Microbiology

General classes of bacteria

 Gram (+)
 Gram (-)
 Anaerobes
 Atypicals

Gram + thicker membrane… mnemonic bulletproof vest

Gram – thin membrane….. mnemonic dry wall

Gram (+)

Staphylococcus

 “bunch of grapes”
 Clusters
 Catalase positive
 Staphylococcus aureus
o Clinical manifestations range from benign skin infections to life-threatening conditions
o Frequent colonizer of the skin and mucosa
o Skin and soft tissue
 Impetigo
 Folliculitis
 Probably caused by nasal colonization
 Furuncles, carbuncles, abscess
 Hidradenitis suppurativa
 Cellulitis
 Erysipelas
 Fasciitis
 Pyomyositis
 Mastitis
 Surgical site infections
o Generally present with purulence and abscess
o MSSA – Methacillin sensitive staph aureus
o MRSA – Methacillin resistant staph aureus
 Produces beta lactamase
 Trimethoprim-sulfamethoxazole (Bactrim)
 Doxycycline (Vibramycin)
 Minocycline (Minocin)
 Clindamycin (Cleocin)
 Linezolid (Zyvox)
 Vancomycin (Vancocin)
 Daptomycin (Cubicin)
 Delafloxacin
 Ceftaroline (Teflaro)
 Coagulase negative staphylococci
o Part of the normal flora of human skin
 o Staphylococcus epidermidis is the most common
o Less virulent that staph aureus
o Infectious vs contaminant

Streptococcus

 Chains or pairs
 Anaerobic
 Catalase negative
 Subdivided into groups by antibodies that recognize surface antigens
o A, B and D
 Viridans
o Do not possess group antigens
 Three types of hemolysis
o Alpha
 Partial hemolysis
 Viridans and Group D
o Beta
 Complete hemolysis
 Group A and B
o Gamma
 No hemolysis
 Group D
 Strep pyogenes
o Group A
o Suppurative pharyngitis (strep throat)
 Sore throat, fever, headache, cervical lymphadenopathy, sick contacts, no cough
o Rheumatic fever
 Inflammatory disease affecting primarily the heart and joints
 Occurs weeks to months after exposure to strep pharyngitis
 Decreased since discovery of PCN
o Post-streptococcal glomerulonephritis
 Immune complex disease of the kidney
 Patient usually have protein in urine
o Scarlet fever
 Begins with a fever and sore throat
 One or two days after onset, a red rash appears
 Initially on the neck, under the arms, and in the groin
 Spreads other parts of the body
 First, the rash is flat, red patches which gradually become fine bumps and feel like
sandpaper
 Rash subsides in about a week and the skin may peel around the finger tips, toes, and
groin area
 Strep agalactiae
o Group B
o In adults, most commonly cause bloodstream infections, pneumonia, skin and soft-tissue
infections, and bone and joint infections
o In newborns, can cause sepsis, pneumonia, and neonatal meningitis
  Transmission from the normal vaginal flora
 Abx during labor can prevent transmission
 Enterococcus
o Group D
o Most common is E. faecalis
o Found in the gut flora
o Infection follows fecal contamination
o Commonly the cause of UTI
o Vancomycin resistant enterococcus (VRE)
 Treated with Linezolid, Daptomycin
 Strep viridans
o Found in the mouth
o Cause endocarditis after release into the bloodstream from tooth extraction and cleanings
o They adhere to fibrin-platelet aggregates at damaged heart valves
o Patients with mechanical heart valves need to be put on prophylactic abx
o If someone having poor dental hygiene, one can ended up having bacterial endocarditis

 Strep pneumoniae
o Diplococci
o More than 90 strains
o Pneumonia, meningitis, otitis media
o Vaccinations
 Pneumovax
 65 years or older
 <65 years old with underlying medical conditions
o Anatomic asplenia
o Chronic renal failure or nephrotic syndrome
o Immunocompromised
o Congestive heart failure
o COPD
o Diabetes
 Revaccination
o 5 years after first dose, then every 10 years
 Prevnar 13
 > 65 years old
 Revaccination is not recommended

