05 Infection Flashcards
1
Q
If ascites culture is poly-microbial, what do you need to rule out if the patient is not getting better on antibiotics?
A
rule out intra-abdominal source (bowel perf)
2
Q
what causes lower and upper GI bleeds in HIV pts?
A
lower: CMV, bacterial, HSV. upper: Kaposi’s sarcoma, lymphoma.
3
Q
what is treatment for cat/dog/human bite?
A
broad-spectrum (augmentin)
4
Q
what drug helps prevent development of cirrhosis in hep C pts?
A
interferon
5
Q
what are the CD4 count ranges for normal, symptomatic, and opportunistic infections to occur?
A
800-1200 normal
300-400 symptomatic disease
<200 opportunistic infection
6
Q
what are CT findings in sinusitis?
A
air-fluid levels in sinus
7
Q
what can human bites do to joints?
A
cause permanent joint injury from eikenella
8
Q
what is treatment for acute septic arthritis?
A
drainage (first), 3rd gen cephalosporin and vanc until cultures show organism
9
Q
what is the treatment for brown recluse spider bite?
A
dapsone initially. may need resection of area and skin graft for large ulcers later
10
Q
what is another name for unasyn?
A
ampicillin/sulfbactam
11
Q
what type of lymphoma most commonly affects HIV pts?
A
non-hodgkin’s (B cell)
12
Q
what bacteria causes impetigo, erysipelas, cellulitis, and folliculitis?
A
staph and strep most common
13
Q
is fulminant hepatic failure common w/ hep C?
A
no. rare.
14
Q
how do oyu treat peritoneal dialysis catheter infection if you find fecal products in peritoneal fluid?
A
laparotomy to find perforation
15
Q
what is treatment for diabetic foot infectinos?
A
broad spectrum antibiotics (unasyn)
16
Q
what are the bugs for acute septic arthritis?
A
gonococcus, staph, H. influenzae, strep
17
Q
is lower or upper GI bleed more common in HIV pts?
A
lower
18
Q
what is a carbuncle?
A
a multiloculated furuncle
19
Q
what are risk factors for sinusitis?
A
nasoenteric tubes, intubation, pts with severe facial fxs
20
Q
what bugs are involved in peritoneal dialysis catheter infections?
A
s. aureus and s. epi most common
21
Q
what is the treatment for lymphoma in HIV pts?
A
chemotherapy usual; may need surgery w significant bleeding or perforation
22
Q
what % of population is infected with hep C?
A
1-2%
23
Q
what is treatment for peritoneal dialysis catheter infection?
A
intraperitoneal vanc and gent. increase dwell time and intraperitoneal heparin can help. remove catheter for peritonitis that lasts >4-5d.
24
Q
what bugs cause cat/dog/human bite infections?
A
polymicrobial
25
which organ is most infected in lymphoma in HIV pts?
stomach, followed by rectum
26
is hepatitis C common with blood transfusion?
no. rare. 0.0001%/unit
27
what is treatment of a furuncle?
drainage +/- antibiotics
28
what is treatment for cat/dog/human bites?
eikenella in human bites. pasteurella in cat and dog bites
29
what is treatment for sinusitis?
broad-spec abx, rare to have to tap sinus percutaneously for systemic illness
30
how often to hep C pts get chronic infection, cirrhosis, and hepatocellular carcinoma?
chronic in 60%, cirrhosis in 15%, hepatocellular carcinoma in 1-5%.
31
what is another name for augmentin?
amoxicillin/clavulanate
32
what bugs cause sinusitis?
polymicrobial
33
what do you do if you grow fungus, TB, or pseudomonas from peritoneal dialysis catheter?
remove peritoneal dialysis catheter
34
what bugs cause diabetic foot infections?
mixed staph, strep, GNRs, anaerobes
35
what is a furuncle and what bug?
it is a boil caused by s. epidermidis or s. aureus
36
what causes fournier's gangrene?
Next organisms (GPC's, GNRs, anaerobes)
37
what is the 2nd most common reason for laparotomy?
neoplastic disease
38
Is actinomyces a true fungus?
no
39
what is the most common intestinal manifestation of AIDS? how does it present?
CMV colitis. Presents w/ pain, bleeding, or perforation
40
What are the signs and symptoms of c. perfringens infection?
Pain out of proportion to exam, may not show skin signs with deep infection. commonly myonecrosis and gas gangrene.
41
what are the different ways you can get HIV, and what is the risk of contracting?
HIV blood transfusion (70%), infant from positive mom (30%), needle stick from positive pt (0.3%), mucous membrane exposure (0.1%)
42
what is the most common opportunistic infection in HIV pts?
CMV
43
Is Nocardia a true fungus?
no
44
What is the treatment for aspergillosis?
