECTION </li></ul><ul><li>* contamination </li></ul><ul><li>* foreign material </li></ul><ul><li>* virulence enhancing effect of some materials,such as soil,calcium and iron .salts </li></ul><ul><li>* delay in primary intention </li></ul><ul><li>* Pathogenic synergy </li></ul><ul><li>* Dentalized tissue </li></ul><ul><li>* oedema / pressure / constriction </li></ul><ul><li>* impaired blood supply </li></ul><ul><li>* extravasation of tissue fluids& blood </li></ul><ul><li>* host factors lowering resistance </li></ul><ul><li>TISSUE OXYGENATION </li></ul><ul><li>SYMPTOMS & SIGNS OF INFECTION </li></ul><ul><li>POST-OPERATIVE WOUND INFECTION </li></ul>
  6. 6. ANAEROBIC INFECTION <ul><li>TETANUS </li></ul><ul><li>GAS GANGRENE/OTHER CLOSTRIDIAL INFECTIONS </li></ul><ul><li>PROGRESSIVE BACTERIAL GANGRENE&NECROTIZING FASCITIS </li></ul><ul><li>OTHER ANAEROBIC INFECTIONS </li></ul>
  7. 7. HOSPITAL-ACQUIRED(NOSOCOMIAL)INFECTIONS <ul><li>SITES OF COLONIZATION </li></ul><ul><li>HAND-BORNE OR SURFACE-MEDIATED CHALLENGES </li></ul><ul><li>AIRBORNE CHALLENGES </li></ul><ul><li>INGESTED CHALLENGES </li></ul><ul><li>INOCULATED CHALLENGES </li></ul><ul><li>HAZARDS ASSOCIATED WITH INTENSIVE CARE </li></ul>
  8. 8. ANTIMICROBIAL MANAGEMENT OF WOUND INFECTIONS <ul><li>ORGANISM FIRST CHOICE ALTERNATIVE </li></ul><ul><li>Methicillin-sensitive Flucloxacillin Eryhthromycin,cefuroxime </li></ul><ul><li>Clindamycin </li></ul><ul><li>Methicillin-resistant Vancomysin Telcoplanin,Linezolid </li></ul><ul><li>Coagulase-negetive Vancomysin Telcoplanin </li></ul><ul><li>Streptococcus pneumoniae Benzylpeniocillin Erythromycin,Cefuroxime </li></ul><ul><li>Ceftriaxone </li></ul><ul><li>Streptococcus pyogenes Benzylpenicillin Erythromycin,clindamycin </li></ul><ul><li>Streptococcus Amoxicillin Gentamycin with Penicillin </li></ul><ul><li>or Amoxicillin,Vancomysin </li></ul><ul><li>Bacteroides species Metronidazole Co-amoxiclav,Clindamycin </li></ul><ul><li>Erythromycin </li></ul><ul><li>Escherichia Coli </li></ul><ul><li>-Sepsis Cefuroxime or gentamicin Ceftriaxone,ceftazidime, </li></ul><ul><li>Ciprofloxacin </li></ul><ul><li>- UTI Trimethoprim or Amoxicillin Coamoxiclav,Cefuroxime </li></ul><ul><li>Cefotaxime,ceftazidine </li></ul><ul><li>Norfloxacin </li></ul><ul><li>Haemophilus influenza Amoxicillin Co-amoxiclav,cefroxime </li></ul><ul><li>Ceftriaxone,trimethoprim </li></ul><ul><li>Chloramphenicol </li></ul><ul><li>Klebsiella Cefuroxime or gentamicin Cefotaxime,ceftazidime, </li></ul><ul><li>Ciprofloxacin,meropenem </li></ul><ul><li>Proteus Cefuroxime or gentamicin Ceftriaxone,ceftazidime, </li></ul><ul><li>Ciprofloxacin </li></ul><ul><li>Pseudomonas aeruginosa Ceftazidime with genatmicin Tazocin or Ciprofloxacin </li></ul><ul><li>Clostridia Benzylpenicillin,metronidazole Clindamycin, </li></ul><ul><li>Erythromycin </li></ul><ul><li>Clostridium difficile Stop predisposing antibiotic Metronidazole </li></ul><ul><li>Or Vancomycin </li></ul>