Clostridium

 Gram positive rods

 Found in the environment (soil) but also our intestines
 Clostridium tetani
o Spore is commonly found in the soil, dust, and animal feces
o Spores enter the wound where they germinate and produce tetanus toxin
o Puncture wounds are most susceptible
o The exotoxin (tetanospasmin) stops nerve impulse transmission to muscle leading to spastic
paralysis
o Most common is lockjaw (trismus)
 o Vaccination
 Given every 10 years
 Clostridium perfringens
o Causes gas gangrene
 Swelling of the tissues due to release of gas
 Think diabetic foot
 Compound fracture following biliary track surgery
 Clostridium botulinum
o Rare but fatal form of food poisoning
 Pre-formed exotoxin from prior germination of spores may be present in inadequately
autoclaved canned food
o Also found in the soil
o Inhibits the release of acetylcholine and inhibits nerve impulses
 Flaccid paralysis
o No honey in children <4 years old
 Clostridium difficile
o Frequently a nosocomial infection
 Pseudomembranous colitis
 Toxic megacolon
 Perforation of the colon
 Sepsis
 Causes diarrhea
o Patients at risk
 Recent abx use
 PPI
 GI surgery
 Long length of stay in healthcare setting
o These patients require isolation

Listeria

 Meningitis in neonates
 Food poisoning
 Common in elderly and pregnant women.

Corynebacterium diphtheria

 Colonization in the upper respiratory tract and less commonly the skin
 The organism does not produce a systemic infection
 Produces an exotoxin that causes myocarditis and neuropathy
 Vaccination
o DPT
 With pertussis and tetanus

Bacillus anthracis
  Found in sheep, cattle, horses, goats and swine
 Transmitted to humans via inoculation of broken skin or mucous membranes, or by inhalation
 Two toxins
o Edema toxin
o Lethal toxin

Gram (-)

Neisseria

 Diplocci
 Meningitis
o Common in young patients in close contact
o Must treat close contacts
 Gonorrhea

Escherichia coli

 Rods
 Live in the human gut
 Common in UTI
 Frequently causes diarrhea

Haemophilus influenza

 Bacillus
 Vaccination
o Hib
 Meningitis
 Conjunctivitis
 Cellulitis
 Epiglottitis
 Otitis media in children
 Bronchitis in adult
 Pneumonia – particularly those with underlying pulmonary conditions

Spirochetes

 Long, thin, helical and motile

 Treponema pallidum
o Syphilis
 Borrelia burgdorferi
o Lyme disease from insect bite e.g tick
Mycobacterium

 Tuberculosis
o Acid fast bacilli
o PPD
 Positive test does not indicate actively disease, it indicates exposure
 If positive, check CXR
o Treatment
 9 months
 Isoniazid, Rifampin, Ethambutol, Pyrazinamide
 Isoniazide and B6
 Isoniazide is hepatotoxic and causes decreases in B6
o Vaccination
 BCG vaccination has not been shown to be effective in most studies
 Widespread vaccination is not used in the United States

Klebsiella

 Pneumonia in alcoholics

Pseudomonas

 Rods with flagella

 Water, soil and air
 Pseudomonas aeruginosa
o Otitis externa
o Post operative surgical wounds
o “hot tub folliculitis”
o Soft tissue, bone and joint infections
 Diabetics
 Fruity smell
 Blue-green secretion
o Corneal ulcer
 Piperacillin-tazobactam (Zosyn)
 Ceftazidime (Fortaz)
 Cefepime (Maxipime)
 Aztreonam (Azactam)
 Ciprofloxacin (Cipro)
 Levofloxacin (Levaquin)
 Meropenam (Merrem)
 Doripenem (Doribax)
 Imipenem (Primaxin)

Anaerobes

 Bacteria that live in places where there is no O2

 o Abscess
o Cholecystitis
o Appendicitis
o Diverticulitis
o Diabetic foot
 Clostridium perferingens is a gram + anaerobe
 Common in bacteria of the GI tract
 Possible abx
o Flagyl (Metronidazole)
o Clindamycin

Atypicals

 Small like a virus but have cell walls like bacteria

Mycoplasma

 Mycoplasma pneumoniae
o Pneumonia, URI
o Walking pneumonia test – cold agglutinin antibodies
 Mycoplasma hominin
o Pyelonephritis, pelvic inflammatory disease
 Mycoplasma genitalium
o Non-gonococcal urethritis

Legionella

 Pneumonia with diarrhea

Chlamydia

 Chlamydia trachomatis
o Urogenital infections, conjunctivitis, pneumonia
 Chlamydia pneumoniae
o Pneumonia, bronchitis, sinusitis
 Chlamydia psittaci
o Pneumonia
 Inhalation of infected bird droppings

Antibiotics (abx)
How do we diagnose infection?

