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Training Manual
Microbes
Microbes are tiny living things
found all around us
too small to be seen by the naked eye.
They live in water, soil, and in the air.
The human body is home to millions of these microbes too, also called microorganisms.
The most common types are
bacteria,
viruses and
fungi.
Protozoa, responsible for diseases such as toxoplasmosis and malaria.
Antimicrobials
Bacteria
Bacteria, also called germs
Microscopic organisms
Not visible with the naked eye.
Uni-cellular
Found inside and outside body.
TYPES
Aerobic
 Need oxygen to live
 e.g
Anaerobic
 Will die around oxygen
 e.g
Facultative anaerobes
 Function best with oxygen but do not need it
 e.g
Gram positive & Gram Negative
Gram-positive bacteria retain the crystal violet color and
stains purple
Gram-negative bacteria lose crystal violet and stain red
Gram Negative Infections:
pneumonia, bloodstream infections, wound or surgical site infections,
and meningitis
Gram Positive Infections:
methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-
resistant enterococci (VRE), and Clostridium difficile
Bacterial Infections
Antibacterial
Medications
used to treat
bacterial
infections
 Identify the causative organism and
potential antibiotic susceptibilities.
 Culture Sensitivity Test must be
performed.
Ideally,
before beginning
antibiotic
therapy
Classification of Antibacterial (structural)
Classification of Antibacterial (MOA)
1. Acute Bacterial Sinusitis
Causes the spaces inside your nose (sinuses) to become
inflamed and swollen.
Interferes with drainage and causes mucus to build up.
With acute sinusitis, it might be difficult to
 Breathe through your nose
 Swelling around eyes & face
 Throbbing facial pain or a headache
Chronic sinusitis: Sinusitis that lasts more than 12 weeks
Caused by the common cold.
2. Community-Acquired Pneumonia (CAP)
An infection that inflames the air sacs in one or both
lungs.
Air sacs may fill with fluid or pus (purulent material),
Causing cough with phlegm or pus, fever, chills, and
difficulty breathing.
Caused by
Bacteria. The most common cause of bacterial pneumonia is Streptococcus
pneumonia.
Fungi. This type of pneumonia is most common in people with chronic health
problems or weakened immune systems, and in people who have inhaled large
doses of the organisms.
Viruses, including COVID-19. Some of the viruses that cause colds and the flu
can cause pneumonia.
Coronavirus 2019 (COVID-19) may cause pneumonia, which can become severe.
3. Acute Exacerbation of Chronic Bronchitis
(AECB)
An inflammation of the lining of
the tubes that carry air to and from
the lungs (bronchial tubes).
Symptoms include coughing,
phlegm production, and wheezing.
Cough that persists for >2 years
and, for at least 3 continuous
months, produces phlegm.
4. Skin and skin structure infection
A bacterial infection of skin
and associated tissues.
Recently, the FDA has called
them acute bacterial skin
and skin structure
infections (ABSSSI).
 ABSSSI are common and
encompass a variety of disease
presentations and severity.
5. Intra-abdominal infections
Infections contained within the peritoneum or retroperitoneal space.
Peritonitis is defined as the acute, inflammatory response of
peritoneal lining to microorganisms, chemicals, irradiation, or foreign
body injury.
An abscess is a purulent collection of fluid separated from surrounding
tissue by a wall consisting of inflammatory cells and adjacent organs.
It usually contains necrotic debris, bacteria, and inflammatory cells.
It is the second most commonly identified cause of severe sepsis in
the intensive care unit (ICU).
1. Complicated Skin & Skin Structure
Infections
Skin and soft tissue infections (SSTIs) are common, and
Complicated SSTIs (cSSTIs) are the more extreme end of this clinical
spectrum
 such as deep-seated infection,
 a requirement for surgical intervention,
 the presence of systemic signs of sepsis,
 the presence of complicating co-morbidities,
 accompanying neutropenia,
 accompanying ischaemia,
 tissue necrosis,
 burns and bites.
Staphylococcus aureus is the commonest cause of SSTI across all continents.
2. Complicated Intra-abdominal Infection
Complicated IAI the infection proceeds beyond
a singularly affected organ and causes either
localized peritonitis (intra-abdominal
abscesses) or diffuse peritonitis.
3. Community-Acquired Pneumonia (CAP)
An infection that inflames the air sacs in one or both
lungs.
