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
Your consent to our cookies if you continue to use this website.