 Fever
 Leukocytosis

How do we identify the specific bug for treatment?

 Empiric treatment
o Best appropriate guess
 Culture and sensitivity
o Targeted therapy
 Specific antigen testing

Considerations when prescribing abx

 Allergies
 Pregnancy and breastfeeding
 Medication interactions
 Is this viral?

Penicillins

 Penicillin
o Streptococccus
o Example
 Penicillin V K
 Beta lactamase penicillin
o Streptococcus
o Staphylococcus
o Examples
 Dicloxicillin
 Methicillin
 Nafcillin
 Oxacillin
 Amino penicillin
o Streptococcus e.g strep throat
o Gram (-)
o Examples
 Amoxicillin
 Ampicillin
 Combination
o Cover for staph
o Amoxicillin + Clavulanic acid = Augmentin
o Ampicillin + Sulbactam = Unasyn e.g for aspiration pneumonia
o Pipercillin + Tazobactam = Zosyn

Cephalosporins

 10% cross reactivity with PCN allergy

  Beta-lactam antibiotics
 1st generation
o Skin infections
o Good gram +
o Cephalexin (Keflex)
o Cefazolin (Ancef)
 2 generation
nd

o Not as good Gram +

o Better Gram -
o Treat H. influenza
o Treat M. catarrhalis
o Cefuroxime (Ceftin)
 3rd generation
o PNA, gram negative meningitis (DoC), UTI and gonorrhea
o Less effective with Gram +
o Very good Gram -
o Ceftriaxone (Rocephin)
o Cefpodoxime (Vantin)
o Ceftazidime (Fortaz) treats Pseudomonas aeruginosa
 4th generation
o Even better Gram –
o Treats Pseudomonas aeruginosa
o Cefepime (Maxipime)
 5th generation
o Similar to 3rd generation but better Gram +
o Treats MRSA
o Ceftaroline (Teflaro)

Macrolides

 These work great against Staph aureus, Strep peumo, H. influenzae and atypicals
 Azithromycin (Zithromax)
o Gram + and -
o Atypicals
 Erythromycin
o Gram +
o Atypicals
 Clarithromycin (Biaxin)
o Gram + and -
o Atypicals

Sulfonamide Derivative

 Trimethoprim-Sulfamethoxazole (Bactrim)
 Very cheap
 UTI
 Cellulitis
  Pneumocystis Pneumonia
o Prophylaxis and treatment for HIV infected patients

Aminoglycosides

 Most commonly used against aerobic gram - bacilli

 Less commonly used against gram + infections
 Rarely used as monotreatment outside of the urinary tract
 Will be used in combination to treat nosocomial respiratory infections, complicated UTI, complicated intra-
abdominal infections, and osteomyelitis
 Side effects
o Nephrotoxicity
 Dose related
 Often reversible
o Ototoxicity
 Not dose related
 Often not reversible
 Gentamicin
 Tobramycin
 Streptomycin
 Neomycin

Fluoroquinolones

 Strong gram -, including pseudomonas

 Poor gram +
 Levofloxacin (Levaquin)
 Ciprofloxacin (Cipro)
 Moxifloxacin (Avelox)
o Anaerobes
 Pneumonia
 UTI
 Resistant sinusitis

Tetracyclines

 Broad spectrum
 Tetracycline
 Doxycycline (Vibramycin)
o Can cause tooth discoloration and bone retardation in children
 Minocycline (Minocin)
 Broad spectrum
o Prostatitis
o Sinusitis
o Syphilis
o Chlamydia
o PID
 o Acne
o Rosacea
o Lyme disease
o MRSA
 Prophylactic
o Anthrax
o Malaria