Professional Documents
Culture Documents
Bacteria
Bacteria
Gram-positive bacterium has a thick layer of peptioglycan. Gram-negative bacterium has a thin peptioglycan layer and an outer membrane.
Gram positive
Gram negative
Empiric Therapy
Administration of antibiotics based on the practitioners judgment of the pathogens most likely to be causing the infection; it involves the presumptive treatment of an infection to avoid treatment delay before specific cuture information has been obtained.
Antibiotics taken before anticipated exposure to an infectious organism in an effort to prevent the development of infection.
Superinfection
An infection occurring during antimicrobial treatment for another infection, resulting from overgrowth of an organism not susceptible to the antibiotic used. A secondary infection that occurs due weakening of the patients immune system by the first infection.
Examples of Superinfections
Fungal or yeast infection Diarrhea due to diminished normal flora of the gastrointestinal tract.
Laboratory Tests
Gram stain microscopic identification of organism Culture identifies causative agent and susceptibility to specific antibiotics Serology titers or antibodies measured CBC looking at WBC
Cultures
Clinical Pearl
Always collect culture: urine, sputum, wound drainage, or blood prior to starting antibiotic therapy. If technician is drawing blood make sure it has been done before starting antibiotics.
Antimicrobials
Two Classifications
Bactericidal drugs kill bacteria directly. Bacteriostatic drugs prevent bacteria from dividing or inhibits their growth.
Infectious Disease
Infections disease involves the presence of pathogen plus clinical signs and symptoms indicating infection. Microorganisms spread by direct contact with infected person or contaminated hands, food, water, or objects.
Opportunistic Infections
Severe burns Cancer HIV Indwelling IV catheter or urinary catheter Corticosteroid therapy Fungal or viral infections
Deep wounds Characterized by abscess formation, foul-smelling pus and tissue destruction
Community-Acquired Infection
Less severe and easier to treat, although drug resistant strains are increasing Remember Staph is everywhere it is normal flora on skin and in the upper respiratory tract MRSA: methicillin-resistant-Staphylococcus aureus
Nosocomial Infections
More severe and difficult to manage because they often result from drug-resistant microorganisms and occur in clients whose resistance is impaired
Pseudomonas Proteus
Bacterial Resistance
Bacteria develop the ability to produce substances which block the action of antibiotics or change their target or ability to penetrate the cells.
Widespread use of antimicrobial drug Interrupted or inadequate antimicrobial treatment of infection Type of bacteria gram-negative strains have higher rates of resistance Re-occurring infections Condition of the host Location critical care areas
Allergies Previous drug reactions Baseline renal and liver function Review culture reports for appropriate antibacterial drug choice Patient response to antibiotics therapy
Antibiotics
Sulfonamides
Action: inhibit the growth of bacteria (bacteriostatic antibiotic) by inhibiting the growth of susceptible bacteria by preventing bacterial synthesis of folic acid. Usually used in combination drugs.
Indications
Broad spectrum: can be used against gram negative and gram positive organisms Very useful in treating kidney infections since they achieve a high concentration in the kidneys. Susceptible organisms: Enterobacter, E.Coli, Klebsiella, Proteus Problem: organisms becoming more resistant
HIV patients with pneumocystis carinii May be given Bactrim or Septra prophylactically.
Contraindications
Drug allergy to sulfa Use of thiazide and loop diuretics Pregnant women Infants younger than 2 months of age
Adverse Effects
Most common is cutaneous reactions can occur weeks after therapy started.
B-Lactam Antibiotics
Penicillin
Penicillin
First generation IM or IV Newer penicillins have been developed that increase gastric acid stability of penicillin Good drug since it enters most bodily fluids: joint, pleural, and pericardial. Not effective against intraocular (eye) or cerebral spinal fluid infection (CSF)
Penicillin
Bactericidal action against sensitive bacteria Action: binds to bacterial wall, resulting in cell death
Susceptible Bacteria
Gram-positive organisms
Adverse Reactions
Most common reaction is GI (diarrhea) when administered orally. Urticaria, pruritus, and angioedema Severe reaction: Stevens Johns Syndrome Note: when giving IV or IM observe for to 1 hour after giving for adverse reactions.
Broad spectrum effective against several gram-positive and gram-negative bacteria E-coli, proteus, Salmonella, Shigella Not effective against staphylococci on gonococci Bronchitis, sinusitis, and otitis media
Ampicillin
Bactericidal action spectrum is broader than penicillin Binds to bacterial wall resulting in cell death
Nursing Implications
Same as penicillin Ask client about oral contraceptive use drug may cause transient decrease in effectiveness Advise to use additional BC barrier protection during antibiotic therapy
Amoxicillin
Oral equivalent of Ampicillin Readily absorbed and reaches therapeutic levels rapidly Drug of choice in prevention of bacterial endocarditis
Clients with total knee or hip replacement, heart valve replacement need to take prior to any dental work, endoscopy exams
Adults: 250 to 500 mg q8h Infants and children less than 20 kg:
Cephalosporins
Widely used drug derived from fungus Used against gramnegative bacteria Widely absorbed and distributed in most bodily fluids placenta and breast milk
Cephalosporin
First generation Cephalosporin drugs do not reach therapeutic levels in CSF (cerebral spinal fluid) but 2nd, and 3rd generation drugs do especially important in treating meningitis
Keflex (PO) still used extensively in treatment of skin infections Ancef often ordered preoperatively
Keflex (PO) still used extensively in treatment of skin infections Ancef often ordered preoperatively
Keflex
First generation cephalosporin Action: binds to bacterial cell wall membrane, causing cell death Therapeutic effect: bactericidal action against susceptible bacteria Active against many gram-positive cocci step and staph
Client teaching
May be taken with or without food but food may minimize the GI irritation Distribution: may cross placenta or enter breast milk in low concentrations. Excreted entirely by the kidneys.
