Gram-positive bacteria: Staphylococci

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Gram-positive bacteria Staphylococci
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Staphylococcus aureus
Staphylococcus aureus causes a variety of
suppurative (pus-forming) infections and
toxinoses in humans. It causes superficial skin
lesions such as boils, styes and furunculosis
more serious infections such as pneumonia,
mastitis, phlebitis, meningitis, and urinary
tract infections and deep-seated infections,
such as osteomyelitis and endocarditis. S. aureus
is a major cause of hospital acquired
(nosocomial) infection of surgical wounds and
infections associated with indwelling medical
devices. S. aureus causes food poisoning by
releasing enterotoxins into food, and toxic shock
syndrome by release of superantigens into the
blood stream.
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Staphylococcus aureus

• http//www.visualdxhealth.com/pdfs/MRSA20Handout.
  pdf

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Superantigens

• http//highered.mcgraw-hill.com/sites/0072556781/s
  tudent_view0/chapter32/animation_quiz_4.html

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Treatment of Infections Caused by Staphylococcus
aureus

• Antistaphylococcal penicillins Nafcillin,
  oxacillin
• First Generation cephalosporins Cefazolin
• Second Generation Cephalosporins Cefurxime
• Third-generation cephalosporins Ceftriaxone,
  cefotaxime, ceftizoxime
• B-Lactam/b-lactamase inhibitor combinations
  Ampicillin-sulbactam, piperacillin-tazobactam,
  ticarcillin-clavulanate
• Carbapenems Imipenem, meropenem

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Treatment of Methicillin-resistant Staphylococcus
aureus

• Vancomycin
• Linezolid
• Streptogramins (Quinupristin-dalfopristin)
• Daptomycin
• Tigecycline

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Gram-positive pathogensStreptococcus pneumoniae
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Streptococcus pneumoniae
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Treatment of Streptococcus pneumoniae

• Penicillin G
• Aminopenicillins Ampicillin

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Treatment of Penicillin-resistant Streptococcus
pneumoniae

• Second Generation Cephalosoporins Cefuroxime
• Third Generation Cephalosporins Cefotaxime,
  Ceftriaxone
• Quinolones Moxifloxacin, Levofloxacin
• Vancomycin
• Macrolides/ketolines Telithromycin

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Streptococcus pyogenes
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Streptococcus pyogenes
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Treatment of Streptococcus pyogenes

• Penicillin G
• Aminopenicillins Ampicillin
• Aminoglycosides are sometimes added for synergy
  Gentamicin
• Clindamycin is added for severe invasive
  Streptococcus pyogenes infections

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Treatment for Penicillin-resistant Streptococcus
pyogenes (and other penicillin resistant
Streptococcus)

• Vancomycin
• Second-generation cephalosporins Cefuroxime
• Third-generation cephalosporins cefotaxime,
  ceftriaxone

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Enterococci
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Enterococcus
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Enterococcus Resistance Mechanisms
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Treatment of Infections Caused by Enterococcus

• Penicillin G
• Aminopenicillins Ampicillin
• Extended-spectrum Penicillins Piperacillin
• Carbapenems Imipenem, meropenem
• For serious infections, add an aminoglycoside for
  synergy Gentamicin

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Treatment for Infections Caused by
Penicillin-resistant Enterococci

• Vancomycin

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Treatment for Vancomycin Resistant Enterococci
(VRE)

• Linezolid
• Tetracycline-like Tigecycline
• Sometimes also active
• Daptomycin
• Quinupristin/dalfopristin

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Gram-positive BacteriaListeria Monocytogenes
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Listeria monocytogenes

• http//www.nature.com/nrmicro/animation/imp_animat
  ion/index.html

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Treatment of Infections Caused by Listeria
monocytogenes

• Ampicillin Gentamicin
• If penicillin allergic
• Trimethoprim-sulfamethoxazole

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Bacillus anthracis
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Bacillus anthracis
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Bacillus anthracis
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Treatment of Infections Caused by Bacillus
anthracis

• Quinolones Ciprofloxacin
• Tetracycline Doxycycline

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Treatment of Infections Caused by Bacillus
anthracis

• For Inhalation Anthrax, a Second Agent Should be
  Added from the Following List
• Rifampin
• Vancomycin
• Penicillin G
• Ampicillin
• Chloramphenicol
• Carbapenem Imipenem
• Clindamycin
• Macrolide Clarithromycin

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Gram-negative BacteriaEnterobacteriaceae
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Escherichia coli
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Klebsiella
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Proteus
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Escherichia coli.

