Microbiolog
Latre Buntaran
Clinical Microbiologist
Infection Control Officer
RSAB Harapan Kita
Bacteriology C/S
Plate sample on blood agar plate others
B
Bacteria
t i divided
di id d iinto
t 2 groups off Gram
G positive
iti (
deep blue or purple ) and Gram negative ( red or
pink )
C
Can bbe used
d tto diff
differentiate
ti t epithelial
ith li l and
d
inflammatory cells
Ski Fl
Skin Flora
Transient
Microbes that happen to be deposited on the skin but do not
multiply there.
Maybe
M b removed db
by a thorough
h h wash
h with
i h soap and
d water
Resident
Colonise the skin.
Cannot be removed by washing with soap and water
Can be reduced to small numbers by disinfectants
T
Transient
i t Bacteria
B t i
Exogenous
E iin origin
i i
Examples
p are S.aureus,, E.coli
R id t B
Resident Bacteria
t i
Endogenous in origin
They
y are Gram-positive
p cocci that appear
pp
microscopically like a bunch of grapes
S.aureus is ubiquitous.
Colonise ( nares, axillae, perineum,etc ) about 30% of
humans.
Person-to-person spread by hands ( common ), nasal
discharges and aerosol ( rare )
Major reservoir varies eg. nose for dialysis patients, oropharynx for
intubated patients
IIn neonates
t administration
d i i t ti off IV li
lipid
id emulsion
l i isi an
independent risk factor
Direct invasion
Dissemination ( haematogenous )
Toxin mediated
Di t IInvasion
Direct i b by S.
S aureus
1. Superficial
Pyoderma including impetigo, paronychia
Skin and soft tissue infections eg.
g boils,,
cellulitis
2. Deep
Septic
S ti arthritis
th iti
Osteomyelitis
Pyomyositis
Haematogenous Dissemination
M
Multisystem
lti t disease
di eg. toxic
t i shock
h k
syndrome
Virulence Factors of S.aureus
S aureus
Group A beta
beta-haemolytic
haemolytic streptococci or
S.pyogenes
M
Mostt important
i t t method
th d off spread
d off VRE iis
through transient carriage on hands of HCWs
Pathogenesis of Streptococcal
Toxic Shock Syndrome ( TSS )
Initial focus is the skin and soft tissues of
previously healthy individuals
Opportunistic
pp pathogens
p g in the elderly,
y,
immunocompromised or when invasive procedures
are done
Non
Non-fermenters
fermenters - Gram - negative
bacteria that do not utilize carbohydrates
as a source of energy or degrade them
through metabolic pathways other than
fermentation eg. Acinetobacter baumannii
Enterobacteriaceae
Escherichia coli
Klebsiella species (pneumoniae)
Enterobacter species
Proteus mirabilis
Pathogenesis of NI caused by
Enterobacteriaceae
1. Pathogen-specific factors
Adhesion
Capsules
Iron chelators
Other factors and Tropisms
2. Host factors
2
control the extent of colonisation
determine
d i the
h susceptibility
ibili off the
h host
h to di
disease
Adhesion
C
Can partly
tl protect
t t th
the bbacteria
t i against
i t
the bactericidal effect of serum and
against phagocytosis eg. Klebsiella spp.
Liberation
Lib ti off ttoxins
i eg. endotoxin.
d t i
Gastric pH
Fibronectin
Loss off fi
fibronectin
i when salivary
i protease secretion
i
is increased in critically ill patients and which then
d
degrades
d theh fib
fibronectin.
i
Hormonal modulation of colonisation
P
Primarily
i il spread
d from
f person to
t person via
i
unwashed hands of HCWs or from
environmental reservoirs to patients.
Differ
Diff substantially
b t ti ll ini virulence.
i l
Patients especially
p y haematology-oncology
gy gy p
patients
are colonised in the rectum and pharynx.
C
Capable
bl off prolonged
l d survival
i l in
i moist
i t or
dry environments eg. A. calcoaceticus
survived
i d 9 days
d on d
dry F
Formica
i surface
f
cf. 1 day for P. aeruginosa.
Conclusion