Infection 29
REVIEW OF MICROBIOLOGY
Pathology of Infection
A. Infection: invasion of body by pathogenic microorganisms
(pathogens) and reaction of tissues to their presence and to
toxins generated by them
1. Pathogenicity: ability of a microbe to cause disease
2. Virulence: degree of pathogenicity
B. Classifications
1. Extent of involvement
a. Local infection: limited to one locality (e.g., abscess),
causing pain, swelling, and erythema; may have
systemic repercussions such as fever, malaise, and
lymphadenopathy
b. Systemic infection: infectious agent is spread
throughout body (e.g., typhoid fever)
2. Length of infectious process
a. Acute infection: one that develops rapidly, usually
resulting in high fever and severe sickness; resolves
in a short time
b. Chronic infection: one that develops slowly, with
mild but longer-lasting clinical manifestation;
sometimes an acute infection can become chronic
3. Etiology of infectious process
a. Primary infection: develops after initial exposure to
pathogen, unrelated to other health problems
b. Secondary infection: develops when pathogens take
advantage of weakened defenses resulting from a
primary infection (e.g., staphylococcal pneumonia as
sequela of measles)
c. Opportunistic infection: develops when host defenses
are diminished because of disease process or
therapeutic modalities (e.g., vaginal yeast infection
following antibiotic therapy)
C. Chain of infection
1. Infectious agent
2. Reservoir: source of almost all pathogens is human or
animal
a. Persons exhibiting manifestations of disease
b. Carriers: persons who harbor pathogens in absence
of discernible clinical disease
(1) Healthy carriers: those who have never had the
disease in question
(2) Incubatory carriers: those in incubation phase of
disease
(3) Chronic carriers: those who have recovered from
disease but continue to harbor pathogens
3. Portals of exit: route by which microorganisms leave
body; blood and body fluids, skin, mucous membranes,
and respiratory, genitourinary, and GI tracts
4. Mode of transmission
a. Contact transmission (e.g., Staphylococcus aureus)
(1) Direct: contact between body surfaces
(2) Indirect: contact between susceptible host and
contaminated intermediate object (e.g., sink
faucets)
b. Droplet transmission: droplets from infected
individual are propelled short distance by coughing,
sneezing, talking, or suctioning respiratory secretions
(e.g., common cold)
c. Airborne transmission: small droplet nuclei (5 µm or
smaller) or dust particles that contain pathogen
remain suspended in air for extended period (e.g.,
Mycobacterium tuberculosis)
d. Common vehicle transmission: microorganisms are
transmitted by contaminated food, water, or
equipment (e.g., typhoid fever)
e. Vector-borne transmission: microorganisms
transmitted by vectors such as mosquitoes, flies,
ticks, and rats (e.g., Rocky Mountain spotted fever,
Lyme disease)
5. Portals of entry: same as portals of exit except skin;
intact skin prevents infection
6. Susceptible host
a. Developmental level: extremes of age
b. Inadequate nutritional status
c. Coexisting disease
d. Decreased immune responses
e. Surgical client; client in intensive care unit (ICU);
presence of invasive lines
Types of Pathogens
A. Bacteria
1. Unicellular microbes without chlorophyll
2. Capsule: material secreted by cell, protects it from
phagocytosis and increases its virulence (e.g., Diplococcus
pneumoniae)
3. Spores: inactive resistant structures into which bacterial
protoplasm can transform under adverse conditions;
under favorable conditions spore germinates into active
cell (e.g., Clostridium tetani, Clostridium defficile)
4. Examples of disease-producing bacteria
a. Eubacteriales: divided into five families based on
shape, gram stain, and endospore formation
(1) Gram-positive cocci
(a) Diplococci: occurring predominantly in pairs
(e.g., Diplococcus pneumoniae)
(b) Streptococci: occurring predominantly in
chains (e.g., Streptococcus pyogenes)
(c) Staphylococci: occurring predominantly in
grapelike bunches (e.g., S. aureus)
(2) Gram-negative cocci include Neisseria gonorrhoeae
and Neisseria meningitidis
(3) Gram-negative rods include enterobacteria such
as Escherichia, Salmonella, and Shigella species
(4) Gram-positive rods that do not produce
endospores include Corynebacterium diphtheriae
(5) Gram-positive rods that produce endospores
include Bacillus anthracis, Clostridium botulinum,
and Clostridium tetani
b. Actinomycetales (actinomycetes): moldlike microbes
with elongated cells, frequently filamentous (e.g.,
Mycobacterium tuberculosis, Mycobacterium leprae)
c. Spirochaetales (spirochetes): flexuous, spiral
organisms (e.g., Treponema pallidum)
d. Mycoplasmatales (mycoplasmas): delicate, nonmotile