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  mov
• http//www.drkoop.com/animation/93/43.html

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Treatment of Infections Caused byE. coli., K.
pneumoniae, Proteus

• Aminopenicillins Ampicillin
• First Generation Cephalosporins Cefazolin
• Sulfa drugs Trimethoprim-sulfamethoxazole
• Quinolones Ciprofloxacin, levofloxacin,
  moxifloxacin

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Treatment of Resistant Infections Caused byE.
coli., K. pneumoniae, Proteus

• Third Generation Cephalosporins Cefoxaxime,
  ceftriaxone, ceftizoxime
• Monobactam Aztreonam
• Extended Spectrum penicillins b-lactamase
  inhibitor Piperacillin-tazobactam,
  ticarcillin-clavulanate
• Carbapenems Imipenem, meropenem, ertapenem
• Carbapenem aminoglycoside in serious
  infections Add Gentamicin, Tobramycin, amikacin

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Treatment of Infections Caused byEnterobacter,
Serratia, Citrobacter, Providencia, and
Morganella Spp.

• Carbapenems Imipenem, meropenem, ertapenem
• Sulfa Drugs Trimethoprim-sulfamethoxazole
• Quinolones Ciprofloxacin, levofloxacin
• Fourth Generation Cephalosporins Cefepime
• aminoglycoside Gentamicin, tobramycin, amikacin

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Treatment of Infections Caused bySalmonella
enterica, Shigella spp.

• Quinolones Ciprofloxacin
• Third-generation cephalosporins Cefotaxime,
  ceftriaxone, ceftizoxime
• Macrolides Azithromycin

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Treatment of Infections Caused byYersinia spp.

• Aminoglycosides Gentamicin, streptomycin
• Tetracyclines Doxycycline
• Quinolones Ciprofloxacin
• Sulfa drugs

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Gram-negative BacteriaPseudomonas
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Pseudomonas
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Resistance of Pseudomonas
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Treatment of Infections caused by Pseudomonas
aeruginosa

• Extended spectrum penicillins Piperacillin,
  Ticarcillin
• Third Generation Cephalosporins Ceftazidime
• Fourth-generation Cephalosporins Cefepime
• Carbapenems Imipenem, meropenem
• Monobactams Aztreonam
• Quinolones Ciprofloxacin, Levofloxacin
• Aminoglycosides Gentamicin, tobramycin, amikacin

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Treatment of Serious Infections Caused by
Pseudomonas aeruginosa

• Antipseudomonal b-lactam aminoclycoside
  Ceftazidime Tobramycin
• Extended-spectrum penicillin antipseudomonal
  quinolone Piperacillin Ciprofloxacin

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Neisseria
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Neisseria meningitidis
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Neisseria gonorrhoeae
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Treatment of Infections Caused by Neisseria
meningitidis

• Penicillin G
• Third generation cephalosporins Ceftriaxone,
  cefotaxime

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Treatment of Infections Caused byNeisseria
Gonorrhoeae

• Third Generation Cephalosporins Ceftriaxone,
  cefixime

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Curved Gram Negative Bacilli

• Includes
• Campylobacter jejuni,
• Helicobacter pylori,
• Vibrio cholerae

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Campylobacter jejuni
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Campylobacter jejuni
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Treatment of Infection Caused by Campylobacter
jejuni

• Macrolides Erythromycin, azithromycin,
  clarithromycin
• Quinolones Ciprofloxacin

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Helicobacteri pylori
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Helicobacter pylori
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Helicobacter pylori
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Duodenal Peptic Ulceration Caused by Helicobacter
pylori
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Treatment of Infection Caused by Helicobacter
pylori

