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Exam 2 - Micro/Immun

Clinical Microbiology Case

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
Created by: 576937752774223



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