Presentation on theme: "M ICROBIOLOGY TOP TIPS FOR G ENERAL P RACTICE. P LAN How the lab works Urine Swabs Sputum Stools A bit about the mysterious world of immunology/virology!"— Presentation transcript:
P LAN How the lab works Urine Swabs Sputum Stools A bit about the mysterious world of immunology/virology! Antimicrobial stewardship The ‘I need some antibiotics’ consultation
T HE LAB Bloods cultures Spits Wounds Urine Stools
HPA G UIDANCE https://www.gov.uk/government/collections/prima ry-care-guidance-diagnosing-and-managing- infections
U RINE Microscopy reader – rapid negative Culture and sensitivities Colony counts >10 5 as threshold. Pure growth at >10 4 would get sensitivities Mixed growth of 2 organisms at >10 5 Clean catch repeat: Mixed growth of 3 or more organisms High number of epithelial cells
U RINE - ORGANISMS E.coli 70% - Major cause of bacteraemia Staph Saprophyticus 15% Proteus Miribalis 10% (always resistant to Nitro & sometimes Trimeth) Less commonly (think immunocompromised or post antibiotics) Klebsiella, Enterobactor, Enterococcus.
U RINE Resistance in Cumbria Trimethoprim around 35% Nitrofurantoin around 3% Amoxicillin – around 50% e.coli resistant Cipro around 7% https://www.gov.uk/government/publications/urin ary-tract-infection-diagnosis
ESBL UTI Extended spectrum Beta-lactmase producing Multi resistant – often Co-Amox as well Fosfomycin 3g sachet every 48hrs MHRS licence but no suppliers Imported – script off licence
A NTIBIOTIC G UIDANCE http://www.networks.nhs.uk/nhs-networks/nhs- cumbria-ccg/medicines-management/guidelines- and-other-publications
S WABS Know your swabs! Clean the site! HPA Guide PVL Staph aureus Panton-Valentine Leukocidin (PVL) produced by less than 2% of S. aureus
S PUTUM Routinely sputum samples grow: Haemophilus Influenzae Strep Pneumoniaie Moraxella Catarralis (previously Branhamella) Also: Coliforms or Pseudomonas No sensitivities for GP samples unless specified CF or Bronchiectasis Staph Aureus CF also for Pseudomonas Capacia
S PUTUM Haemophilius can be Beta lactamase Positive, around 10% in Cumbria – usually Amoxicillin resistant and can be Co-Amoxiclav resistant also. Strep Pneumoniae – less than 5% resistant to Amoxicillin in Cumbria Moraxella Catarralis – 95% resistant to Amoxicillin
S TOOLS Routinely test for: Salmonella Shigella Campylobactor E.coli Giardia Cryptosporidium HPA Sheet Streptococcus Bovis – gut or billiary. Associated with GI malignancy.
F UNGAL HPA sheet Common Trychophyton Rubrum and Trychophytom Interdigitalis http://www.bmj.com/content/345/bmj.e4380
C ONSIDERING TB Mairi Black is TB specialist Nurse for North Cumbria Liaises with respiratory team Based at Wigton Hospital
P ROSTHETIC JOINT INFECTION 1. Acute postoperative infection - <3months. e.g. Staph Aureus 2. Late Chronic infection - 3-24months. 3. Acute Haematogenous infection Urine, Sore throat (group A strep), Infected ulcer, GI tract. <2 weeks salvage surgery >2 weeks most likely 2 stage revision
T OOLS FOR ASSESSMENT To reassure ourselves! CENTOR for sore throat CRB-65 – LRTI BMJ – Acute Rhinosinusitis BMJ EPOS - Sinusitis EPOS
O K HAVE SOME ANTIBIOTICS ! Consider immediate antibiotics if >80 years of age and with one of the following: Hospitalization in past year Oral steroids Diabetic Congestive heart failure OR >65 years of age and two of the above
E XPLANATION Avoid virus vs bacteria? Delayed prescription Explain why no antibiotics now Clear indication of when to start antibiotics Safety netting in case of worsening despite antibiotics
S AFETY NETTING Communicate diagnostic uncertainty Explain likely time course & natural history of illness Indicate specific features to look out for which may indicate signs or worsening illness or complication Give permission to re-consult if any concerns Give advice on how to seek further help including out of hours services Can also incorporate delayed prescriptions into this Check patient understanding.
S UMMARY Pragtmatic use of lab resources If unsure pick up the phone Multitude of resources Think about antimicrobial stewadrship