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INFECTION &
NOSOCOMIAL INFECTION
Introduction
Pathogenesis
Multi-factorial process
depends on:
factors) and
3.the number of organisms in the initial
exposure.
In the hospital,
nosocomial.
Cardinal Signs of
Inflammation
Calor
Rubor
Tumor
Transmission
Contact most common
Direct (physical contact)
Indirect (via contaminated objects)
Airborne Transmission
Droplet respiratory secretions on surfaces
Inhalation of infectious particles
Blood-borne transmission
Food-borne
Host Defenses
Prevent invasion
Limit proliferation
Contain or eradicate
streptococci, corynebacterium,
propionobacterium
Respiratory tract
Respiratory mucus coughing / swallowing
Pulmonary alveolar macrophages
phagocytosis
Normal flora :
Gram (+) : staphylococcus aureus,
streptococcus pneumopniae
Gram (-) : moraxella catarhalis,
haemophilus, neisseria
Urogenital, Billiary, Pancreatic ductal and
- Invasiveness
- Toxigenesis
Invasiveness
The ability to invade tissues
Mechanisms for colonization (adherence
COLONIZATION
The first stage of microbial infection
Toxigenesis
The ability to produce toxins
exotoxins : a potent toxin form and excreted by
responses.
On infection with gram (+) bacteria
peptidoglycan and its breakdown products, as well
as teichoic and lipoteichoic acids, are released
,stimulate toxin like pyrogenic responses.
The LPS produced by gram (-) bacteria is an even
more powerful activator of inflamm.reactions, and
its presence is like a multi alarm warning to the
body to activate the hosts protective systems
The lipid A portion of LPS is responsible for
endotoxin activity.
Its is important to appreaciate that endotoxin is not the same as
exotoxin & that only gram(-) bact can produce endotoxin
Exotoxins
Are protein produced by gram (+) or gram (-)
Exotoxins
The B portion of the A-B toxins that constitute
SUPERANTIGENS
Special group of toxins
Toxin like molecules activate T cells by binding
to both the T cell receptor and also MCHC II on
another cell without requiring antigen
This nonspesific means activating T cells can
trigger life-threatening auto-imune like
responses by stimulating the release of large
amounts of IL.
Superantigen include the toxic syndrome toxin of
S.aureus, staphylococcal enterotoxins ant the
erythrogenic toxin A or C of S.pyogenes
ways.
The can produce enzymes capable of lysing phagocytic
cells
They can inhibit phagocytosis or block intraceluller killing
enzymes/substances.
Ability to exit the phagosome into the host cytoplasma
before being exposed to lysosomal enzymes.
Nosocomial infections
are
Infections that are
acquired in hospital
(48 hours or more after
admission)
Approx 10% of
patients will suffer
from an infection
whilst in hospital risk
increases with length
of stay
Problem oriented
Nosocomial
Infections.
antimicrobics
Variety of nosocomial
infection
Nosocomial infections
Bloodstream infections, 28%
Ventilator-associated pneumonia, 21%
Urinary tract infection (UTI), 15%
Lower respiratory infection, 12%
Gastrointestinal, skin, soft tissue, and
Bloodstream nosocomial
infections
Coagulase-negative staphylococci, 40%
Enterococci, 11.2%
Fungi, 9.65%
Staphylococcus aureus, 9.3%
Enterobacter species, 6.2%
Pseudomonads, 4.9%
Acinetobacter baumannii with substantial
Nosocomial infection
host
Text in here
microbes
environment
Text in here
Treatment
The Host
People in hospital are already sick!
They may have poor general resistance to infection
Lack of immunity
Extremes of age
Immunocompromised (eg HIV+, cancer chemotherapy)
Reduced immunity
Diabetes, severe burns
Surgery
Wounds, sutures
Medical devices
Catheters, prostheses, tubing etc
The microbes
Virtually any infection can be acquired in
hospital
However a number of usual suspects
predominate
What are they, where do they come from and
why do they cause nosocomial infection?
Opportunistic infections
Nosocomial
Opportunistic pathogens
Pseudomonas aeruginosa
staphylococci
E. coli and other coliforms
streptococci and enterococci
Bacteroides fragilis
Candida albicans
Herpes simplex virus
Cytomegalovirus
Biofilms
Biofilms are microbial
communities (cities)
living attached to a solid
support eg catheters/
other medical devices
Biofilms are involved in
up to 60% of nosocomial
infections
Antibiotics are less
effective at killing
bacteria when part of a
biofilm
The Environment
There are many different sources of
Treatment
There is continuous usage of antibiotics in
Causes of death
1. Pneumonia
2. Infection of surgical site
3. Primary bloodstream infection
Infection Control
Infections may derive
from endogenous
(auto-infection) or
exogenous sources
(cross-infection)
We need to consider
Decontamination of environment
Hand washing
Decontamination of equipment
THANK YOU..