Keflex Dosing
Cefazolin or Ancef
Cefazolin first generation cephalosporin Well absorbed following IM or IV administration Crosses to placenta and breast milk in small concentrations Minimal CSF penetration Excreted by kidneys
Ancef Dosing
IV Used for UTI, bone and skin infections, endocarditis Not suitable for treatment of meningitis Perioperative prophylaxis
1 gram within 60 minutes of incision Post operatively every 8 hours for 24 hours (3 doses)
Second-Generation Cephalosporins
More active against some gram-negative organisms and anaerobic organisms than the first generation drugs. May be effective in infections resistant to other antibiotics Penetration into CSF is poor but adequate to be used in meningitis Action: bactericidal binds to cell wall
Similar to the second generation but has increased activity against gram-negative pathogens even for drug resistant pathogens. CSF penetration is better than the first two generation cephalosporin drugs.
If a client is allergic to penicillin there is a 1 to 18% chance they will be allergic to cephalosporin drugs.
Carbapenems
Has very broad antibacterial action Are often used for complicated body cavity and connective tissue infections in the hospitalized patient.
imipenem-cilastatin (Primaxin) meropenen (Merrem): only drug in this class used in the treatment of bacterial meningitis.
Macrolides
Macrolides
Two of the new drugs in the macrolide classification: azithromycin and clarithromycin have longer duration and improved resistance to acid degradation in the stomach.
Macrolides
Action: work by inhibiting protein synthesis in susceptible bacteria. Contraindications: drug allergy Adverse effect: two new drugs have lower GI effects and are used in patients allergic to penicillin / cephalosporin drugs.
Ketaloids
Only one drug in this drug classification Generic: telithromycin Trade: Ketek Available for oral use only. Better acid stability and antibacterial coverage than macrolides.
Tetracyclines
Action: binds to divalent (Ca2 + mg2) and Al3 mettalic ions to form insoluble complexes. Why do you need to know this?
When given with milk, antacids or iron there is a reduction in oral absorption. Contraindicated in children under 8 years of age because it can result in tooth discoloration.
Tetracyclines
IM or IV administration Have more toxic side effects Blood levels may need to be monitored to determine therapeutic versus toxic levels of mediation in the blood.
Nephrotoxicity: Toxicity to kidneys, often drug induced and manifesting in compromised kidney function. Ototoxicity: Toxicity to the ears, often druginduced and manifested by varying degrees of hearing loss than is likely to be permanent. Pseudomembranous colitis: a necrotizing, inflammatory bowel condition associated with antibiotic therapy.
Aminoglycosides
Pharmacologic classification: Bactericidal drugs Therapeutic classification: anti-infective Action: inhibits protein synthesis at the level of the 30s ribosome Work primarily on dosing due to concentration dependent killing of bacteria
Concentration Dependent
A property of some antibiotics, especially aminoglycosides and vancomycin, of achieving a relatively, high plasma drug concentration, results in the most effective bacterial kill.
Trough levels: refers to lowest level of drug present in the blood plasma.
Since the drugs can cause severe adverse effects the excretion of the drug needs to be monitored. Blood drawn just before the next dose given.
Nephrotoxicity occurs in 5 to 25% and ototoxicity (damage to VIII cranial nerve) occurs in 3 to 14%.
Aminoglycosides
used to irrigate bowel before major bowel surgery Topical applied to eye and skin infections
Floroquinolones
Action: destroys bacteria by altering their DNA. Two most common drugs:
Used in treatment of chronic infections or deep (anaerobic) abdominal infections and MRSA.
Clindamycin or Cleocin can cause pseudomembranous colitis Signs and symptoms: abdominal pain and diarrhea
MRSA Infections
MRSA infection is caused by Staphylococcus aureus bacteria often called "staph." MRSA stands for methicillin-resistant Staphylococcus aureus. It's a strain of staph that's resistant to the broad-spectrum antibiotics commonly used to treat it. MRSA can be fatal.
Vancomycin
Action: destroys bacteria by binding to the bacterial cell wall, producing immediate inhibition of cell wall synthesis and death. Most common drug used in MRSA infections.
Adverse Effect
Red man syndrome has often been associated with rapid infusion of the first dose of the drug and was initially attributed to impurities found in vancomycin preparations. Even after improvement in vancomycin's purity, however, reports of the syndrome persist. Flushing on upper chest, neck and face Intervention: slow the infusion rate.
Anti-viral Drugs
Kill or suppress viruses by either destroying virons or inhibiting their ability to replicate. Does not irradiate the virus but helps the immune system to eliminate the virus.
Tamiflu and Relenza Uses: active against influenza virus types A and B. Shown to reduce the duration of influenza infection by a few days.
Herpes Zoster
Herpes simplex virus type 1: cold sore Herpes simplex virus type 2: genital herpes Human herpesvirus type 3: chicken pox or shingles Human herpesvirus type 4: Espstein Barr Virus Human herpesvirus type 5: CMV or cytomegalovirus
Herpes Drugs
Generic: acyclovir Trade: Zovirax Action: interferes with DNA synthesis. Therapeutic effects: Inhibition of viral replication, decreased viral shedding and reduced time for healing of lesions.
acyclovir