Exam 3 NUR 340
Identify 4 ways patients can decrease the risk of antibiotic-resistant infections and
explain why each one decreases risk. - answer"1. Do Not Take Antibiotics to Prevent
Illness (unless prescribed)
Doing this increases your risk for developing resistant infection. Exceptions include
taking antibiotics as prescribed before certain surgeries and dental work or in the
presence of immune dysfunction.
2. Wash Your Hands Frequently
Hand washing is the single most important thing you can do to prevent infection.
3. Follow Directions When Taking Antibiotics
Not taking your antibiotic as prescribed or skipping doses can allow antibiotic-resistant
bacteria to develop.
4. Do Not Request an Antibiotic for Flu or Colds
If your health care provider says that you do not need an antibiotic, chances are you do
not. Antibiotics are effective against bacterial infections but not viruses, which cause
colds and flu.
5. Finish Your Antibiotic
Do not stop taking your antibiotic when you feel better. If you stop taking your antibiotic
early, the hardiest bacteria survive and multiply. Eventually you could develop an
infection resistant to many antibiotics. You should never have leftover antibiotics.
6. Do Not Take Leftover Antibiotics
Do not save unfinished antibiotics for later use or borrow leftover drugs from family or
friends. This is dangerous because (1) the leftover antibiotic may not be appropriate for
you, (2) your illness may not be a bacterial infection, (3) old antibiotics can lose their
effectiveness and in some cases can even be fatal, and (4) there will not be enough
doses in a leftover bottle to provide full treatment." (Lewis 230 Table 15-7)
A) List three bacteria that frequently cause health care-associated infection.
B) Which patients are at highest risk for acquiring a health care-associated infection? -
answerMethicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococci (VRE),
and penicillin-resistant Streptococcus pneumoniae
Geriatric are 2-3x more likely to acquire a HAI compared to the adult population d/t co-
morbidities, risk for infection & atypical presentation (cog/beh changes, acute inability to
perform daily activities, lower core temp)
Describe the most effective strategy for decreasing health care-associated infections. -
answerHand washing and use of gloves are best practice to reduce HAI's.
Identify 2 ways bacteria and viruses differ from each other. - answerBacteria are one
celled organisms while viruses are infectious particles with no cellular structure. Viruses
,spread by releasing genetic material into the cells of a living organism while bacteria
cause disease by growing inside cells & causing damage to the outside of cells by
secreting toxins.
How do mosquitoes spread West Nile virus? What early warning sign does a health
department watch for when controlling for this virus? - answer"West Nile virus is carried
and transmitted by mosquitoes. Mosquitoes acquire the virus as they draw blood from
infected animals and people. The virus does not cause illness in the mosquito, but can
be transferred to uninfected animals and humans as the mosquito continues to feed.
Bird deaths are an early warning sign of a West Nile virus outbreak" (Lewis 228)
Identify 4 factors that increased the risk for the widespread distribution of emerging
infections such as novel influenza viruses or measles. - answer"Global travel,
population density, encroachment into new environments, misuse of antibiotics, and
bioterrorism have increased the risk for widespread distribution of emerging infections."
(Lewis 228)
How do antimicrobials work - answerSelective Toxicity
take advantage of the differences in cellular chemistry between mammals and
microbes.
-Disrupt bacterial cell wall
-Inhibit enzymes critical to bacterial survival
-Disrupt ribosomal protein synthesis in bacteria
How are antimicrobials classified - answerBy action (Bactericidal, Bacteriostatic)
& effectiveness (Broad spectrum.
Narrow spectrum)
Bactericidal - answerDirectly lethal to bacteria at specific concentrations
Ex: aminoglycosides (Gentamicin)
Bacteriostatic - answerSlow down bacterial growth, but not lethal
Healthy immune system works with phagocytes to eliminate bacteria
Ex: tetracyclines
won't work well in immunosupressed, elderly bc works w/ immune system
What kind of antibacterial do you give to immunosuppressed patients & why -
answerbactericidal, bacteriostatic work w/ immune system (phagocytes eliminate
bacteria)
Broad spectrum antibacterial - answereffective against wide variety of bacteria
Penicillins: ampicillin
Cephalosporins - 3rd generation (cefotaxime)
Carbapenems - imipenem
,Tetracyclines - doxycycline
Fluoroquinolones: ciprofloxacin
Narrow spectrum antibacterial - answereffective against specific bacteria
Penicillin G and V
Vancomycin
Erythromycin
Aminoglycosides: gentamicin, amikacin
Cephalosporins: 1st (cephalexin) and 2nd generation (cefoxitin)
Acquired resistance - answerThe microbes become resistant, not the host.
All antibiotics have potential to promote development of resistant microbes.