Air sacs may fill with fluid or pus (purulent material),
Causing cough with phlegm or pus, fever, chills, and
difficulty breathing.
Caused by
Bacteria. The most common cause of bacterial pneumonia is Streptococcus
pneumonia..
Fungi. This type of pneumonia is most common in people with chronic health
problems or weakened immune systems, and in people who have inhaled
large doses of the organisms.
Viruses, including COVID-19. Some of the viruses that cause colds and the flu
can cause pneumonia.
Coronavirus 2019 (COVID-19) may cause pneumonia, which can become
severe.
4. Febrile Neutropenia
A single oral temperature measurement of 38.3属
C (101属 F) or a temperature of 38.0属 C (100.4属 F)
Sustained over 1 hour.
A condition marked by fever and a lower-than-
normal number of neutrophils in the blood.
A neutrophil is a type of white blood cell that
helps fight infection.
5. Bacterial Meningitis
Meningitis affects the meninges
Meninges: the membranes that surround the brain
and spinal cord and protect the central nervous
system (CNS), together with the cerebrospinal fluid.
Bacterial meningitis is the most serious type of
meningitis.
It can lead to death or permanent disability.
Causing Bacteria: Streptococcus pneumoniae (S.
pneumoniae) and Group B Streptococcus
1. Serious Gram-negative infections
Gram-negative bacteria can cause many serious
infections
 Pneumonia
 Peritonitis (inflammation of the membrane
that lines the abdominal cavity)
 Urinary tract infections
 Bloodstream infections
 Wound or surgical site infections
 Meningitis
2. Bone Joint Infections
Occur in the bones and
joints of the arms and
legs.
 An infection of the bone is
called osteomyelitis and
 Joint infection is called
septic arthritis
Bone and joint infections
are usually caused by
bacteria called
Staphylococcus aureus
(or staph)
3. Lower respiratory tract infections
Infections in the lungs or
below the voice box.
These include
 Pneumonia,
 Bronchitis,
 Tuberculosis.
4. Septicemia
Septicemia is a serious bloodstream
infection.
It's also known as blood poisoning.
Septicemia occurs when a bacterial
infection elsewhere in the body, such
as the lungs or skin, enters the
bloodstream.
5. Bacterial Meningitis
Meningitis affects the meninges
Meninges: the membranes that surround the brain
and spinal cord and protect the central nervous
system (CNS), together with the cerebrospinal fluid.
Bacterial meningitis is the most serious type of
meningitis.
It can lead to death or permanent disability.
Causing Bacteria: Streptococcus pneumoniae (S.
pneumoniae) and Group B Streptococcus
1. Intra-abdominal infections
Infections contained within the peritoneum or retroperitoneal space.
Peritonitis is defined as the acute, inflammatory response of
peritoneal lining to microorganisms, chemicals, irradiation, or foreign
body injury.
An abscess is a purulent collection of fluid separated from surrounding
tissue by a wall consisting of inflammatory cells and adjacent organs.
It usually contains necrotic debris, bacteria, and inflammatory cells.
It is the second most commonly identified cause of severe sepsis in
the intensive care unit (ICU).
2. Skin and skin structure infections
A bacterial infection of skin
and associated tissues.
Recently, the FDA has called
them acute bacterial skin
and skin structure
infections (ABSSSI).
 ABSSSI are common and
encompass a variety of disease
presentations and severity.
3. Lower respiratory tract infections
Infections in the lungs or below the
voice box.
These include pneumonia,
bronchitis, and tuberculosis.
4. Gynecological infections
A number of conditions affecting the vagina and genital
tract caused by pathogens.
Types of gynecological infection include:
 Bacterial vaginosis (change in the normal balance of vaginal bacteria)
 Candida (fungal infection)
 Chlamydia
 Gonorrhea (sexually transmitted bacterium)
 Pelvic inflammatory disease (sexually transmitted bacteria spread from your vagina
to your uterus, fallopian tubes or ovaries)
 Herpes (infection due to virus)
5. Febrile Neutropenia
A single oral temperature measurement of 38.3属
C (101属 F) or a temperature of 38.0属 C (100.4属 F)
Sustained over 1 hour.
A condition marked by fever and a lower-than-
normal number of neutrophils in the blood.
