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Microbiology Microbiology Bacteria Gram positive Gram negative Cocci Staphylococcus (clusters and catalase +ve) Diplococci ↘Coagulase +ve (aureus) – skin, pneumonia, Neisseria endocarditis, abscess formation ↘meningitidis – meningitis ↘Coagulase -ve (epidermidis; saprophyticus) ↘gonorrhoeae –gonorrhoea, conjunctivitis, pharyngitis, disseminated CONS = Contaminants (unless foreign bodies present) infection, arthritis Streptococcus (strips and catalase -ve) Moraxella ↘α-haemolytic i.e. partially lyse RBCs ↘catarrhalis –URTI s, chronic lung disease exacerbations, pneumonia -pneumoniae – pneumonia, meningitis, URTIs, invasive -viridans group (mitis, mutans, salivarius, sanguinis, anginosus) – endocarditis, dental ↘β-haemolytic i.e. completely lyse RBCs -Group A strep (pyogenes) – skin, Rh fever, scarlet fever, strep throat, post-strep GN, erysipelas, nectrotising fascitis, strep toxic shock -Group B strep (agalactiae) – vaginal colonisation, neonatal infection ↘Non-haemolytic -Group D strep (bovis; equinus) – bacteraemia -Enterococcus (faecium; faecalis) –UTIs, bacteraemia, endocarditis, diverticulitis Rods (bacilli) Big and spore forming Enteric Non-enteric Clostridium (anaerobic) Long Coccobacilli ↘difficile – C diff diarrhoea E. Coli Haemophilus ↘tetani – tetanus – UTIs, gastroenteritis, ↘influenzae neonatal meningitis ↘perfringens – gas gangrene Aerobic glucose + – pneumonia, meningitis, Klebsiella epiglottits ↘botulinum – botulism lactose fermenting – pneumonia, UTIs (COLIFORMS – Bordetella Enterobacter ↘pertussis Bacillus normal bowel flora) – LRTIs, UTIs, skin, intra- – Whooping cough abdominal, endocarditis ↘anthracis – anthrax (infected animal/product spores → Garnerella cutaneous: black ulcer, lymphadenopathy, fever; Citrobacter ↘vaginalis lung: pneumonia; or GI: haematemsis/diarrhoea) – UTIs – bacteria vaginosis ↘cereus – gastroenteritis (improperly refrigerated rice) Salmonella – gastroenteritis, typhoid Acinetobacter – nosocomial infections Small and non-spore forming Shigella Legionella Listeria – gastroenteritis/dysentery Proteus Aerobic glucose ↘pneumophilia ↘monocytogenes – gastroenteritis, septicaemia, – Legionnaires’ disease ENTEROBACTERIACEAE – UTIs, nosocomial only fermenting meningitis, encephalitis, pneumonia, neonatal, endocarditis (water tanks/air conditioners (risks = soft cheeses, unpasteurized milk, meats) Yersinia → atypical pneumonia) – yersinosis (diarrhoeal Coxiella Corynebacterium illness), plague Serratia ↘burnetii ↘diphtheriae – diphtheria, colonisation –Q fever (livestock → flu- – nosocomial like illness, pneumonia, Pseudomonas Aerobic non- granulomatous hepatitis, – pneumonia, UTIs, sepsis, fermenting endocarditis) Gastrointestinal, wound Brucella Bacteroides Anaerobic – brucellosis (unpasteurized – intra-abdominal milk → long flu-like illness) Curved Pasteurella Vibrio – pasturellosis (cat bite → septic phlegmon) ↘cholerae – cholera (dysentery) Francisella Campylobacter (microaerophilic) – tularaemia (tick/deer fly ↘jejuni – gastroenteritis (raw meat) bite → ulcer at site of entry, Helicobacter fever/sepsis, lymphadenopathy) ↘pylori – gastritis Spirochetes Treponema ↘pallidum – syphilis Borrelia ↘burgdorferi – Lyme disease Leptospira – leptospirosis (spread by rodents) Branching Actinomyces (anaerobic) filamentous – dental, actinomycosis (abscesses) growth Nocardia (partially acid fast) – pneumonia, endocarditis, encephalitis, brain abscess, skin Pleomorphic Chlamydia ↘trachomatis – cervicitis/urethritis ↘psittaci – psittacosis/pneumonia (spread by birds) Rickettsiae – typhus, rickettsialpox, Boutonneuse fever, African tick bite fever, Rocky Mountain spotted fever (all tick borne) Unique cell Mycobacterium (acid fast) wall ↘tuberculosis – TB No cell wall Mycoplasma ↘pneumoniae – pneumonia © 2013 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students’ finals OSCE revision . Antibiotics Gram Positive Gram Negative Cocci Rods (bacilli) Class Subclass Antibiotic Enterococcus MRSA Staphylococcus Streptococcus Neisseria Haemophilus E. Coli and Β-lactamase Pseudomonas Anaerobes Atypical aureus (MSSA) meningitidis coliforms resistance* (except C. Diff) pneumonias β-lactams Penicillins Flucloxacillin β-lactam ring Large so not affected by ++++ + lodges in β-lactamase bacterial cell Benzylpenicillin Staph secretes -Penicillinase wall penicillinase ++++ ++ -ESBL + Amoxicillin/ (β-lactamase that -Amp C destroys β-lactam Ampicillin - Carbapenemase ring of penicillin) +++ + + Many resistant -Amp C Co-Amoxiclav (Amoxicillin + β- (resistant to inhibitor) MRSA is ++ -Carbapenemase lactamase inhibitor) ++ resistant to Tazocin (Piperacillin + β-lactams due ESBLs sensitive in vitro Not all to modification but have variable β-lactamase inhibitor) +++ +++ ++ of penicillin activity in vivo Carbapenems Meropenem binding protein -Carbapenemase Antibiotic of choice for +++ ESBL/Amp C Target cell wall 2nd gen Cefuroxime