Voriconazole for severe infections
45
What is the treatment for SBP?
Ceftriaxone or other third-generation cephalosporin
46
what is the most common neoplasm in AIDS pts?
kaposi's sarcoma
47
What is the treatment for Cryptococcus?
Liposomal amphotericin for severe infections
48
What are the findings of histoplasmosis?
Pulmonary symptoms are usual, Mississippi and Ohio River valleys
49
What is the treatment for necrotizing fasciitis?
Early debridement, high-dose penicillin, broad spectrum if poly-organismal
50
What is the treatment for histoplasmosis?
Liposomal amphotericin for severe infections
51
What are the findings of Cryptococcus and who gets it?
CNS symptoms most common, usually in AIDS patients
52
what are the most common bugs in secondary bacterial peritonitis?
B. fragilis, e. coli, enterococcus
53
when should antivirals be given after exposure?
1-2hrs
54
What are the risk factors for fournier's gangrene?
Diabetes mellitus and immunocompromised state
55
What causes spontaneous bacterial peritonitis?
Decreased host defenses (intrahepatic shunting, impaired bactericidal activity in ascites), not due to transmucosal migration
56
What is the treatment for actinomyces infection?
Drainage and penicillin G
57
What is a major risk factor for spontaneous bacterial peritonitis?
low protein (<1 g/dL) in peritoneal fluid
58
What bacteria causes necrotizing fasciitis?
beta-hemolytic group A strep, can be poly organismal
59
What are fluid cultures in SBP?
negative in many cases
60
What are the findings of coccidioidomycosis? where in the USA is it located?
pulmonary sx, southwest.
61
how many weeks after exposure does seroconversion occur?
6-12 weeks
62
What toxin does C. perfringens have?
alpha toxin
63
what is the treatment for fournier's gangrene?
early debridement, preserve testicles, antibiotics
64
What are the findings in necrotizing tissue infection?
```
Pain out of proportion to skin findings
wbc's greater than 20
thin grey drainage
blistering/necrosis
induration and edema
crepitus or soft tissue gas on XR
can be septic
```
65
What are the findings of nocardia infection?
Pulmonary and CNS symptoms most common
66
What is the treatment for c. perfringens infections?
Early debridement, high-dose penicillin
67
what is treatment for secondary bacterial peritonitis?
usually need laparotomy to find source
68
what is the treatment for coccidioidomycosis?
liposomal amphotericin for severe infections.
69
what meds do you use to decrease seroconversion after exposure?
AZT (zidovudine, reverse transcriptase inhibitor), and ritonavir (protease inhibitor)
70
is surgery needed for kaposi's sarcoma?
No
71
what does the gram stain show in c. perf infections?
GPRs without WBCs.
72
How many PMNs in ascitic fluid is diagnostic of SBP?
>500cells/cc
73
What bacteria are present in spontaneous bacterial peritonitis?
monobacterial (50% e.coli, 30% strep, 10% kleb)
74
what causes necrotizing fasciitis?
beta-hemolytic group A strep has exotoxin
75
What is the treatment for Candida infection?
Fluconazole, anidulafungin for severe infections
76
What are the findings in necrotizing fasciitis?
Overlying skin may be pale red and progress to purple with blister or bullae development, overlying skin can look normal in the early stages, thin, gray, foul-smelling drainage; crepitus
77
In a patient with active infection, can you give liver transplantation?
No
78
What symptoms does Actinomyces cause?
pulmonary symptoms most common; can cost tortuous abscesses in cervical, thoracic, and abdominal areas.
79
What is a good antibiotic for prophylaxis for SBP?
fluoroquinolones (norfloxacin)
80
When is a fungal infection real?
Positive blood cultures, two sites other than blood, one site with severe symptoms, endophthalmitis, or patients on prolonged bacterial antibiotics with failure to improve
81
What is the treatment for nocardia infection?
Drainage and sulfonamides (bactrim)
82
what is the most common cause for laparotomy in HIV pts?
opportunistic infections
83
what is fournier's gangrene?
Severe infection in perineal and scrotal region
84
How does the patient get c. perfringens infection?
Necrotic tissue decreases oxidation-reduction potential, setting up environment for bacteria
85
When do you know you need a new central line and that this line is currently infected?
>15 colony forming units
86
What percent of abdominal abscesses have both anaerobic and aerobic bacteria?
80%
87
What percentage of clean surgeries get infected? And what is an example of the surgery?
2%, hernia
88
When you have to give antibiotics for abscesses?
Give antibiotics for patients with diabetes, cellulitis, clinical signs of sepsis, fever, elevated WBC, or who have bioprosthetic hardware
89
what does endotoxin do?
endotoxin triggers release of TNF-a from macrophages, activates, complement, and activates coagulation cascade.
