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Enterobacterales (i) (intro (antibiotic resistance = becoming an…

- - - - UTI
        
        originates from perianal area + travels along urethra to bladder
        
        urinary frequency + dysuria
        
        usually systemically well
        
        may spread to urinary tract from blood stream (<10%)
        
        commonest cause of UTI in the community (>80%) + in hospitals (>50%)
        
        pathogenic strains often have pili/fimbriae that aid attachment to epithelial cells: type 1 fimbriae
        
        certain serotypes are more commonly a/w UTIS: 01, 02, 04 (symptoms based on O antigen - rarely clinically relevant)
        
        Tx usually nitrofurantoin/trimethoprim
      - intra-abdo infection
        
        acute cholecystitis (give co-amox +/- gentamicin)
        
        appendicitis
        
        peritonitis
        
        subphrenic abscess
        
        liver abscess
      - meningitis
        
        neonatal
        
        early onset: soon after delivery; acquired during birth (esp in prematurity + prolonged membrane rupture - ascending infection from genital tract)
        
        late onset: up to 3 months/neonatal period, may have been acquired during birth or later
        
        tx for 3 wks + close followup
        
        other age groups
        
        may occur in patients with CNS devices, any device, or neurosurgical patients
        
        Dx = CSF
        
        high WCC (esp polymorphs)
        
        low glucose
        
        high protein
        
        culture + sensitivity
      - gastroenteritis
        
        toxin-producing strains only
    - - pneumonia
      - post-op intra-abdo pus collection
      - BSI
        
        septic shock - endotoxic or gram -ve shock
        
        often v severe, regularly review patient with +ve gram -ve blood cultures
        
        sources may be intra-abdo pathology, urinary tract sepsis, neonatal meningitis
        
        increased risk with certain genetic inborn errors of metabolism e.g. galacaesaemia
    - - depends on source/patient factors/local resistance patterns
      - many are amoxicillin resistant
      - additional resistantce more common in hospital stains - ESBL
- - - - gram -ve sepsis
      - vasodilation
      - hypotension
      - end organ damage