  9. 9. PRINCIPLES OF GOVERNING THE CHOICE AND USE OF ANTIBIOTICS <ul><li>INITIAL THERAPHY FOR ACUTE INFECTIONS </li></ul><ul><li>Type of infection Antimicrobial </li></ul><ul><li>Chest Infection </li></ul><ul><li>------------------ </li></ul><ul><li>Uncomplicated Amoxicillin,erythromycin </li></ul><ul><li>Community-acquired pneumonia Cefuroxime+erythromycin </li></ul><ul><li>Hospital-acquired/post operative Ceftazidime/ciprofloxacin+metronidazole </li></ul><ul><li>Aspiration pneumonia Coamoxiclav or amoxicillin+metronidazole </li></ul><ul><li>Atypical or legionella likey erythromycin or tetracycline </li></ul><ul><li>UTI </li></ul><ul><li>---- </li></ul><ul><li>Lower infection Trimethoprim/amoxicillin/cephalexin/nitrofurantoin </li></ul><ul><li>Acute pyelonephritis Cefuroxime/Ceftriaxone/ciprofloxacin/gentamycin </li></ul><ul><li>Wound Infection </li></ul><ul><li>-------------------- </li></ul><ul><li>Abdominal and Pelvic Metronidazole with 2nd or 3rd generation </li></ul><ul><li>Cephalosporin or Benzyl Penicillin </li></ul><ul><li>Genatmycin </li></ul><ul><li>If Staph.Aureus suspected Fluxacillin or Cefuroximeor Erythromycin; </li></ul><ul><li>Vancomycin for MRSA orCombination Theraphy </li></ul><ul><li>As guided by sesnstivities </li></ul><ul><li>Amputation and gas gangrene Benzyl Penicillin,Metronidazole </li></ul><ul><li>Septicaemia and Septic Shock Bezyl Penicillin+Metronidazole and Genatamicin/ </li></ul><ul><li>Ciprofloxacin </li></ul><ul><li>Severe Pseudomonas infections Ceftazidime or piperacillin with Gentamicin for </li></ul><ul><li>Candida Sepsis Synergy;ciprofloxin.amphotericin B; </li></ul><ul><li>Alternative fluconazole </li></ul>
  10. 10. PROPHYLACTIC USE OF ANTIBIOTICS <ul><li>SKULL FRACTURES & MENINGITIS </li></ul><ul><li>TETANUS </li></ul><ul><li>GAS GANGRENE </li></ul><ul><li>PREVENTION OF ENDOCARDITIS </li></ul><ul><li>CLEAN SURGERY </li></ul><ul><li>GASTROINTESTINAL&GENITOURINARY SURGERY </li></ul><ul><li>TREATMENT OF COMPOUND LIOMB FRACTURES </li></ul><ul><li>PROSTHETIC IMPLANTS </li></ul>
  11. 11. MANAGEMENT OF IMMUNOSUPPRESSED PATIENTS(including those who had splenectomy) <ul><li>PROPHYLAXIS </li></ul><ul><li>TREATMENT ( A combination of Aminoglycoside with an antipseudomonal Penicillin or Cephalosporin is recommended for immunosuppressed patient ) </li></ul>
  12. 12. INFECTION & ANTIBIOTICS <ul><li>Clinical Scenarios </li></ul>
  13. 13. 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?
  14. 14. <ul><li>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. </li></ul><ul><li>What is the likely diagnosis? </li></ul><ul><li>What is the likely organism? </li></ul><ul><li>What other intervention might be necessary? </li></ul>
  15. 15. <ul><li>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. </li></ul><ul><li>What is the likely organism? </li></ul><ul><li>What antibiotic would be most suitable for treatment? </li></ul>

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