• Amoxicillin clarithromycin proton pump
  inhibitor
• Metronidazole clarithromycin proton pump
  inhibitor
• Bismuth subsalicylate metronidazole
  tetracycline proton pump inhibitor

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Vibrio cholerae
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Vibrio cholerae
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Treatment of Infection Caused by Vibrio cholerae

• Tetracyclines tetracycline, doxycycline
• Sulfa drugs Trimethoprim-sulfamethoxazole
• Quinolones Ciprofloxacin
• Macrolides Erythromycin, Azithromycin

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Haemophilus influenzae
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Haemophilus influenzae
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Haemophilus influenzae
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Treatment of Infections Caused by Haemophilus
influenzae

• Aminopenicillins b-lactamase inhibitor
• Amoxicillin/clavulanate
• Ampicillin/sulbactam
• Second-generation cephalosporin
• Cefuroxime
• Third-generation cephalosporin
• Ceftriaxone
• Cefotaxime

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Bordetalla pertussis
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Bordetella pertussis
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Treatment of Infection Caused by Bordetella
pertussis

• Macrolides Azithromycin, Clarithromycin,
  Erythromycin

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Moraxella catarrhalis

• Causes otitis media, pneumonia, and sinusitis
• Usually produces b-lactamase

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Treatment of Infections Caused by Moraxella
catarrhalis

• Extended spectrum penicillins piperacillin,
  ticarcillin
• B-lactam/b-lactamase inhibitor combinations
  piperacillin/tazobactam, ticarcillin/clavulanate
• Second and third-generation cephalosporins

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Acinetobacter

• Recent outbreak among soldiers in Iraq
• Second leading cause of infection among troops
  during the Vietnam conflict

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Acinetobacter
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Treatment of Infection Caused by Acinetobacter

• Sulbactam
• Carbapenems
• Quinolones

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Anaerobic BacteriaGram positive Clostridia spp.
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Clostridium tetani

• Clostridium tetani is the etiologic agent of
  tetanus
• Characterized by persistent tonic spasm, usually
  involving the masseter muscles (lockjaw)
• Usually caused by deep wound becoming infected
  with C. tetani spores.

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Clostridium botulinum

• Clostridium botulinum is usually acquired by
  ingestion of food contaminated with C. botulinum
  spores
• Botulinum toxin leads to cranial neuroopathies
  and weakness rather than muscular spasm.

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Treatment of Infections Caused by Clostridium spp.

• Penicillin G
• Metronidazole (may be associated with better
  outcomes

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Clostridium difficile
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Clostridium difficile
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Treatment of Infections Caused by Clostridium
difficile

• Oral metronidazole
• Oral vancomycin

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Clostridium perfringens is the cause of gas
gangrene
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Treatment of Infections Caused by Clostridium
perfringens

• Penicillin one of the following
• Clindamycin
• Tetracycline
• Metronidazole

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Anaerobic Gram-negative Bacteria
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Common Anaerobic Gram-negative Pathogens

• Bacteroides fragilis
• Usually produces b-lactamase
• Prevotella
• Porphyromonas

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Treatment of Anaerobic Gram-negative Infections

• b-lactam/b-lactamase inhibitor combinations
• Ampicillin-sulbactam
• Piperacillin-tazobactam
• Ticarcillin-clavulanate
• Carbapenems Imipenem, Meropenem, Ertapenem
• Metronidazole

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Atypical Bacteria Chlamydia
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Chlamydia trachomatis

• One of the most common sexually transmitted
  diseases
• Also a leading cause of blindness in some parts
  of the world

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Chlamydia trachomatis
Chlamydia is a bacterial infection of the genital
tract spread through sexual contact. If
untreated, it can result in various medical
complications, including damage to the
reproductive organs. The disease affects both
women and men, although reported cases for women
greatly exceed those for men. Chlamydia affects
people in all age groups, but it is particularly
prevalent among teenagers and young adults.
According to the U.S. Centers for Disease Control
and Prevention (CDC), the infection is most
prevalent among women aged 20 to 25.
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Chlamydia trachomatis