A neutrophil is a type of white blood cell that
helps fight infection.
1. Staphylococcus enterocolitis
An inflammation that is usually caused by eating or
drinking substances contaminated with staph enterotoxin.
The toxin, not the bacterium, settles in the small intestine
and causes inflammation and swelling.
Cause abdominal pain, cramping, dehydration, diarrhea
and fever.
2. Pseudomembranous colitis
Swelling or inflammation
of the large intestine
(colon) due to an
overgrowth of
Clostridioides difficile (C
difficile) bacteria.
Large intestine
inflammation
3. Endocarditis
Infection of the inner layer of the
heart or the heart valves.
The heart has 4 valves. These
valves help the blood flow
through the heart and lungs and
out to the body.
When a person has
bacterial endocarditis, these
valves may not be able to work
properly.
4. Enterococci
Enterococci are gram-positive, facultative anaerobic organisms.
Cause a variety of infections, including
Endocarditis
Urinary tract infections
Prostatitis (painful urination)
Intra-abdominal infection
Cellulitis (skin infection)
5. Staphylococcus
Staph infections are caused by staphylococcus bacteria
Types of germs commonly found on the skin or in the nose of
even healthy individuals.
Most of the time, these bacteria cause no problems or result
in relatively minor skin infections.
6. Streptococcal species
Streptococcus species are responsible for many cases of
Pink eye
Meningitis
Bacterial pneumonia
Endocarditis
Erysipelas
Necrotizing fasciitis (infection due to death of soft tissues).
7. Septicemia
Bloodstream infection.
It's also known as blood poisoning.
Septicemia occurs when a bacterial infection elsewhere in
the body, such as the lungs or skin, enters the bloodstream.
This is dangerous because the bacteria and their toxins can
be carried through the bloodstream to your entire body.
1. Acute Exacerbation of Chronic
Bronchitis (AECB)
An inflammation of the lining of
the tubes that carry air to and from
the lungs (bronchial tubes).
Symptoms include coughing,
phlegm production, and wheezing.
Cough that persists for >2 years
and, for at least 3 continuous
months, produces phlegm.
2. Community-Acquired Pneumonia (CAP)
An infection that inflames the air sacs in one or both
lungs.
Air sacs may fill with fluid or pus (purulent material),
Causing cough with phlegm or pus, fever, chills, and
difficulty breathing.
Caused by
Bacteria. The most common cause of bacterial pneumonia is Streptococcus
pneumonia..
Fungi. This type of pneumonia is most common in people with chronic health
problems or weakened immune systems, and in people who have inhaled
large doses of the organisms.
Viruses, including COVID-19. Some of the viruses that cause colds and the flu
can cause pneumonia.
Coronavirus 2019 (COVID-19) may cause pneumonia, which can become
severe.
3. Cystitis
Cystitis is an inflammation of the bladder.
Inflammation is where part of your body
becomes irritated, red, or swollen.
The cause of cystitis is a urinary tract
infection (UTI).
A UTI happens when bacteria enter the
bladder or urethra and begin to multiply.
4. Skin and skin structure infections
A bacterial infection of skin and
associated tissues.
Recently, the FDA has called
them acute bacterial skin and
skin structure infections
(ABSSSI).
 ABSSSI are common and encompass a
variety of disease presentations and
severity.
5. Intra-abdominal infections
Infections contained within the peritoneum or retroperitoneal space.
Peritonitis is defined as the acute, inflammatory response of peritoneal
lining to microorganisms, chemicals, irradiation, or foreign body injury.
An abscess is a purulent collection of fluid separated from surrounding
tissue by a wall consisting of inflammatory cells and adjacent organs. It
usually contains necrotic debris, bacteria, and inflammatory cells.
It is the second most commonly identified cause of severe sepsis in the
intensive care unit (ICU).
6. Pyelonephritis
Pyelonephritis is inflammation of the
kidney
due to a bacterial infection.
Symptoms most often include
 Fever, tenderness
 Nausea
 Burning with urination
 Frequent urination.
Complications may include pus around
the kidney, sepsis, or kidney failure.
7. Bone Joint Infections, Osteomyelitis
Occur in the bones and joints of
the arms and legs.
