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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!

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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:

1 M ICROBIOLOGY TOP TIPS FOR G ENERAL P RACTICE

2 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

3 T HE LAB Bloods cultures Spits Wounds Urine Stools

4 HPA G UIDANCE https://www.gov.uk/government/collections/prima ry-care-guidance-diagnosing-and-managing- infections

5 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

6 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.

7 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

8 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

9 A NTIBIOTIC G UIDANCE cumbria-ccg/medicines-management/guidelines- and-other-publications

10 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

11 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

12 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

13 S TOOLS Routinely test for: Salmonella Shigella Campylobactor E.coli Giardia Cryptosporidium HPA Sheet Streptococcus Bovis – gut or billiary. Associated with GI malignancy.

14 F UNGAL HPA sheet Common Trychophyton Rubrum and Trychophytom Interdigitalis

15 C ONSIDERING TB Mairi Black is TB specialist Nurse for North Cumbria Liaises with respiratory team Based at Wigton Hospital

16 P ROSTHETIC JOINT INFECTION 1. Acute postoperative infection - <3months. e.g. Staph Aureus 2. Late Chronic infection months. 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

17 A N UNUSUAL FINGER INFECTION

18

19 ?Cat scratch disease - Bartonella henselae Mycoplasma Marinum – Aquarium Granuloma

20 V INCENT ’ S A NGINA Gingivitis Periodontitis Stomatitis Pen V & Metronidazole Dentist

21 I MMUNOLOGY VIROLOGY

22 A NTIMICROBIAL STEWARDSHIP Medicines Optimisation team Reducing use of Cephalosporins, quinolones and Co-amoxiclav Audit of appropriate duration

23 ‘I NEED SOME ANTIBIOTICS D OC ’ Difficult consultations Potential for conflict How can we do it better? RCGP TARGET ToolkitTARGET Toolkit RCGP MARTIMARTI

24 Videos & exercises

25 T OOLS FOR ASSESSMENT To reassure ourselves! CENTOR for sore throat CRB-65 – LRTI BMJ – Acute Rhinosinusitis BMJ EPOS - Sinusitis EPOS

26 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

27 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

28 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.

29 S UMMARY Pragtmatic use of lab resources If unsure pick up the phone Multitude of resources Think about antimicrobial stewadrship


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