Beruflich Dokumente
Kultur Dokumente
microbiology%
Blood%culturing%
OBlood culture is a microbiological culture of blood.
Method%of%blood%culturing%
O A minimum of 10 ml of blood is taken through venipuncture and injected into two or
more "blood bottles" with specific media for aerobic and anaerobic organisms.
O A common medium used for anaerobes is thioglycollate broth.
O To maximise the diagnostic yield of blood cultures, multiple sets of cultures (each
set consisting of aerobic and anaerobic vials filled with 310 mL) may be ordered
by medical staff.
O A common protocol used in US hospitals includes the following:
O Set 1 = left antecubital fossa at 0 minutes
O Set 2 = right antecubital fossa at 30 minutes
O Set 3 = left or right antecubital fossa at 90 minutes
pathogenic organism in the blood and reduces the probability of having a positive
culture due to skin contaminants.
O After inoculating the culture vials, the vials are sent to the clinical pathology
microbiology department.
O Here the bottles are entered into a blood culture machine, which incubate the
specimens at body temperature.
O The blood culture instrument reports positive blood cultures (cultures with bacteria
present, thus indicating the patient is "bacteremic"). Most cultures are monitored
for five days, after which negative vials are removed.
If%positive%
OIf a vial is positive, a microbiologist will perform a Gram
Infective%endocarditis%and%
Microbiology%
OBacteraemia leads to colonisation of the thrombus
S.%aureus%
OA gram-positive coccal bacterium
OResponsible for many infections but it
Resistant%strains%
OMethicillin-resistant S. aureus [MRSA] is one of a number
S.%Aureus%&%Infective%
endocarditis%
OSigns & symptoms of endocarditis ! Initially presents
Management%of%S.%aureus%
OEmpiric therapy with penicillins or cephalosporins may be
OFor Endocarditis
and gentamicin)
OIn patients with MRSA, combinations of vancomycin with
aminoglycosides
ORifampin can be added to combination therapy, especially for
prosthetic valve endocarditis
ODuration of therapy is at least 4 weeks
OBacteremia, fever, and leukocytosis for at least a week after therapy is
initiated
Treatment%continued%
OSerious staphylococcal infections require
Strep.%pyogenes%
OStreptococci are a large group of gram-positive, nonmotile,
Rheumatic%Heart%Disease%&%
Streptococcus%pyogenes%
ORheumatic fever is a late inflammatory, nonsuppurative complication of
Management%of%RHD%
OFor carditis, the most important initial aspect is management of any
O enalapril 0.1 mg/kg (adult: 2.5 mg) orally, daily in 1 or 2 divided doses
O lisinopril 0.1 to 0.2 mg/kg (adult: 2.5 to 20 mg) orally, daily up to a maximum of
Classication%of%Streptococcus%species%
Haemolysis - The ability of bacterial colonies to induce hemolysis when grown on blood
agar is used to classify certain microorganisms
O Alpha/partial haemolysis - the agar under the colony is dark and greenish. Streptococcus
complete lysis of red blood cells. There are two types of streptolysin: Streptolysin O (SLO)
and streptolysin S (SLS).
OStreptolysin O is an oxygen-sensitive cytotoxin, secreted by most Group A streptococcus (GAS),
and interacts with cholesterol in the membrane of eukaryotic cells (mainly red and white
blood cells, macrophages, and platelets), and usually results in -hemolysis under the
surface of blood agar.
OStreptolysin S is an oxygen-stable cytotoxin also produced by most GAS strains which results
in clearing on the surface of blood agar. SLS affects immune cells, including
polymorphonuclear leukocytes and lymphocytes, and is thought to prevent the host immune
system from clearing infection. Streptococcus pyogenes, or Group A beta-hemolytic Strep
(GAS), displays beta hemolysis.
O Gamma - does not induce hemolysis, the agar under and around the colony is
Pharmacology of Antibiotics
Antibiotics
Type/Mechanism
Used On
Unwanted effects
Resistance
Cephalosporins
Glycopeptides
Narrow
spectrum
Bacterial meningitis
(Neisseria, streptococcus)
-Lactams
Contain a -lactam
ring; inhibit cell
wall synthesis by
binding to
transpeptidase,
inactivating it and
preventing crosslinking peptide
chains attached to
the peptidoglycan
backbone
Hypersensitivity
reactions
Ampicillin
Amoxycillin
Moderate
spectrum
Piperacillin
Ticarcillin
Broad
spectrum
Cephalexin
1st generation
Cefaclor
2nd generation
Ceftriaxone
3rd generation
Cefepime
4th generation
Pseudomonas aeruginosa
Vancomycin
Flucloxacillin is not
susceptible to -lactamase
Sinusitis
Septicaemia; pneumonia
Meningitis
1. Destruction by microbial
-lactamase
2. Failure to reach the target
transpeptidase alteration
of porins to reduce entry
3. Failure to bind to the
transpeptidase poor
affinity
Hypersensitivity
reactions
Ototoxicity,
nephrotoxicity
Augmentin = amoxicillin +
clavulanate clavulanate
competitively inhibits lactamase not susceptible
Alteration of the binding site so
that vancomycin cannot bind
(e.g. vancomycin-resistant
enterococcus, VRE)
Tetracycline
Doxycycline
Aminoglycosides
Gentamycin
Tobramycin
Macrolides
Erythromycin
Roxithromycin
Clarithromycin
GIT disturbances,
Vit B deficiency
Ototoxicity,
nephrotoxicity
GIT disturbances,
hypersensitivity
Inactivation by microbial
enzymes, alterations of cell
membrane
Plasmid-controlled alteration of
the ribosomal binding site