Staphylococcal Infection
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Staphylococcal Infection
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Bacteriology
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Bacteriology
Gm +ve cocci Cluster Facultative Nonfastidious
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Classification
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Classification
Staph. Aureus; Coagulase positive
Staph. Epidermidis; Coagulase negative
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Staph. Aureus Infections
Mechanism of pathogenesis;
1-coenzymes local destruction
2-Secretion of Toxins
3-Superantigens activating T cell receptors
4-Interfer with opsonophagocytosis
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Epidemiology
Normal human flora; nose& moist areas
Transmission; Hands/nose sec/contact/rarely air. Colonize; skin, newborn nasoph& umb.
Invasion; Skin breaks, I/V access, immune defect, steroids and neutropenea.
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Clinical conditions
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Clinical conditions
Suppurative.
Toxic related;
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Clinical conditions
Suppurative.
Toxic related;
Scalded Skin Syndrome SSS
Toxic Shock Syndrome
??Kawasaki’ Disease
Food poisoning
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Skin
Foliculitis
Furaculosis (Boils)/Carbunkles
Emptigo contagoesa
Bullous Emptigo
SSS (Ritter disease)
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Respiratory Infections
Sinusitis
Parotitis
Cervical adenitis
Tracheitis compared to croup
Pnumonia;
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Sepsis
Start as focal lesion e.g. a boil
Yield to septicemia
Localize to organs e.g. lung, bone, heart, brain etc
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Muscles/Bone/Joints
Tropical pyomyositis;
Localized abscesses and high CPK
Osteomylitis;
Trauma/Sx, pain, fever
Septic arthritis;
Usually hematogenous
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CNS
Meningitis;
Bacteremea, O.M, skull osteo., neural canal defects.
Neurosurgical procedures and VP shunt
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Heart
Bacterial endocarditis;
-Perforated heart valve
-myocardial abscess
-purulent pericarditis
-Sudden death
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Kidney
Perinephric abscess
UTI;
Staph. saprophyticus (CONS)
Sexually active adolescent girls
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G.I.
Food poisoning;
Meat, mayonnase, creamed foods
Short incubation period of 1 to 7 HRs
Perfuse vomiting, no fever
Test susp. food for staph bacteria/ toxins
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Diagnosis
Isolate staph. bacteria
Gram stain
Identify Toxins
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Treatment
Penicillinase resistant antibiotics;
Oxacillin (Cloxacillin, Flucloxacillin)
methicillin
Nafcillin
1st generation cephalosporine, cefazolin
(Ultracef)
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Treatment cont.
Betalacamase hyperprodcer staph.;
Amoxicillin/Clavulenic acid(Augumentin)
Ampicillin/Salbactam
Imipenem
Fluoroquinilones
1st generation cephalosporin
Vancomycin
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Coagulase negative Staph. (CONS)
Common Skin Flora Ubiquitous organism Has affinity to plastic (surface hydophobicity
& production of slim) Neonates, I/V access and shunt devices
infections (nosocomial infections)
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Clinical Conditions
Premature neonatal sepsis/NEC. Older children sepsis is rare (minimal signs
of sepsis) Persistent pactreamia usual with indwelling
devices (I/V cath, VP shunt, cardiac grafts and prosthesis etc.)
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Clinical Cond. Cont.
Single positive blood culture is a contaminant
UTI in adolescent girls Staphylococcus Saprophyticus (CONS)
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Treatment
Remove the access devices/shunts.
May externalize the VP shunt.
Vancomycin or Rifampin.
Amoxicillin or Quinolones for the Staph Saprophyticus UTI.
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Nosocomial Infections
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Definition
Infections not present or incubating at the time of admission that develop during
admission or less than one incubation period after discharge
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Definition cont.
Infections 48 HRs or more after admission is assumed to be nosocomial unless the infection is clearly community acquired
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Clean Surgery
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Clean Surgery
Incision through prepared normal skin and the operative field dose not include infected
tissue , abscess, or entry into normally unsterile areas such as the bowel, the upper respiratory tract, or the lower female genital
tract.
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Rate of Nosocomial Infections
Number of nosocomial infections divided by the number of patients at risk multiplied by
100
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Epidemiology
1/3 hospital infections are nosocomial (estimate in the USA)
i.e. 2 million patients
i.e. 4 million patient days of hospitalization
i.e. 4.5 Billion USD
i.e. 17 Billion SAR
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Epidemiology cont.
In USA (1978) nosocomial inf. rate;
-All services 3.37%
-Pediatric services 1.2%
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Epidemiology cont.
Common sites of ped. nosocomial infections (as per the NNIS);
Blood stream Surgical sites Lower respiratory tract Urinary tract
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Epidemiology cont.
In adults;
Urinary tract Surgical sites Lower respiratory tract Blood stream
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Epidemiology cont.
Common PEDIATRIC nosocomial bacteria; Staphylococcus aureus Escherichia coli CONS Klebsiella
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Epidemiology cont.
Common NEONATAL nosocomial bacteria; CONS Staphylococcus aureus Escherichia coli Group B sterptococci Klebsiella
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Epidemiology cont.
Areas of high nosocomial infection rates; NICU PICU Burn Units
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Risk Factors of Nosocomial Inf.
General risk factors; Prior colonization with nosocomially acquired bacteria Catheters Exposure to antibiotics
• Specific risk factors Inhalation equipments Specific monitoring cath’s e.g. arterial cath etc. Viral infections
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General risk factors
Prior colonization; Klebsiella colonization after admission gave
50% incidence of infection Inhalation therapy, N/G suction and
antibiotics are behind the colonization
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General risk factors
Catheters; Increase risk of septicemia with method of
insertion, type of solution and duration of placement (I/V catheter)
Major risk of septicemia in neonates Urine catheter is a risk for UTI in females,
elderly and critical pt.’s Risk increase with method of insertion, length
of tube and break of the system
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General risk factors
Exposure to Antibiotics; Prior use of broad spectrum antibiotics Normal flora protect the host through
blocking the surface receptor/attachment sites
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Specific risk facors
Special catheters Pressure trasducers Arterial catheters Swan-Ganz catheters
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Specific risk facors
Viral infections RSV close contact with infants at risk Varicella ( 8-21 days incubation) and risk for
nonimmune and immune suppressed. Screen hospital personnel
Rota virus
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Prevention and control of nosocomial infections
General measures; A team of infection control team Enforce surveillance of equipments,
disinfection and isolation techniques
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Specific risk factors
Inhalation equipments Nebulizers and humidifiers Risk of necrotizing pneumonia Decontamination with .25% acetic acid and
ethylene oxide
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Prevention and control of nosocomial infections
Universal precautions; Barrier precautions prevent exposure Hand wash Proper handling of sharp instruments Resuscitation equipments Personnel with exudative lesions Pregnant health workers
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Prevention and control of nosocomial infections
Isolation techniques;
Apply specific isolation to specific diseases
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Prevention and control of nosocomial infections
Hand wash practice; Most effective and least expensive practice
to prevent transmission of pathogens Educate personnel of the method of hand
wash (15 seconds with warm water and soap then dry and turn faucet with towel)
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Prevention and control of nosocomial infections
Intravenous therapy; Hand wash Clean site with 70% alcohol and 10% providone-
iodine Preferred locations in pediatrics are scalp, hands
and foot Minimize duration if possible Prophylactic antibiotics are not recommended Remove catheter if sign of inflammation