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COAGULASE +VE COAGULASE -VE
1. Always Pathogenic
2. Eg: S. Aureus
1. Often contaminants in culture.
2. Can be pathogenic in situations like
Indwelling Prosthetic devices
Plastic Vascular Catheters
3. Eg: S. Epidermis,
S. Hemolyticus
Tests to differentiate S. AureusTests to differentiate S. Aureus
• Coagulase Production
• Rapid Test : Latex Assay
Coagulase + VeCoagulase + VeA. Eg: S.Aureus
B. CARRIER: Skin, Nasopharynx, Vagina
C. INFECTIONS:
SKIN
DEEP: Endocarditis, Meningitis, Arthritis, Pneumonia, Sepsis, MOF
TOXIN MEDIATED:
Food poisoning
Toxic Shock Syndrome
Scalded Skin Syndrome
Coagulase - VeCoagulase - VeA. Eg : S. Epidermis
B. CARRIER: Skin , Ear canal,GU Tract, Mucous membranes.
C. INFECTIONS
Indwelling Foreign body
Valves, Catheter, Pacemakers, Shunts, Grafts, IV Catheter.
UTI
Others : Post OP, Endocarditis
D. TREATMENT:
Vancomycin + Aminoglycoside
Surgical Removal
Folliculitis,Furunculosis& Recurrent FurunculosisFolliculitis,Furunculosis& Recurrent Furunculosis
FOLLICULITIS (Superficial Skin Infection)Staphylococcus, Pseudomonas
FURUNCULOSIS ( Inflamm.. Nodule around hair follicle)
EXTENSIVE CELLULITIS
BACTRAEMIA
Hyper Immunoglobunaemia E SyndromeHyper Immunoglobunaemia E Syndrome
• Primary immunodeficiency disease with high IgE titre.
• Chronic Staphylococcal infections ( Furunculosis).
• Rx of Chronic Furunculosis : - Avoid strong irritants
- Role of Vitamin C ?
- 2 % Mupirocin – Intra nasal 5 days every month for 1 year
- Oral Rifampicin + Pencillinase resistant penicillin
• 1940 : Pencillin
• 1960 : Methicillin, Oxacillin
• 1961 : MRSA Identified
• 1970 & Later : Hospital Acquired MRSA
• 1990 : VISA ( Vancomycin Intermediate S. Aureus)
Seen in Hemodialysis Patients on prolonged vancomycin Rx.
Responds to Cotrimoxazole, Linezolid, Streptogramins.
• 2002 : VRSA
Sensitive to same drug as VISA and Tetracycline.
What Are TheseWhat Are These ? ?
1. MRSA ( Methicillin Resistant S. Aureus)
- Resistant to all Beta Lactam Antibiotics
(Pencillin, Cephalosporin, Carbepenem)
DOC : Vancomycin
DOC in deep infection : Vancomycin + Aminoglycoside, Rifampicin Cotrimoxazole
MRSA as a Nosocomial pathogenMRSA as a Nosocomial pathogen
• In Tertiary Care Hospitals
• Rapid Detection
• Prompt Implementation of barrier precautions
• Eradication of Nasal discharge in patients / Carriers using Intra nasal muciporin
2. MSSA (Methicillin Sensitive S. Aureus)
A. DOC : Nafcillin, Oxacillin
B. If Allergy to Pencillin : 1st Gen Cephalosporin's : Caphazolin. C. If Allergy to all Beta Lactams : Vancomycin / Clindamycin / Macrolides
3. GRSA (Glycopeptide Resistant S. Aureus)
MIC > 32 mcg/ml of V
4. VRE (Vancomycin Resistant Enterococci)
STREPTOGRAMINSSTREPTOGRAMINS• MOA : Complex with Bacterial Ribosome's to
inhibit Protein synthesis.
• Useful against VRE, VISA, VRSA Strep. Pneumoniae when vancomycin can’t be
tolerated.
• Eg : Quinupristin, Dalfopristin
DRUG RESISTANCE IN DRUG RESISTANCE IN STAPHYLOCOCCISTAPHYLOCOCCI
• Beta Lactamase
• Methicillin resistant
• Plasmid Mediated Drug inactivation.
• Chromosomal Linked
Decreased activity to penicillin binding protein
• Plasmid Mediated
VIRULENCE OF MRSA & MSSAVIRULENCE OF MRSA & MSSA• Both are equally capable of producing life
threatening infections (Endocarditis, Pneumonia, Bactraemia).
• Source may be carrier• Mortality is up to 50% .• Drugs useful : Vancomycin, Linezolid, Quinopristin,
Dalfopristin, Daptomycin, Ciprofloxacin, Cotrimoxazole
STERPTOCOCCISTERPTOCOCCI
• Gram + Ve
• Catalase – Ve
• Grow in Pairs/ Chains
CLASSIFICATIONCLASSIFICATIONPatterns of Hemolysis in Blood Agar (Alpha, Beta, Gamma)
Antigenic differences in Cell Wall carbohydrates (A to H J K to V) in LANCEFIELD scheme for beta hemolytic streptococci
Biochemical Reactions
Growth Characteristics
BASED ON
DISEASESDISEASES
• Group A S. Pyogenes
Non Suppurative
• Pharyngitis, Tonsillitis, Scarlet fever, pneumonia, Septicemia, Necrotizing Fascitis.
