Microbiology

Bacteria
Gram positive Gram negative
Cocci  Staphylococcus (clusters and catalase +ve) Diplococci
↘Coagulase +ve (aureus) – skin, pneumonia,  Neisseria
endocarditis, abscess formation ↘meningitidis – meningitis
↘Coagulase -ve (epidermidis; saprophyticus) ↘gonorrhoeae –gonorrhoea, conjunctivitis, pharyngitis, disseminated
CONS = Contaminants (unless foreign bodies present) infection, arthritis

 Streptococcus (strips and catalase -ve)  Moraxella

↘α-haemolytic i.e. partially lyse RBCs ↘catarrhalis –URTI s, chronic lung disease exacerbations, pneumonia
-pneumoniae
– pneumonia, meningitis, URTIs, invasive
-viridans group (mitis, mutans, salivarius,
sanguinis, anginosus) – endocarditis, dental
↘β-haemolytic i.e. completely lyse RBCs
-Group A strep (pyogenes) – skin, Rh fever,
scarlet fever, strep throat, post-strep GN, erysipelas,
nectrotising fascitis, strep toxic shock
-Group B strep (agalactiae)
– vaginal colonisation, neonatal infection
↘Non-haemolytic
-Group D strep (bovis; equinus)
– bacteraemia
-Enterococcus (faecium; faecalis)
–UTIs, bacteraemia, endocarditis, diverticulitis
Rods (bacilli) Big and spore forming Enteric Non-enteric
 Clostridium (anaerobic) Long Coccobacilli
↘difficile – C diff diarrhoea  E. Coli  Haemophilus
↘tetani – tetanus – UTIs, gastroenteritis, ↘influenzae
neonatal meningitis
↘perfringens – gas gangrene Aerobic glucose + – pneumonia, meningitis,
↘botulinum – botulism  Klebsiella epiglottits
lactose fermenting
– pneumonia, UTIs
(COLIFORMS –  Bordetella

ENTEROBACTERIACEAE

Enterobacter ↘pertussis
 Bacillus – LRTIs, UTIs, skin, intra-
normal bowel flora)
– Whooping cough
↘anthracis – anthrax (infected animal/product spores → abdominal, endocarditis
 Garnerella
cutaneous: black ulcer, lymphadenopathy, fever;  Citrobacter
lung: pneumonia; or GI: haematemsis/diarrhoea) – UTIs
↘vaginalis
– bacteria vaginosis
↘cereus – gastroenteritis (improperly refrigerated rice)  Salmonella
– gastroenteritis, typhoid
 Acinetobacter
– nosocomial infections
Small and non-spore forming  Shigella
 Legionella
 Listeria – gastroenteritis/dysentery
 Proteus Aerobic glucose ↘pneumophilia
↘monocytogenes – gastroenteritis, septicaemia, – Legionnaires’ disease
meningitis, encephalitis, pneumonia, neonatal, endocarditis – UTIs, nosocomial only fermenting (water tanks/air conditioners
(risks = soft cheeses, unpasteurized milk, meats)  Yersinia → atypical pneumonia)
– yersinosis (diarrhoeal
illness), plague
 Coxiella
 Corynebacterium ↘burnetii
 Serratia
↘diphtheriae – diphtheria, colonisation – nosocomial
–Q fever (livestock → flu-
like illness, pneumonia,
 Pseudomonas Aerobic non- granulomatous hepatitis,
– pneumonia, UTIs, sepsis, fermenting endocarditis)
Gastrointestinal, wound  Brucella
 Bacteroides Anaerobic – brucellosis (unpasteurized
– intra-abdominal milk → long flu-like illness)
Curved  Pasteurella
 Vibrio – pasturellosis (cat bite →
septic phlegmon)
↘cholerae – cholera (dysentery)
 Francisella
 Campylobacter (microaerophilic) – tularaemia (tick/deer fly
↘jejuni – gastroenteritis (raw meat) bite → ulcer at site of entry,
 Helicobacter fever/sepsis,
lymphadenopathy)
↘pylori – gastritis
Spirochetes  Treponema
↘pallidum – syphilis
 Borrelia
↘burgdorferi – Lyme disease
 Leptospira – leptospirosis (spread by rodents)
Branching  Actinomyces (anaerobic)
filamentous – dental, actinomycosis (abscesses)
growth  Nocardia (partially acid fast)
– pneumonia, endocarditis, encephalitis, brain abscess, skin
Pleomorphic  Chlamydia
↘trachomatis – cervicitis/urethritis
↘psittaci – psittacosis/pneumonia (spread by birds)
 Rickettsiae – typhus, rickettsialpox, Boutonneuse fever, African
tick bite fever, Rocky Mountain spotted fever (all tick borne)
Unique cell  Mycobacterium (acid fast)
wall ↘tuberculosis – TB
No cell wall  Mycoplasma
↘pneumoniae – pneumonia
© 2013 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students’ finals OSCE revision .
Antibiotics Gram Positive Gram Negative
Cocci Rods (bacilli)
Class Subclass Antibiotic Enterococcus MRSA Staphylococcus Streptococcus Neisseria Haemophilus E. Coli and Β-lactamase Pseudomonas Anaerobes Atypical
aureus (MSSA) meningitidis coliforms resistance* (except C. Diff) pneumonias
β-lactams Penicillins Flucloxacillin
β-lactam ring Large so not affected by
β-lactamase
++++ +
lodges in
Benzylpenicillin
bacterial cell
wall
Staph secretes
penicillinase ++++ ++ -Penicillinase
-ESBL
+
(β-lactamase that
Amoxicillin/ -Amp C
Ampicillin
destroys β-lactam
ring of penicillin) +++ + + - Carbapenemase