• Some signs and symptoms that may be present in
  people infected with chlamydia are
• Abnormal discharge from the penis or vagina
• Burning sensation during urination
• Lower abdominal or back pain
• Nausea
• Fever
• Pain during intercourse
• Burning or itching around the head of the penis
• Swollen or tender testicles
• Bleeding between menstrual cycles
• Proctitis (inflammation of the rectum)

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Treatment of Infections Caused by Chlamydia
trachomatis

• Tetracyclines
• Tetracycline
• Doxycycline
• Macrolides
• Azithromycin
• Erythromycin
• Telithromycin
• Quinolones
• Ofloxacin
• Moxifloxacin
• Gemifloxacin

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Mycoplasma pneumoniae
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Mycoplasma pneumoniae
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Treatment of Infections Caused by Mycoplasma
pneumoniae

• Macrolides Azithromycin, clarithromycin,
  erythromycin telithromycin
• Tetracyclines Tetracycline, doxycycline
• Quinolones Levofloxacin, moxifloxacin,
  gemifloxacin

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Atypical Bacteria Legionella

• Legionella pneumophila is the most common
  species, and is the causative agent of
  Legionaires disease
• Once in the lung, Legionella organisms are taken
  up by macrophages and multiply within them.

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Legionalla pneumophila

• http//www.nature.com/nrmicro/animation/imp_animat
  ion/index.html

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Treatment of Infections Caused by Legionella
pneumophila

• Macrolides Azithromycin
• Quinolones Levofloxacin, moxifloxacin

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Brucella

• Brucellosis is a disease of animals, that is
  occasionally transmitted to humans
• Contact with animals and/or ingestion of
  unpasteurized milk or cheese are risk factors

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Brucella
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Brucella
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Treatment of Infections Caused by Brucella spp.

• Doxycycline rifampin
• Dixycycline gentamicin
• Doxycycline streptomycin

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Francisella tularensis
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Francisella tularensis
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Treatment of Infections Caused by Francisella
tularensis

• Aminoglycosides Streptomycin, Gentamicin
• Tetracyclines Tetracycline, doxycycline

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Rickettsia spp
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Rickettsia rickettsii
Rocky Mountain spotted fever is the most severe
and most frequently reported rickettsial illness
in the United States. The disease is caused by
Rickettsia rickettsii, a species of bacteria that
is spread to humans by ixodid (hard) ticks.
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Treatment of Infections Caused by Rickettsia spp.

• Tetracyclines
• Doxycycline
• Tetracycline

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Spirochetes Treponema pallidum
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Treponema pallidum
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Treponema pallidum
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Treponema pallidum
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Treatment of Infections Caused by Treponema
pallidum

• Penicillin G (including benzathine penicillin)
• Tetracyclines
• Third Generation Cephalosporins

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Penicillin G benzathine
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Procaine penicillin G
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Borrelia borgdorferi
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Borrelia burgdorferi
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Borrelia burgdorferi is the causative agent of
Lyme Disease
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Treatment of Infections Caused by Borrelia
burgdorferi

• Tetracyclines Doxycycline
• Aminopenicillins Amoxicillin

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Leptospira interrogans
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Leptospira interrogans
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Treatment of Infection Caused by Leptospira
interrogans

• Tetracyclines Doxycycline
• Aminopenicillins Amoxicillin
• Severe Disease can be treated with Penicillin G,
  Ampicillin, or Ceftriaxone

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Mycobacteria

• Mycobacterium tuberculosis
• Mycobacterium avium complex
• Mycobacterium leprae

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Mycobacterium tuberculosis
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Mycobacterium tuberculosis
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Mycobacterium tuberculosis
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Treatment of Infections Caused by Mycobacterium
tuberculosis

• Active Disease
• Isoniazid Rifampin Pyrazinamide Ethambutol
  for two months
• Followed by Isoniazid Rifampin for Four months
• Latent Disease
• Isoniazid for 9 months

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Mycobacterium avium complex
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Mycobacterium avium complex
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Treatment of Infections Caused by Mycobacterium
avium complex (MAC)

• Clarithromycin ethambutol rifabutin

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Mycobacterium leprae
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Mycobacterium leprae
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Leprosy
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Treatment of Infections Caused by Mycobacterium
leprae

• Dapsone rifampin clofazimine