An infection of the bone is
called osteomyelitis and
Joint infection is called septic arthritis
Bone and joint infections are
usually caused by bacteria
called Staphylococcus aureus
(or staph)
Osteomyelitis is a bone
infection usually caused by
bacteria

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BACTERIAL INFECTIONS.pptx

  • 2. Microbes Microbes are tiny living things found all around us too small to be seen by the naked eye. They live in water, soil, and in the air. The human body is home to millions of these microbes too, also called microorganisms. The most common types are bacteria, viruses and fungi. Protozoa, responsible for diseases such as toxoplasmosis and malaria. Antimicrobials
  • 3. Bacteria Bacteria, also called germs Microscopic organisms Not visible with the naked eye. Uni-cellular Found inside and outside body. TYPES Aerobic Need oxygen to live e.g Anaerobic Will die around oxygen e.g Facultative anaerobes Function best with oxygen but do not need it e.g
  • 4. Gram positive & Gram Negative Gram-positive bacteria retain the crystal violet color and stains purple Gram-negative bacteria lose crystal violet and stain red Gram Negative Infections: pneumonia, bloodstream infections, wound or surgical site infections, and meningitis Gram Positive Infections: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin- resistant enterococci (VRE), and Clostridium difficile
  • 6. Antibacterial Medications used to treat bacterial infections Identify the causative organism and potential antibiotic susceptibilities. Culture Sensitivity Test must be performed. Ideally, before beginning antibiotic therapy
  • 9. 1. Acute Bacterial Sinusitis Causes the spaces inside your nose (sinuses) to become inflamed and swollen. Interferes with drainage and causes mucus to build up. With acute sinusitis, it might be difficult to Breathe through your nose Swelling around eyes & face Throbbing facial pain or a headache Chronic sinusitis: Sinusitis that lasts more than 12 weeks Caused by the common cold.
  • 10. 2. Community-Acquired Pneumonia (CAP) An infection that inflames the air sacs in one or both lungs. Air sacs may fill with fluid or pus (purulent material), Causing cough with phlegm or pus, fever, chills, and difficulty breathing. Caused by Bacteria. The most common cause of bacterial pneumonia is Streptococcus pneumonia. Fungi. This type of pneumonia is most common in people with chronic health problems or weakened immune systems, and in people who have inhaled large doses of the organisms. Viruses, including COVID-19. Some of the viruses that cause colds and the flu can cause pneumonia. Coronavirus 2019 (COVID-19) may cause pneumonia, which can become severe.
  • 11. 3. Acute Exacerbation of Chronic Bronchitis (AECB) An inflammation of the lining of the tubes that carry air to and from the lungs (bronchial tubes). Symptoms include coughing, phlegm production, and wheezing. Cough that persists for >2 years and, for at least 3 continuous months, produces phlegm.
  • 12. 4. Skin and skin structure infection A bacterial infection of skin and associated tissues. Recently, the FDA has called them acute bacterial skin and skin structure infections (ABSSSI). ABSSSI are common and encompass a variety of disease presentations and severity.
  • 13. 5. Intra-abdominal infections Infections contained within the peritoneum or retroperitoneal space. Peritonitis is defined as the acute, inflammatory response of peritoneal lining to microorganisms, chemicals, irradiation, or foreign body injury. An abscess is a purulent collection of fluid separated from surrounding tissue by a wall consisting of inflammatory cells and adjacent organs. It usually contains necrotic debris, bacteria, and inflammatory cells. It is the second most commonly identified cause of severe sepsis in the intensive care unit (ICU).
  • 14. 1. Complicated Skin & Skin Structure Infections Skin and soft tissue infections (SSTIs) are common, and Complicated SSTIs (cSSTIs) are the more extreme end of this clinical spectrum such as deep-seated infection, a requirement for surgical intervention, the presence of systemic signs of sepsis, the presence of complicating co-morbidities, accompanying neutropenia, accompanying ischaemia, tissue necrosis, burns and bites. Staphylococcus aureus is the commonest cause of SSTI across all continents.
  • 15. 2. Complicated Intra-abdominal Infection Complicated IAI the infection proceeds beyond a singularly affected organ and causes either localized peritonitis (intra-abdominal abscesses) or diffuse peritonitis.