Caused by genetic mutations in the bacteria to the antibiotics
Which antibacterials have higher risk for acquired resistance? - answerBroad spectrum
antibacterials have greatest potential because they kill many competing microbes
Kill normal flora as well as infectious agent.
Leave drug-resistant microbes without check and balance system
Narrow spectrum antibacterials have less potential
Are effective against only a few microbes
To decrease the development of acquired drug resistance, which of the following
antibiotics would be preferred?
A. Amikacin
B. Ampicillin
C. Doxycycline
D. Cefotaxime - answerA. Amikacin
narrow spectrum antibiotic, the rest are broad spectrum
Suprainfection - answerType of drug resistance
New infection that appears during course of treatment for a primary infection
Antibiotics eliminate the inhibitory influence of normal flora and allow a new infectious
agent to develop
More common with broad-spectrum antibiotics
Common examples:
thrush (Candida albicans),
antibiotic-associated diarrhea (Clostridium difficile)
Clostridium difficile - answerA gram-positive anaerobic bacillus that infects the bowel
causing relatively mild to very severe symptoms.
, Infection almost always preceded by use of antibiotics.
Highly contagious
-Isolate patients with C. diff or place 2 patients with C. diff in same room
-Gown and glove and when entering the room
C diff treatment - answerDiscontinue antibiotic
Start different antibiotic: metronidazole and/or oral vancomycin
Hand hygiene
-Soap and running water rinse spores from hands but don't kill them
-Alcohol-based hand rubs won't kill or remove spores from hands
Use bleach disenfectant to kill spores
NDM-1 gene - answerConfers extensive drug resistance
DNA segment that codes for a powerful form of beta-lactamase
Inactivates all drugs with a beta-lactam ring
-Penicillins
-Cephalosporins
-Carbapenems
DNA can be easily transferred to other bacteria
-First discovered in K. pneumoniae in 2008
-Also found in common enteric bacteria such as E. coli, enterobacter, salmonella, &
others
Only a few cases have been reported in US and Canada to date.
Factors that inhibit drug penetration - answerBlood-brain barrier (meningitis)
Bacterial vegetation (endocarditis)
Infectious material (pus, necrotic tissue)
Foreign material (heart valves, prosthetic joints)
When is it okay to use antibiotics prophylacticly? - answerSurgery - 1st generation
cephalosporin given pre-op
-Cardiac
-Peripheral vascular
-Orthopedic
-GI tract
-Gynecologic surgery
Identify 4 ways patients can decrease the risk of antibiotic-resistant infections and
explain why each one decreases risk. - answer"1. Do Not Take Antibiotics to Prevent
Illness (unless prescribed)
Doing this increases your risk for developing resistant infection. Exceptions include
taking antibiotics as prescribed before certain surgeries and dental work or in the
presence of immune dysfunction.
2. Wash Your Hands Frequently
Hand washing is the single most important thing you can do to prevent infection.
3. Follow Directions When Taking Antibiotics
Not taking your antibiotic as prescribed or skipping doses can allow antibiotic-resistant
bacteria to develop.
4. Do Not Request an Antibiotic for Flu or Colds
If your health care provider says that you do not need an antibiotic, chances are you do
not. Antibiotics are effective against bacterial infections but not viruses, which cause
colds and flu.
5. Finish Your Antibiotic
Do not stop taking your antibiotic when you feel better. If you stop taking your antibiotic
early, the hardiest bacteria survive and multiply. Eventually you could develop an
infection resistant to many antibiotics. You should never have leftover antibiotics.
6. Do Not Take Leftover Antibiotics
Do not save unfinished antibiotics for later use or borrow leftover drugs from family or
friends. This is dangerous because (1) the leftover antibiotic may not be appropriate for
you, (2) your illness may not be a bacterial infection, (3) old antibiotics can lose their
effectiveness and in some cases can even be fatal, and (4) there will not be enough
doses in a leftover bottle to provide full treatment." (Lewis 230 Table 15-7)
A) List three bacteria that frequently cause health care-associated infection.
B) Which patients are at highest risk for acquiring a health care-associated infection? -
answerMethicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococci (VRE),
and penicillin-resistant Streptococcus pneumoniae
Geriatric are 2-3x more likely to acquire a HAI compared to the adult population d/t co-
morbidities, risk for infection & atypical presentation (cog/beh changes, acute inability to
perform daily activities, lower core temp)
Describe the most effective strategy for decreasing health care-associated infections. -
answerHand washing and use of gloves are best practice to reduce HAI's.
Identify 2 ways bacteria and viruses differ from each other. - answerBacteria are one
celled organisms while viruses are infectious particles with no cellular structure. Viruses
,spread by releasing genetic material into the cells of a living organism while bacteria
cause disease by growing inside cells & causing damage to the outside of cells by
secreting toxins.
