What percentage of hospitalized patients develop nosocomial infections? a. 5% b. 10% c. 15% d. 20%
what is the cost of treating the nosocomial infections annually?
$4-$11 billion annually this is a huge problem
The most common sites for nosocomial infections are urinary tract infections and incisional infections.
what percentage of nosocomial infections are preventable? a. 50% b. 70% c. 93% d. 100%
The normal endogenous or environmental flora, which became pathogens in their hosts. - Usually due to a compromised defense system - Likely to occur with sever burns (1st line of defense is compromised), CA (chemo/radiation), Indwelling IVs or Urinary catheters, and AIDS
- Occurs in the presence of a suspected life threatening infection, I.e. Meningitis. - An antibiotic capable of killing the microorganism known to be the most common causative is given. - before the antibiotic is given, cultures must be obtained to identify the causative agent. once the organism is defined through the culture and sensitivity report, the antibiotic therapy can be tailored to the specific organism via a sensitivity report.
- Broad spectrum antibiotics are given with numbers organisms. - ** Overuse causes resistance - Narrow spectrum is active with only a few organisms - THE GOALIS TO USE THE NARROWEST SPECTRUM OF ANTIBIOTICS.
- Used to prevent an infection - Often will see this used before an invasive procedure; i.e. surgery, especially GI surgery, dental work, or suspected STD, pre-op heart valves (left ventricle not working)
To optimize the antibiotic therapy, patients should be assessed for therapeutic effects and adverse drug affects.
Therapeutic effects of antibiotics
1. decrease in the signs and symptoms of infections 2. decreased WBCs
- Occurs when the blood levels are too high, or when an allergic or adverse reaction occurs.
Major adverse reaction of antibiotic therapy
- rash, itching, hives, fever, chills, joint pain, and difficulty breathing or wheezing.
Minor reactions to antibiotic therapy
- GI discomfort - Diarrhea - Nausea
Occurs when antibiotics reduce or completely eliminate normal flora
- occur when antibiotics reduce or completely eliminate normal flora - a big issue because the body needs certain bacteria and fungi to maintain normal function--> the opportunity arises for other bacteria to take over-->infection
What is this an example of ? -Vaginal yeast infections occurs when normal vaginal flora is reduced by antibiotic therapy-->yeast growth goes wild.
A vaginal yeast infection is an example of a superinfection.
What is this an example of? - pseudomembranous colitis occurs due to the disruption of the normal GI flora-->overgrowth of Clostridium Difficule
Pseudomembranous Colitis (C-Diff) is and example of a superinfection.
what are common signs and symptoms of pseudomembranous colitis (C-Diff)
- Watery diarrhea - Abdominal Pain - Fever
In addition to superinfections, Secondary infections may occur also.
- an infections closely following a primary infection and comes from an external source. ex. a viral respiratory infections develops into a secondary bacterial infection.
- Considered a major health problem - A major cause is the over prescribing of antibiotics and patients not completing their prescribed course of antibiotics.
what is the primary cause of antibiotic resistance
- overuse of antibiotics
How do they do that?
1. produce enzymes that inactivate the drug 2. modify target sites for antibiotic 3. produce alternative enzyme to bypass antibiotic activity 4. change cell wall structure to decrease permeability
How do we stop antibiotic resistance?
1. reconstruct the antibiotic (very costly, very research and labor intensive, it takes years for drug to get FDA approval, 5-6 years to get on market) 2. Only treat true bacterial infections when necessary 3. Do NOT use antibacterials to treat viral infections, they are of no significant value.
Most common mechanics of antibiotic reaction
1. interference with bacterial cell wall synthesis 2. interference protein synthesis 3. Interference with replication of DNA and RNA 4. Disruption of antimetabolite action inside the bacteria.
what is the goal of antibiotic therapy?
to reduce or remove the presence of bacteria
- block synthesis of components necessary for cell metabolism and growth
Penicillins, Cephalosporins, and Vancomycins
- Inhibit formation of cell wall
- Inhibit DNA gyrase, and enzyme required for reproduction
Aminoglycosides, macrolides, ketolides, tetracyclines, linezolid, and quinupristin/dalfopristin
- bind to ribosomes and inhibit production of essential proteins.
Kills the organism
Inhibits the growth of the organism
Sulfonamides- Mechanism of Actions
- a bacteriostatic antibiotic (inhibit the growth of susceptible bacteria by preventing bacterial synthesis of folic acid) - Folic acid is necessary for formation of purine and pyrimidine (precursors of DNA & RNA)
True or False - Humans produce their own folic acid
False, humans must get folic acid from dietary sources.
True of False - Bacteria produce their own folic acid
Sulfonamides - Indications
- A broad spectrum of activity against both Gram+ and Gram- organisms. - Often used to treat urinary tract infections - Commonly susceptible organisms = enterobactor species, Escherichia coli, Klebsiella species, proteus mirabilis, proteus vulgaris, and S. aureus.