  • 16. 3. Community-Acquired Pneumonia (CAP) An infection that inflames the air sacs in one or both lungs. Air sacs may fill with fluid or pus (purulent material), Causing cough with phlegm or pus, fever, chills, and difficulty breathing. Caused by Bacteria. The most common cause of bacterial pneumonia is Streptococcus pneumonia.. Fungi. This type of pneumonia is most common in people with chronic health problems or weakened immune systems, and in people who have inhaled large doses of the organisms. Viruses, including COVID-19. Some of the viruses that cause colds and the flu can cause pneumonia. Coronavirus 2019 (COVID-19) may cause pneumonia, which can become severe.
  • 17. 4. Febrile Neutropenia A single oral temperature measurement of 38.3属 C (101属 F) or a temperature of 38.0属 C (100.4属 F) Sustained over 1 hour. A condition marked by fever and a lower-than- normal number of neutrophils in the blood. A neutrophil is a type of white blood cell that helps fight infection.
  • 18. 5. Bacterial Meningitis Meningitis affects the meninges Meninges: the membranes that surround the brain and spinal cord and protect the central nervous system (CNS), together with the cerebrospinal fluid. Bacterial meningitis is the most serious type of meningitis. It can lead to death or permanent disability. Causing Bacteria: Streptococcus pneumoniae (S. pneumoniae) and Group B Streptococcus
  • 19. 1. Serious Gram-negative infections Gram-negative bacteria can cause many serious infections Pneumonia Peritonitis (inflammation of the membrane that lines the abdominal cavity) Urinary tract infections Bloodstream infections Wound or surgical site infections Meningitis
  • 20. 2. Bone Joint Infections Occur in the bones and joints of the arms and legs. An infection of the bone is called osteomyelitis and Joint infection is called septic arthritis Bone and joint infections are usually caused by bacteria called Staphylococcus aureus (or staph)
  • 21. 3. Lower respiratory tract infections Infections in the lungs or below the voice box. These include Pneumonia, Bronchitis, Tuberculosis.
  • 22. 4. Septicemia Septicemia is a serious bloodstream infection. It's also known as blood poisoning. Septicemia occurs when a bacterial infection elsewhere in the body, such as the lungs or skin, enters the bloodstream.
  • 23. 5. Bacterial Meningitis Meningitis affects the meninges Meninges: the membranes that surround the brain and spinal cord and protect the central nervous system (CNS), together with the cerebrospinal fluid. Bacterial meningitis is the most serious type of meningitis. It can lead to death or permanent disability. Causing Bacteria: Streptococcus pneumoniae (S. pneumoniae) and Group B Streptococcus
  • 24. 1. Intra-abdominal infections Infections contained within the peritoneum or retroperitoneal space. Peritonitis is defined as the acute, inflammatory response of peritoneal lining to microorganisms, chemicals, irradiation, or foreign body injury. An abscess is a purulent collection of fluid separated from surrounding tissue by a wall consisting of inflammatory cells and adjacent organs. It usually contains necrotic debris, bacteria, and inflammatory cells. It is the second most commonly identified cause of severe sepsis in the intensive care unit (ICU).
  • 25. 2. Skin and skin structure infections A bacterial infection of skin and associated tissues. Recently, the FDA has called them acute bacterial skin and skin structure infections (ABSSSI). ABSSSI are common and encompass a variety of disease presentations and severity.
  • 26. 3. Lower respiratory tract infections Infections in the lungs or below the voice box. These include pneumonia, bronchitis, and tuberculosis.
  • 27. 4. Gynecological infections A number of conditions affecting the vagina and genital tract caused by pathogens. Types of gynecological infection include: Bacterial vaginosis (change in the normal balance of vaginal bacteria) Candida (fungal infection) Chlamydia Gonorrhea (sexually transmitted bacterium) Pelvic inflammatory disease (sexually transmitted bacteria spread from your vagina to your uterus, fallopian tubes or ovaries) Herpes (infection due to virus)
  • 28. 5. Febrile Neutropenia A single oral temperature measurement of 38.3属 C (101属 F) or a temperature of 38.0属 C (100.4属 F) Sustained over 1 hour. A condition marked by fever and a lower-than- normal number of neutrophils in the blood. A neutrophil is a type of white blood cell that helps fight infection.
  • 29. 1. Staphylococcus enterocolitis An inflammation that is usually caused by eating or drinking substances contaminated with staph enterotoxin. The toxin, not the bacterium, settles in the small intestine and causes inflammation and swelling. Cause abdominal pain, cramping, dehydration, diarrhea and fever.