How do mosquitoes spread West Nile virus? What early warning sign does a health
department watch for when controlling for this virus? - answer"West Nile virus is carried
and transmitted by mosquitoes. Mosquitoes acquire the virus as they draw blood from
infected animals and people. The virus does not cause illness in the mosquito, but can
be transferred to uninfected animals and humans as the mosquito continues to feed.
Bird deaths are an early warning sign of a West Nile virus outbreak" (Lewis 228)
Identify 4 factors that increased the risk for the widespread distribution of emerging
infections such as novel influenza viruses or measles. - answer"Global travel,
population density, encroachment into new environments, misuse of antibiotics, and
bioterrorism have increased the risk for widespread distribution of emerging infections."
(Lewis 228)
How do antimicrobials work - answerSelective Toxicity
take advantage of the differences in cellular chemistry between mammals and
microbes.
-Disrupt bacterial cell wall
-Inhibit enzymes critical to bacterial survival
-Disrupt ribosomal protein synthesis in bacteria
How are antimicrobials classified - answerBy action (Bactericidal, Bacteriostatic)
& effectiveness (Broad spectrum.
Narrow spectrum)
Bactericidal - answerDirectly lethal to bacteria at specific concentrations
Ex: aminoglycosides (Gentamicin)
Bacteriostatic - answerSlow down bacterial growth, but not lethal
Healthy immune system works with phagocytes to eliminate bacteria
Ex: tetracyclines
won't work well in immunosupressed, elderly bc works w/ immune system
What kind of antibacterial do you give to immunosuppressed patients & why -
answerbactericidal, bacteriostatic work w/ immune system (phagocytes eliminate
bacteria)
Broad spectrum antibacterial - answereffective against wide variety of bacteria
Penicillins: ampicillin
Cephalosporins - 3rd generation (cefotaxime)
Carbapenems - imipenem
,Tetracyclines - doxycycline
Fluoroquinolones: ciprofloxacin
Narrow spectrum antibacterial - answereffective against specific bacteria
Penicillin G and V
Vancomycin
Erythromycin
Aminoglycosides: gentamicin, amikacin
Cephalosporins: 1st (cephalexin) and 2nd generation (cefoxitin)
Acquired resistance - answerThe microbes become resistant, not the host.
All antibiotics have potential to promote development of resistant microbes.
Caused by genetic mutations in the bacteria to the antibiotics
Which antibacterials have higher risk for acquired resistance? - answerBroad spectrum
antibacterials have greatest potential because they kill many competing microbes
Kill normal flora as well as infectious agent.
Leave drug-resistant microbes without check and balance system
Narrow spectrum antibacterials have less potential
Are effective against only a few microbes
To decrease the development of acquired drug resistance, which of the following
antibiotics would be preferred?
A. Amikacin
B. Ampicillin
C. Doxycycline
D. Cefotaxime - answerA. Amikacin
narrow spectrum antibiotic, the rest are broad spectrum
Suprainfection - answerType of drug resistance
New infection that appears during course of treatment for a primary infection
Antibiotics eliminate the inhibitory influence of normal flora and allow a new infectious
agent to develop
More common with broad-spectrum antibiotics
Common examples:
thrush (Candida albicans),
antibiotic-associated diarrhea (Clostridium difficile)
Clostridium difficile - answerA gram-positive anaerobic bacillus that infects the bowel
causing relatively mild to very severe symptoms.
, Infection almost always preceded by use of antibiotics.
Highly contagious
-Isolate patients with C. diff or place 2 patients with C. diff in same room
-Gown and glove and when entering the room
C diff treatment - answerDiscontinue antibiotic
Start different antibiotic: metronidazole and/or oral vancomycin
Hand hygiene
-Soap and running water rinse spores from hands but don't kill them
-Alcohol-based hand rubs won't kill or remove spores from hands
Use bleach disenfectant to kill spores
NDM-1 gene - answerConfers extensive drug resistance
DNA segment that codes for a powerful form of beta-lactamase
Inactivates all drugs with a beta-lactam ring
-Penicillins
-Cephalosporins
-Carbapenems
DNA can be easily transferred to other bacteria
-First discovered in K. pneumoniae in 2008
-Also found in common enteric bacteria such as E. coli, enterobacter, salmonella, &
others
Only a few cases have been reported in US and Canada to date.
Factors that inhibit drug penetration - answerBlood-brain barrier (meningitis)
Bacterial vegetation (endocarditis)
Infectious material (pus, necrotic tissue)
Foreign material (heart valves, prosthetic joints)
When is it okay to use antibiotics prophylacticly? - answerSurgery - 1st generation
cephalosporin given pre-op
-Cardiac
-Peripheral vascular
-Orthopedic
-GI tract
-Gynecologic surgery