Sulfonamides - indications
- used in the treatment of Opportunistic infections in this with HIV (pneumocystis jirovecii) - sulfamethoxazole/trimethoprim (Bactrim, Septra) used to treat outpatient staphylococcus infections.
Sulfonamides - Contraindications
- Know Drug Allergy to Sulfonamides - Allergy to Celecoxib (celebrex) - Pregnant and lactating women and infants younger than 2 months of age - may cause birth defects and Kernicterus (a condition of abnormally high bilirubin which causes irreversible brain damage)
Sulfonamides - Adverse Reactions
- Believed to be immune mediated and involve production of reactive drug metabolites. - A common cause of allergic reactions; may be described as a "sulfa allergy" by patients --Typically delayed skin reaction which begin with a fever, followed by a rash. --Photosensitivity may occur when patient is exposed to sun light causing sever sunburn (use a lot os sunscreen) - Other reactions are: GI (N/V/D, abdominal pain and stomatitis), Hepatic (renal crystalluria, hematuria, protonuria), and Hematologic
Sulfonamides - Interactions
- May potentiate the hypoglycemic effects of sulfonylureas in diabetics, increase phenytoin toxicity, and enhance anticoagulant effects of warfarin (coumadin) - May decrease the effects of oral contraceptives
Sulfonamides - 1. Co-trimoxazole (Bactrim)
Dosage is one double strength tablet every 12-24 hours PO - IV 8-20mg/kg/day as Trimethoprim in divided doses q6-12 hours - Nursing considerations - make sure culture and specimen report is done. Monitor bowel patterns daily, assess skin for rash, monitor renal, hematological, and hepatic function.
Co-trimoxazole (Bactim) PO Dosage
1 double strength table q12-24 hours PO
Co-Trimoxzole (Bactrim) IV Dosage
8-20mg/kg/day as trimethoprim in divided doses q 6-12 hours
- Very commonly used drugs - 4 major sublcasses 1. Penicillins 2. Cephalosporins 3. Carbapenms 4. Monobactams Inhibit the synthesis of cell wall
1. some strains of bacteria lactamase which leads to bacterial resistance. due to this, beta lactamase inhibitors are added to several of the penicillin antibiotics to make the drug powerful agains the beta lactamase producing strains. Examples: - ampicillin/subactam (Unasyn) - Amoxicillin/Clavulanic Acid (Augmentin) - Ticarcillin/clavulanic acid (Timentin - Piperacillin/tazobactam (Zosyn)
1. Bactericidal antibiotics 2. discovered by Sir Alexander Flemming in 1928. Introduced in the 1940s WWII. 3. First drug to be effective against syphilis and staphylococcus infections.
Penicillins - Mechanism of actions
1. Inhibition of cell wall synthesis by entering the cell wall. 2. Some penicillins are too large to pass through the cell wall so they must find an appropriate binding site; Penicillin binding proteins. - Binding with these proteins-->interferes with normal cell synthesis-->defective cell walls that are weak-->cellular death by lysis (rupture)
Penicillins - Indications
1. Used in prevention and treatment of infections 2. Most commonly destroys gram+ organisms, (streptococcus, enterococcus, staphylococcus) 3. Extended spectrum penicillins have very good gram+, gram-, and anaerobic coverage. - used to treat many hospital acquired infections.
Penicillin - Contraindications
- Drug allergies - you need to also know the reaction, because it is individualized.
Penicillin - Adverse Effects
- Allergic reactions occur in 0.7-14% of treatment courses. - Most common reactions are: Urticaria, Pruritis, and angiodema. Unpredictable reactions are: maculopapular eruptions, eosinophilia, stevens-jackon syndrome, exfoliative dermatitis. - anaphylaxis is less common
Penicillin - Adverse effects
** Problem is: Cross sensitivity may occur with penicillins and cephalosporins. - patients must be asked to describe their allergic reaction. **** Those patients whose reactions include hives, and throat swelling should never be given cephalosporins.
Penicillin - Teaching
Have some form of ID, in case you cannot communicate in an emergency.
Penicillin - Interactions
1. Most oral forms of PCN are destroyed by acids. - avoid taking them with orange juice and cranberry juice.
Penicillin G (prototype) and Penicillin V Potassium
1. IM form is useful in treatment of sexually transmitted disease. 2. Limited use due to many stains which have developed resistance. PCN G is drug of choice for STREP PHARYNGITIS, reoccurrence of RHEUMATIC FEVER, and NEUROSYPHILIS. 3. PCN G is given IM - destroyed by stomach acid. 4. may cause cardiac arrest 5. contains 1.5mEq of potassium/1 million units--> watch for increased Potassium levels
Penicillin V Potassium
- The same as PCN G, BUT is NOT destroyed by gastric acid. -- Can only be given orally 125-500mg PO q6-8 hours
- resist breakdown by penicillin destroying enzyme (enicillinase) commonly produced by staphylococci. -Nafcillin, clxacillin (Apo-Cloxi), dicloxacillin, and oxacillin (Bactocill) are available