  • 30. 2. Pseudomembranous colitis Swelling or inflammation of the large intestine (colon) due to an overgrowth of Clostridioides difficile (C difficile) bacteria. Large intestine inflammation
  • 31. 3. Endocarditis Infection of the inner layer of the heart or the heart valves. The heart has 4 valves. These valves help the blood flow through the heart and lungs and out to the body. When a person has bacterial endocarditis, these valves may not be able to work properly.
  • 32. 4. Enterococci Enterococci are gram-positive, facultative anaerobic organisms. Cause a variety of infections, including Endocarditis Urinary tract infections Prostatitis (painful urination) Intra-abdominal infection Cellulitis (skin infection)
  • 33. 5. Staphylococcus Staph infections are caused by staphylococcus bacteria Types of germs commonly found on the skin or in the nose of even healthy individuals. Most of the time, these bacteria cause no problems or result in relatively minor skin infections.
  • 34. 6. Streptococcal species Streptococcus species are responsible for many cases of Pink eye Meningitis Bacterial pneumonia Endocarditis Erysipelas Necrotizing fasciitis (infection due to death of soft tissues).
  • 35. 7. Septicemia Bloodstream infection. It's also known as blood poisoning. Septicemia occurs when a bacterial infection elsewhere in the body, such as the lungs or skin, enters the bloodstream. This is dangerous because the bacteria and their toxins can be carried through the bloodstream to your entire body.
  • 36. 1. Acute Exacerbation of Chronic Bronchitis (AECB) An inflammation of the lining of the tubes that carry air to and from the lungs (bronchial tubes). Symptoms include coughing, phlegm production, and wheezing. Cough that persists for >2 years and, for at least 3 continuous months, produces phlegm.
  • 37. 2. Community-Acquired Pneumonia (CAP) An infection that inflames the air sacs in one or both lungs. Air sacs may fill with fluid or pus (purulent material), Causing cough with phlegm or pus, fever, chills, and difficulty breathing. Caused by Bacteria. The most common cause of bacterial pneumonia is Streptococcus pneumonia.. Fungi. This type of pneumonia is most common in people with chronic health problems or weakened immune systems, and in people who have inhaled large doses of the organisms. Viruses, including COVID-19. Some of the viruses that cause colds and the flu can cause pneumonia. Coronavirus 2019 (COVID-19) may cause pneumonia, which can become severe.
  • 38. 3. Cystitis Cystitis is an inflammation of the bladder. Inflammation is where part of your body becomes irritated, red, or swollen. The cause of cystitis is a urinary tract infection (UTI). A UTI happens when bacteria enter the bladder or urethra and begin to multiply.
  • 39. 4. Skin and skin structure infections A bacterial infection of skin and associated tissues. Recently, the FDA has called them acute bacterial skin and skin structure infections (ABSSSI). ABSSSI are common and encompass a variety of disease presentations and severity.
  • 40. 5. Intra-abdominal infections Infections contained within the peritoneum or retroperitoneal space. Peritonitis is defined as the acute, inflammatory response of peritoneal lining to microorganisms, chemicals, irradiation, or foreign body injury. An abscess is a purulent collection of fluid separated from surrounding tissue by a wall consisting of inflammatory cells and adjacent organs. It usually contains necrotic debris, bacteria, and inflammatory cells. It is the second most commonly identified cause of severe sepsis in the intensive care unit (ICU).
  • 41. 6. Pyelonephritis Pyelonephritis is inflammation of the kidney due to a bacterial infection. Symptoms most often include Fever, tenderness Nausea Burning with urination Frequent urination. Complications may include pus around the kidney, sepsis, or kidney failure.
  • 42. 7. Bone Joint Infections, Osteomyelitis Occur in the bones and joints of the arms and legs. An infection of the bone is called osteomyelitis and Joint infection is called septic arthritis Bone and joint infections are usually caused by bacteria called Staphylococcus aureus (or staph) Osteomyelitis is a bone infection usually caused by bacteria

Editor's Notes

  • #15: Sepsis>severity of infection increase, neutropenia>deficency of white cells, necrosis>cell death
  • #16: Peritonitis, diffuse peritonitis.油
  • #18: Febrile>high grade fever
  • #29: Febrile>high grade fever