Many resistant
Co-Amoxiclav -Amp C
(Amoxicillin + β- ++ (resistant to inhibitor)
lactamase inhibitor) ++ MRSA is -Carbapenemase
Target cell wall

resistant to
Tazocin (Piperacillin +
β-lactamase inhibitor)
Not all
β-lactams due
to modification +++ ESBLs sensitive in vitro
but have variable +++ ++
of penicillin activity in vivo
Carbapenems Meropenem binding protein -Carbapenemase

Antibiotic of choice for

+++
2nd gen Cefuroxime Cefuroxime
+++ ESBL/Amp C

Cephalosporins doesn’t -ESBL (but sensitive to

penetrate BBB cephamycins)
3rdgen Ceftriaxone/ ++ -Amp C Ceftazidime is used
Cephalosporins Cefotaxime ++++ -Carbapenemase for pseudomonas
only (best agent)
4th gen Cefepime -ESBL (variable)
Cephalosporins +++ -Carbapenemase
(variable)
+++
Glycopeptides Vancomycin/
Inhibit peptidoglycan links in cell wall Teicoplanin +++ +++ ++ +
Some strains
resistant (VRE)
Aminoglycosides Gentamicin Some cross resistance Aminoglycosides
Inhibit 30S ribosomal subunit + + +++ with ESBL and +++ use oxygen
Target protein synthesis

carbapenemase dependent active

transport
Tetracyclines Doxycycline
Inhibit 30S ribosomal subunit ++ +/- ++
Lincosamides Clindamycin ++
Inhibit 50S ribosomal subunit ++ ++ ++
Macrolides Erythromycin/ ++
Inhibit 50S ribosomal subunit Clarithromycin/ ++ +++
Azithromycin (gram -ve)
Misc Chloramphenicol
Inhibit 50S ribosomal subunit ++ + + + + + +/- ++
Fluroquinolones Ciprofloxacin Some cross resistance
Inhibit DNA gyrase + +++ +++ with ESBL and
carbapenemase
++ +++
Not alone
Misc Metronidazole
+++
Target DNA

Inhibit DNA
Trimethoprim
+ ++
Co-trimoxazole
(sulfamethoxazole +
+ ++ ++
Some cross resistance
with ESBL and
trimethoprim) carbapenemase

