Resistant Bacterial Infections
  • C. difficile

This is a Gram-positive bacterium which colonises the gut in the absence of one’s commensal, harmless bacteria. Normal flora in the gut can be killed secondary to the use of broad-spectrum anti-biotics, leaving the individual vulnerable to a C. diff infection.

– The bacteria make a toxin which leads to inflammation in the colon giving pseudomembranous colitis

– It is a major problem on the wards and can spread rapidly between patients


Causes: Most common is cephalosporins, clindamycin, PPIs


Symptoms – Diarrhoea and abdominal pain

– If severe, can lead to toxic megacolon (surgical emergency)


Tests – Blood test shows raised White blood cell count

   – Diagnostic Test is Clostridium difficile toxin (CDT) in stool

   – C. difficile antigen positivity only shows exposure to bacteria, not current infection


Management – 1st line is Metronidazole (oral) for 10-14 days

   – If severe –> oral vancomycin


  • CRE (Carbapenem-resistant Enterobacteriaceae)

CRE are Gram-negative bacteria that are resistant to carbapenem, one of the strongest antibiotics

– This is because they produce the enzyme carbapenemase which deactivates the drug

– People can be colonised with CRE but it causes infection when it enters blood or spreads locally

– They are more common in hospital patients and care facilities who take long courses of antibiotics and have ventilators and catheters


Organisms: Resistant E. Coli, Klebsiella Pneumonia, Enterobacter aerogenes


Symptoms – Variety of illnesses e.g. wound infections, UTI, pneumonia


Diagnosis – Blood cultures


Management – Aim is to prevent infection as treatment options severely limited

– Antibiotics of choice are Fosfomycin, tigecycline and aminoglycosides



  • MRSA (Methicillin-resistant Staphylococcus Aureus)

This is a hospital acquired infection due to the bacteria S. Aureus resistant to the antibiotic methicillin

– It is common in hospital, prisons and care homes in people with open wounds and indwelling devices

– All patients awaiting elective surgery + A&E admission are screened for MRSA


Risk factors – Long course of antibiotics, recent surgery, catheters, immunosuppressed


Symptoms – Most infections localised to the skin and soft tissue, but can enter blood stream

– Common presentation –> Small red bumps which develop into deep painful pus-filled boils

– Can have fever and rash


Tests – Nasal swabs + swab of skin lesions and wounds sent for culture



– If asymptomatic carrier –> mupirocin cream (if nose swab positive) or chlorhexidine (if on skin)

– If infection –> Antibiotics vancomycin, teicoplanin or linezolid


  • VRE (Vancomycin resistant Enterococci)

This is a group of bacteria of the Enterococcus family resistant to the antibiotic vancomycin

– People can be colonised with VRE but it causes infection when it enters blood or spreads locally


Risk factors – Long course of cephalosporins, recent surgery, catheters, immunosuppressed


Symptoms – Variety of illnesses e.g. wound infections, UTI, bloodstream infections, endocarditis


Diagnosis – Blood cultures


Management – Newer antibiotics e.g. Linezolid + Quinupristin-dalfopristin


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