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PATHOGENESIS OF INFECTION
Host Defenses
o Prevent microbial invasion
o Limit microbial proliferation within the host
o Contain or eradicate invading organisms
o Include site specific defenses (first line of host
defenses)
Skin
Respiratory Tract
Ex. Entry of foreign body ---- action
of macrophages--- movement of
prganisms towards the upper
respiratory tract with the help of
cilia --- coughing out and release
o Circulate throughout the body
Polymorphonuclear neutrophils/PMNs
Causes eradication of microbes that
invade the systemic circulation
1
Definitions
o Possible Outcome
Eradication
Containment
Ex. Acne
Locoregional infection with or without
distant spread of infection
Ex. Local infection that led to
myofascitis (inflammation of a
muscle and its fascia)
Systemic infection
o Infection identification of microorganisms in
host tissue or blood stream, plus an
inflammatory response to their presence
o SIRS/Systemic Inflammatory Response
Syndrome constellation of signs and
symptoms brought about by the presence of
inflammation; not localized
o Sepsis - presence of SIRS caused by infection (mediated by cascade of proinflammatory
mediators produced in a response to exposure
to microbial products
o Severe Sepsis - characterized by sepsis with the
presence of an organ failure
o Septic Shock - state of acute circulatory failure
identified by the presence of arterial
hypotension despite adequate fluid
resuscitation, without other identifiable cause.
- Most severe manifestation of infection
b. Empiric
Comprises
the
use
of
antimicrobial agent when risk of
infection is high, based on the
underlying disease process
Should be Limited to a short
course (3 to 5 days)
Ex. In appendicitis, antimicrobials
are given because of the expected
presence of gram negative
microorganisms in the colon
c. Treatment of established infection/
Specific
Antimicrobials are given after
determination by gram stain or
culture and sensitivity
d. Duration
decided upon when regimen is
prescribe
Therapy for monomicrobial
infections:
3 to 5 days = UTIs
7 to 10 days = pneumonia
6 to 12 weeks = osteomyelitis,
endocarditis or prosthetic
infections
least toxic, least expensive and
most sensitive to which the
organism is sensitive to must be
the drug of choice.
e. Allergies
must be considered before
prescribing antibiotics
Patients undergo intradermal
testing ( ex: vancomycin)
f.
Misuse
rampant in the inpatient and
outpatient setting
emergence of Clostridium difficile
colitis, and other multidrug
resistant pathogens
must limit prophylaxis to the
therapy and not included in the
empiric therapy except under well
defined conditions
ii.
INTRA-ABDOMINAL INFECTIONS
aka peritonitis
Microbial contamination of the peritoneal
cavity
(taken from Schwartz 9th ed pp. 124-125)
spreading cellulites and pain on motion of his right hip 2 weeks after
total colectomy