microbes displaying a variety of sizes and shapes
30 CHAPTER 3  Integral Aspects of Nursing Care
B. Viruses
1. Obligate intracellular parasite; replicates only within cell
of another organism; composed of either ribonucleic
acid (RNA) or deoxyribonucleic acid (DNA), not both
2. Examples of disease-producing viruses
a. Human immunodeficiency virus (HIV): AIDS
b. Hepatitis B virus (HBV): hepatitis type B
c. Haemophilus influenza virus: influenza
d. Varicella-zoster virus: chickenpox, herpes zoster,
shingles
C. Fungi
1. Saprophytic organisms that live on organic material
2. Molds: fuzzy growths of interlacing filaments called
hyphae; reproduce by spores
3. Yeasts: organisms that usually are single-celled; usually
reproduce by budding
4. Examples of disease-producing fungi
a. Candida albicans, a yeast: moniliasis (“thrush”)
b. Histoplasmosis capsulatum: histoplasmosis
c. Trichophyton rubrum: tinea pedis (“athlete’s foot”)
D. Control of microorganisms
1. Medical asepsis (Table 3-1: Precautions to Prevent the
Spread of Microorganisms)
a. Standard precautions (e.g., hand hygiene, personal
protective equipment [PPE])
b. Transmission-based precautions (e.g., airborne,
droplet, contact)
2. Surgical asepsis
3. Disinfection: removal or destruction of pathogens
4. Sterilization: removal or destruction of all microbes
5. Antiseptic: inhibits microbial growth
6. Heat sterilization
a. Moist heat
(1) Steam under pressure (autoclave)
(2) Boiling objects in water; some spores resist boiling
b. Dry heat
7. Radiation: all types of radiation injurious to microbes
a. Gamma rays: sterilize food and drugs
b. Ultraviolet light: inhibits microbial population of air
in operating rooms, nurseries, and laboratories
RELATED PHARMACOLOGY
Definition of Terms
A. Bactericidal effect: destroys bacteria at low concentrations
B. Bacteriostatic effect: slows reproduction of bacteria
C. Superinfection (secondary infection): emergence of
microorganism growth when natural protective flora are
destroyed by an anti-infective drug
D. Bacterial resistance: natural or acquired characteristic of an
organism that prevents destruction by a drug to which it
was previously susceptible
Antibiotics
A. Description
1. Destroy bacteria or inhibit bacterial reproduction to
control infection
2. Available in oral, parenteral, and topical forms,
including ophthalmic and ear drop preparations
B. Antibiotic sensitivity tests: identify antibiotics that are
effective against a particular organism
C. Mechanism of action: interfere with or inhibit cell-wall
synthesis of RNA or DNA of pathogen
D. Examples
1. Penicillins (broad spectrum): amoxicillin may be
combined with a second drug to prevent bacterial
resistance such as amoxicillin and clavulanate
(Augmentin), ampicillin and sulbactam (Unasyn),
piperacillin and tazobactam (Zosyn)
2. Cephalosporins (broad spectrum): cefazolin (Ancef ),
cephalexin (Keflex)
3. Erythromycins: clindamycin HCl (Cleocin HCl),
azithromycin (Zithromax), erythromycin (Ery-Tab, Eryc)
4. Tetracyclines (broad spectrum): doxycycline
(Vibramycin), tetracycline (Sumycin)
5. Aminoglycosides (broad spectrum): gentamicin,
neomycin, streptomycin
6. Quinolones (broad spectrum): ciprofloxacin (Cipro) and
levofloxacin (Levaquin)
7. Polymyxin group: polymyxin B
8. Glycopeptides: vancomycin (Vancocin)
E. Major side effects
1. Depressed appetite (altered taste sensitivity)
2. Nausea, vomiting (normal flora imbalance)
3. Diarrhea (normal flora imbalance)
4. Suppressed absorption of variety of nutrients including
fat; protein; lactose; vitamins A, D, K, and B12; and
the minerals calcium, iron, and potassium (normal
flora imbalance)
5. Increased excretion of water-soluble vitamins and
minerals (normal flora imbalance)
6. Superinfection (normal flora imbalance)
7. Allergic reactions, anaphylaxis (hypersensitivity)
8. Nephrotoxicity (direct kidney toxic effect)
9. Can render oral contraceptives ineffective
10. Tetracyclines
a. Hepatotoxicity (direct liver toxic effect)
b. Phototoxicity (degradation to toxic products by
ultraviolet rays)
c. Hyperuricemia (impaired kidney function)
d. Enamel hypoplasia, dental caries, and bone defects
in children younger than 8 years of age (drug binds
to calcium in tissue)
11. Aminoglycosides
a. Ototoxicity (direct toxic effect to auditory [eighth
cranial] nerve)
b. Leukopenia (decreased white blood cell [WBC]
synthesis)
c. Thrombocytopenia (decreased platelet synthesis)
d. Headache, confusion (neurotoxicity)
e. Peripheral neuropathy (neurotoxicity)
f. Nephrotoxicity (direct kidney toxic effect)
g. Respiratory paralysis (neuromuscular blockade)
12. Vancomycin
a. Ototoxicity (hearing loss)
b. Nephrotoxicity (kidney damage)
F. Nursing care