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Exam 2 - Micro/Immun
Clinical Microbiology Case
| Term | Definition |
|---|---|
| Simplified Steps for us | 1. Assess presence, severity, & cause*** 2. Choose therapy that's effective & safe 3. Monitor effectiveness & safety |
| Chest S-ray (CXR) | Thoracic cavity shows clear lungs filled with oxygen if all black; pneumonia depicts white obstructions in the lungs |
| Step 1 - Presence, severity, cause List 5 reasons a patient is diagnosed with CA-pneumonia | 1. decreased breath sounds in lungs (respiratory PE findings), 2. increased WBC count (lukocytosis w left shit to increase bands & high neutrophils=bacterial infection), 3. Fever & inc. body temp. 4. CXR 5. HPI |
| Does this patient have a mild, moderate or severe infection? | Moderate infection bc: 1. PSI Class lll = mortality 0.9-2.8%, 2. CURB-65 score1-2 = mortality 2.7-6.8% 3. untreated pneumonia x10days |
| Sepsis/Septic Shock | leaky blood vessels so the heart compensated by increasing MAP |
| What causes of CAP would appear on the gram stain performed on JT's sputum sample? | C. pneumoniae and M. pneumonia |
| The tech sees yeast in the sputum sample. What's the likelihood that Candida is the cause of JT's pneumonia? | Very unlikely (<1%) bc JT is immunocompetent and yeast is a common colonizer of the oropharynx |
| Given the gram stain and morphology, what is the most likely cause of JT's CAP? | S. pneumonia |
| Step 2 - Effective and Safe Antibiotics : Make a list of IV antibiotics from highest to lowest susceptibility | Vancomycin( not a PO med.), Meropenem, Ceftriaxone, Moxifloxacin, Amoxicillin, Penicillin G, Azithromycin |
| Make a list of PO antibiotics from highest to lowest susceptibility | Cefdinir, Moxifloxacin, Amoxicillin, Azithromycin (No Vancomycin bc no systemic absorption) |
| Major Mechanisms of Resistance | 1. Decreased Permeability 2. Efflux Pumps - pump antibiotic out 3. Target Site Alteration - G+ orgs. do this type of antibiotic resistance commonly 4. Enzymatic Degradation/Modification - beta-lactamases = enzymes that degrade beta-lactam antibiotics |
| Step 3 - Monitor for Effectiveness and Safety: Suppose antimicrobial susceptibility results return as all susceptible except R:azithromycin. The most likely mechanism of resistance is... | macrolide efflux pump |
| Suppose antimicrobial susceptibility results return as all susceptible except R:azithromycin and R:clindamycin. The most likely mechanism of resistance is... | 50S ribosomal subunit mutation |
| Suppose antimicrobial susceptibility results return as all resistant except S: doxycycline. The most likely mechanism of resistance is... | penicillin binding protein mutation |
| What are gram stain and morphology results good for? | They can help determine the cause of an infection if one can first list the common organisms causing the specific infection. |
| What is an antibiogram used for? | It's used by clinicians bc it is a collection of Minimum Inhibitory Concentration (MIC) interpretive data that gives the percent of isolates susceptible to a wide range of antimicrobials. |
| When given an antimicrobial's mechanism of action,... | one can determine the likely way in which an organism may become resistant to that pathogen |
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