• Acute Rheumatic Fever
Acute Glomerular nephritis
• Group B :
• Strep. Pneumoniae
• Serious Neonatal Infections
( Meningitis, Sepsis), Female pelvic Infection.
• Pneumonia, Otitis Media, Sinusitis, Meningitis, Bactraemia.
• Enterococcus Faecalis
• Anaerobic Streptococci (pepto streptococcus)
• Endocarditis, UTI
• Peritonitis, Dental infections, Liver abscess, PID
*All Streptococci cause Septicemia
Streptococcus PyogenesStreptococcus Pyogenes
• Pyogenic Exotoxins: A, B, C
A – Toxic Shock Syndrome
M Protein
- Major Virulence Antigen
- Makes the bacterium resistant to phagocytosis
Necrotizing FascitisNecrotizing Fascitis• Produced by Strep. Pyogenes “Flesh eating Bacteria”
PAIN
NECROTIZING SKIN & SUB CUTANEOUS TISSUE
FRANK GANGRENE SEVERE SEPSIS
SEPTIC SHOCK, MULTI ORGAN FAILURE,
DICDEATH
TYPESTYPES
• Polymicrobial ( Enterobacteriacae and
Anaerobes)
• Seen Commonly following surgery in DM, HIV
• Pure growth of Strep. Pyogenes.
• Cutaneous findings do not correlate with extent of the disease
• Seen following Anesthesia of skin, Nerve damage, Vascular blockade
TYPE I TYPE II
DifferentialsDifferentials
1. Clostridia : Anaerobic Cellulitis, Myonecrosis
2. Staph Aureus + Strepto : Progressive bacterial synergistic gangrene.
3. Anaerobic Streptococci : Myonecrosis
4. Group A Streptococci : Myositis with out abscess
Treatment of NFTreatment of NF
A. High dose Penicillin IV
B. Penicillin Allergy : Cephalosporin, Vancomycin, Clindamycin
Toxic Shock SyndromeToxic Shock Syndrome
• Streptococcal TSS :
- Group A Streptococcus ( pyogenic exotoxin A)
- Initially influenza like illness.
- 50 % has features of NF
- Faint rash followed by multisystem involvement and MOF
Rx :
Fluid restriction.
BenzylPencillin + Clindamycin
• Staphylococcal TSS - F > M (9:1) - Vaginal Colonization of Staph. Aureus - TSS Toxin 1 is responsible for systemic manifestations.
Fever + Rash (localised erythema in Flexural Areas)
Rapidly Progressive (Erythroderma Desquamatum)
Multisystem Involvement
TreatmentTreatment
SPECIFIC Rx SUPPORTIVE Rx
1.Flucloxacillin, Vancomycin 2.Avoid Tampon Use
1.Haemodynamic Monitoring2. Supportive Care
ENTEROCOCCIENTEROCOCCIINFECTIONS INDUCED
COMMON
UTI, Bactraemia, Endocarditis, Intra abdominal & Pelvic infections.
UNCOMMON
Soft tissue, Meningitis, Neonatal sepsis, Pneumonia
Treating Enterococcal InfectionsTreating Enterococcal Infections• UTI
Penicillin, Ampicillin, Vancomycin, Quinolones, Nitrofurantoin.
• ENDOCARDITIS / BACTRAEMIA Penicillin/ Ampicillin + Amino glycoside
Vanomycin + Amino glycoside
• INTRA ABDOMINAL/ PELVIC INFECTIONS Ampicillin / Penicillin + Aminoglycoside
Vancomycin Resistant EnterococusVancomycin Resistant Enterococus
• Action: Inhibits cell wall synthesis by binding to cell wall precursors.
• Resistance to Vancomycin By producing Cell Wall precursors with less affinity
to Vancomycin.• E. Faecium – VRE
It is also resistant to Tobramycin
Bactericidal of Choice : Gentamicin
• RESISTANCE TO GENTAMYCIN By altering the molecule (G) by phosphorylation and
Acetylating.
• INFECTIONS Hospitalized patients, Device related.
• LESSONS
1. Infection Control Measures
2. Avoid Excessive antibiotic use especially Vancomycin
Treatment of VRETreatment of VRE
• Device Removal
• Surgical Debridgment of Source
• UTI : Nitrofurantoin, Amoxicillin, Fluroquinolone, Linezolid, Daptomycin, Otrivancin, Daflopristin.
LINEZOLIDLINEZOLID
• Acts on VRE, MRSA, GRSA, Penicillin Resistant Strep. Pneumoniae.
• S/E : Thrombocytopenia (25%), Reversible Bone marrow Toxicity