90
What is the definition of line infection?
>15 CFU
91
list the parts of GI tract with types of bacteria.
stomach: sterile, some GPCs, some yeast.
proximal small bowel: 10^5 bacteria, mostly GPC.
distal small bowel: 10^7 bacteria, GPC, GPR, GNR.
colon: 10^11 bacteria, almost all anaerobes, some GNRs, GPCs
92
what is the most common organism in the GI tract?
anaerobes, 1000:1
93
what causes c.diff colitis?
c.diff toxin
94
What percentage of gross contamination surgeries get infected? What are examples of these surgeries?
30%, abscess
95
What is the most common anaerobe in the colon?
bacteroides fragilis
96
How do you treat abscess?
drainage
97
What are the risk factors for wound infection?
Long operations, hematoma or seroma around that formation, advanced age, chronic disease, malnutrition, immunosuppressive drugs.
98
What happens just before the patient becomes clinically septic?
hyperglycemia
99
When do necrotizing soft tissue infections present?
Very quickly after surgical procedures, within hours
100
What bacteria are the most common causes of line infection?
#1 s. epi, #2 s. aureus, #3. yeast
101
What is the most common gram-negative rod in surgical wound infections?
E. coli
102
what is nosocomial pneumonia related to?
length of time on vent, aspiration from duodenum thought to have role
103
What is the most common infection in surgery patients?
Urinary tract infection. The most common risk factor is urinary catheters, commonly e. coli
104
What percentage of contaminated surgeries get infected? What are examples of these surgeries?
5 to 10%, gunshot wound to colon with repair
105
What is the optimal glucose level in the septic patient?
100-120 mg/dL
106
What endotoxin is released from gram-negative sepsis?
lipopolysaccharide lipid A
107
How many bacteria are needed for wound infection?
>10^5
108
What is exoslime?
released by staph species, a exopolysaccharide matrix
109
What are the time periods for fever? What are the sources of infection?
Atelectasis: 2d
UTI: 2-5d.
Wound: >5d
110
What are the risk factors for necrotizing soft tissue infection?
Immunocompromised, diabetes mellitus, patients who have poor blood supply
111
What should you do if you're worried about line infection?
Pull the central line in, place IVs if central lines not needed
112
Which bacteria can cause infection within hours postoperatively? How does it do it?
c. perfringens and beta-hemolytic strep can present within hours postop by producing exotoxins
113
When should your central line be moved to a new site?
Site shows signs of infection, >15 CFU
114
What is the most common anaerobe in surgical wound infections?
B. fragilis
115
What percent of abdominal abscesses have anaerobes?
90%
116
What bacteria cause necrotizing soft tissue infection?
beta hemolytic strep (group A), C. perfringens, or mixed organisms.
117
what is the treatment for c. diff colitis?
oral: vanc or flagyl. IV: flagyl. lactobacillus can help. stop other antibiotics or change them
118
What is the line salvage rate with anabiotics?
50%, less with yeast infection
119
What are the most common organisms in ICU pneumonia?
#1 s. aureus, #2 PSA. GNRs are #1 class of organisms in ICU PNA
120
if there is b. fragilis in wound, what does it imply?
traslocation from gut and if there is recovery from tissue, there is likely necrosis or abscess (b. fragilis only grows in low redox state)
121
What percent of clean-contaminated surgeries get infected? What are some examples of surgeries?
3 to 5%, elective colon resection with prepped bowel.
122
What happens to insulin and glucose in early gram-negative sepsis?
dec insulin, inc glucose (impaired utilization)
123
how long do you give postop prophylactic antibiotics? Which type of surgery is there an exception?
Stop within 24 hours of and operation time, except cardiac, which is Stotzer than 48 hours of an operation time
124
what is the most common cause of immune deficiency?
malnutrition
125
What is the most common cause of gram-negative sepsis?
e.coli
126
Of Staphylococcus aureus and staphylococcus epidermidis, which are coagulase positive in which I coagulase negative?
s. aureus is coag+, s. epi is coag-
127
What is the most common organism in surgical wound infections?
Staphylococcus aureus
128
What kind of line is at highest risk for infection?
femoral lines
129
When do abscesses occur after operation?
7-10d
130
What surgical infections occur within 48 hours of procedure?
Injury it's a bell with leak, invasive soft tissue infection.
131
What happens to an slim and glucose in late gram-negative sepsis?
inc insulin, inc glucose secondary to insulin resistance
132
What are the different types of contaminations during surgery?
Clean, clean contaminated, contaminated, gross contamination
133
What is the most common aerobic bacteria in the colon?
e. coli
134
What is the leading cause of infectious death after surgery?
nosocomial pneumonia