Cefuroxime +++ Cephalosporins doesn’t -ESBL (but sensitive to penetrate BBB cephamycins) 3rd gen Ceftriaxone/ ++ -Amp C Ceftazidime is used Cephalosporins Cefotaxime ++++ -Carbapenemase for pseudomonas only (best agent) 4th gen Cefepime -ESBL (variable) Cephalosporins -Carbapenemase +++ (variable) +++ Glycopeptides Vancomycin/ Inhibit peptidoglycan links in cell wall Teicoplanin +++ +++ ++ + Some strains resistant (VRE) Aminoglycosides Gentamicin Some cross resistance Aminoglycosides Inhibit 30S ribosomal subunit + + +++ with ESBL and +++ use oxygen carbapenemase dependent active transport Tetracyclines Doxycycline Inhibit 30S ribosomal subunit ++ +/- ++ Lincosamides Clindamycin ++ Inhibit 50S ribosomal subunit ++ ++ ++ protein synthesis Macrolides Erythromycin/ ++ Inhibit 50S ribosomal subunit Clarithromycin/ ++ +++ Azithromycin (gram -ve) Target Misc Chloramphenicol Inhibit 50S ribosomal subunit ++ + + + + + +/- ++ Fluroquinolones Ciprofloxacin Some cross resistance with ESBL and Inhibit DNA gyrase + +++ +++ ++ +++ carbapenemase Not alone Misc Metronidazole Inhibit DNA +++ DNA Trimethoprim + ++ Co-trimoxazole Some cross resistance Target + (sulfamethoxazole + ++ ++ with ESBL and trimethoprim) carbapenemase Nitrofurantion ++ ++ Atypical pneumonias: legionella (gram –ve), mycoplasma Coliforms (lactose-fermenting enterobacteriaceae): E. Coli, enterbacter, klebsiella Anaerobes: clostridium (gram +ve rod), bacteroides (gram -ve rod) Other important bacteria to know antibiotics for: mycobacterium (gram +ve rod); clostridium difficile (gram +ve rod); chlamydia (gram –ve) *β-lactamase resistance: β-lactamases are enzymes produced some bacteria which break down the β-lactam ring of certain β-lactam antibiotics and cause resistance. Penicillinase is produced by several bacteria, most notably staphylococcus; the other β-lactamases (ESBL, Amp C, carbapenemase) are mainly produced by some enterobacteriaceae. © 2013 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students’ finals OSCE revision . Coverage Needed Gastroenteritis/diarrhoea → ceftriaxone/ciprofloxacin/azithromycin Community acquired pneumonia Salmonella enteritidis Streptococcus pneumoniae Shigella Haemophilus influenza (if not vaccinated) Campylobacter Atypicals E. coli (enterotoxic) If immunocompromised (i.e. malnourished, alcoholic, diabetic, on long term steroids), also: staphylococcus aureus, coliforms, TB Less common: yersinia enterocolitica, bacillus cereus, staphylococcus aureus If severely immunosuppressed (i.e. HIV with CD4<200, transplant recipient): pneumocystis carinii, cryptococcus, CMV, varicella zoster virus, influenza, fungal If been at risk, also: clostridium difficile, vibrio cholerae, salmonella typhi infections If dysentery: shigella, vibrio cholera, amoeba Don’t forget viral, parasitic and non-infectious causes! Hospital acquired pneumonia Staphylococcus aureus (including MRSA) Skin/joints/bone Anaerobes Staphylococcus aureus Coliforms Streptococcus pyogenes Pseudomonas For wound/ulcer infections or severe/necrotising cellulitis, also: anaerobes For burns, also: anaerobes, pseudomonas For post-surgical wounds, also: gram negative bacilli (e.g. E. coli, kelbsiella, pseudomonas), enterococci, MRSA, CONS Colonising bacteria in chronic respiratory ill health (may or may not cause infection e.g. exacerbation) NB. wound colonising bacteria (colonise exudate without necessarily causing infection) include: coliforms, enterococcus, anaerobes Streptococcus pneumoniae Haemophilus influenzae Meningitis Moraxella catarrhalis Nisseria meningitidis (meningococcal) Staphylococcus aureus Streptococcus pneumonia (pneumococcal) Pseudomonas Haemophilus influenza (if not vaccinated) Listeria (if >65y or immunocompromised) In cystic fibrosis, also: burkholderia cepacia If neonatal: group B streptococcus, E. coli/coliforms, listeria (rare) Upper respiratory tract infections Streptococcus pneumoniae Urine Streptococcus pyogenes 1. E. coli Haemophilus influenzae 2. Staphylococcus saprophyticus Moraxella catarrhalis 3. Non-E. Coli enterobacteriaceae (klebsiella, enterobacter, proteus), pseudomonas, enterococci, staphylococci (CONS/aureus) Cavitating pneumonia Less common organisms (3) are associated with: catheters, hospital, structural abnormalities and instrumentation Streptococcus pneumoniae Staphylococcus aureus Infective endocarditis Klebsiella Viridans group streptococci and other streptococci (e.g. bovis) TB Enterococci Anaerobes Staphylococcus aureus and coagulase negative staphylococci (e.g. epidermidis) Coxiella burnetii Intra-abdominal (including biliary) HACEK organisms Normal bowel flora: Anaerobes e.g. bacteroides Surgical prophylaxis Coliforms Need to cover skin ± intra-abdominal Enterococcus Sepsis of unknown origin Need to cover skin, chest, urine, meningitis, intra-abdominal © 2013 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students’ finals OSCE revision . .
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