Nitrofurantion
++ ++
Atypical pneumonias: legionella (gram –ve), mycoplasma Coliforms (lactose-fermenting enterobacteriaceae): E. Coli, enterbacter, klebsiella
Anaerobes: clostridium (gram +ve rod), bacteroides (gram -ve rod) Other important bacteria to know antibiotics for: mycobacterium (gram +ve rod); clostridium difficile (gram +ve rod); chlamydia (gram –ve)
*β-lactamase resistance: β-lactamases are enzymes produced some bacteria which break down the β-lactam ring of certain β-lactam antibiotics and cause resistance.
Penicillinase is produced by several bacteria, most notably staphylococcus; the other β-lactamases (ESBL, Amp C, carbapenemase) are mainly produced by some enterobacteriaceae.
© 2013 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students’ finals OSCE revision .
Coverage Needed
Gastroenteritis/diarrhoea → ceftriaxone/ciprofloxacin/azithromycin
Community acquired pneumonia  Salmonella enteritidis
 Streptococcus pneumoniae  Shigella
 Haemophilus influenza (if not vaccinated)  Campylobacter
 Atypicals  E. coli (enterotoxic)
If immunocompromised (i.e. malnourished, alcoholic, diabetic, on long term steroids), also: staphylococcus aureus, coliforms, TB Less common: yersinia enterocolitica, bacillus cereus, staphylococcus aureus
If severely immunosuppressed (i.e. HIV with CD4<200, transplant recipient): pneumocystis carinii, cryptococcus, CMV, varicella zoster virus, influenza, fungal If been at risk, also: clostridium difficile, vibrio cholerae, salmonella typhi
infections If dysentery: shigella, vibrio cholera, amoeba
Don’t forget viral, parasitic and non-infectious causes!

Hospital acquired pneumonia

 Staphylococcus aureus (including MRSA) Skin/joints/bone
 Anaerobes  Staphylococcus aureus
 Coliforms  Streptococcus pyogenes
 Pseudomonas For wound/ulcer infections or severe/necrotising cellulitis, also: anaerobes
For burns, also: anaerobes, pseudomonas
For post-surgical wounds, also: gram negative bacilli (e.g. E. coli, kelbsiella, pseudomonas), enterococci, MRSA, CONS
Colonising bacteria in chronic respiratory ill health (may or may not cause infection e.g. exacerbation) NB. wound colonising bacteria (colonise exudate without necessarily causing infection) include: coliforms, enterococcus, anaerobes
 Streptococcus pneumoniae
 Haemophilus influenzae Meningitis
 Moraxella catarrhalis  Nisseria meningitidis (meningococcal)
 Staphylococcus aureus  Streptococcus pneumonia (pneumococcal)
 Pseudomonas  Haemophilus influenza (if not vaccinated)
 Listeria (if >65y or immunocompromised)
In cystic fibrosis, also: burkholderia cepacia
If neonatal: group B streptococcus, E. coli/coliforms, listeria (rare)
Upper respiratory tract infections
 Streptococcus pneumoniae Urine
 Streptococcus pyogenes 1. E. coli
 Haemophilus influenzae 2. Staphylococcus saprophyticus
 Moraxella catarrhalis 3. Non-E. Coli enterobacteriaceae (klebsiella, enterobacter, proteus), pseudomonas, enterococci,
staphylococci (CONS/aureus)
Cavitating pneumonia Less common organisms (3) are associated with: catheters, hospital, structural abnormalities and instrumentation
 Streptococcus pneumoniae
 Staphylococcus aureus Infective endocarditis
 Klebsiella  Viridans group streptococci and other streptococci (e.g. bovis)
 TB  Enterococci
 Anaerobes  Staphylococcus aureus and coagulase negative staphylococci (e.g. epidermidis)
 Coxiella burnetii
Intra-abdominal (including biliary)  HACEK organisms
Normal bowel flora:
 Anaerobes e.g. bacteroides Surgical prophylaxis
 Coliforms  Need to cover skin ± intra-abdominal
 Enterococcus
Sepsis of unknown origin
 Need to cover skin, chest, urine, meningitis, intra-abdominal
© 2013 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students’ finals OSCE revision .