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ABSITE > 05 Infection > Flashcards

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)

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2
Q

what causes lower and upper GI bleeds in HIV pts?

A

lower: CMV, bacterial, HSV. upper: Kaposi’s sarcoma, lymphoma.

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3
Q

what is treatment for cat/dog/human bite?

A

broad-spectrum (augmentin)

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4
Q

what drug helps prevent development of cirrhosis in hep C pts?

A

interferon

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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

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6
Q

what are CT findings in sinusitis?

A

air-fluid levels in sinus

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7
Q

what can human bites do to joints?

A

cause permanent joint injury from eikenella

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8
Q

what is treatment for acute septic arthritis?

A

drainage (first), 3rd gen cephalosporin and vanc until cultures show organism

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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

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10
Q

what is another name for unasyn?

A

ampicillin/sulfbactam

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11
Q

what type of lymphoma most commonly affects HIV pts?

A

non-hodgkin’s (B cell)

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12
Q

what bacteria causes impetigo, erysipelas, cellulitis, and folliculitis?

A

staph and strep most common

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13
Q

is fulminant hepatic failure common w/ hep C?

A

no. rare.

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14
Q

how do oyu treat peritoneal dialysis catheter infection if you find fecal products in peritoneal fluid?

A

laparotomy to find perforation

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15
Q

what is treatment for diabetic foot infectinos?

A

broad spectrum antibiotics (unasyn)

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16
Q

what are the bugs for acute septic arthritis?

A

gonococcus, staph, H. influenzae, strep

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17
Q

is lower or upper GI bleed more common in HIV pts?

A

lower

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18
Q

what is a carbuncle?

A

a multiloculated furuncle

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19
Q

what are risk factors for sinusitis?

A

nasoenteric tubes, intubation, pts with severe facial fxs

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20
Q

what bugs are involved in peritoneal dialysis catheter infections?

A

s. aureus and s. epi most common

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21
Q

what is the treatment for lymphoma in HIV pts?

A

chemotherapy usual; may need surgery w significant bleeding or perforation

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22
Q

what % of population is infected with hep C?

A

1-2%

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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.

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24
Q

what bugs cause cat/dog/human bite infections?

A

polymicrobial

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25
Q

which organ is most infected in lymphoma in HIV pts?

A

stomach, followed by rectum

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26
Q

is hepatitis C common with blood transfusion?

A

no. rare. 0.0001%/unit

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27
Q

what is treatment of a furuncle?

A

drainage +/- antibiotics

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28
Q

what is treatment for cat/dog/human bites?

A

eikenella in human bites. pasteurella in cat and dog bites

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29
Q

what is treatment for sinusitis?

A

broad-spec abx, rare to have to tap sinus percutaneously for systemic illness

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30
Q

how often to hep C pts get chronic infection, cirrhosis, and hepatocellular carcinoma?

A

chronic in 60%, cirrhosis in 15%, hepatocellular carcinoma in 1-5%.

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31
Q

what is another name for augmentin?

A

amoxicillin/clavulanate

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32
Q

what bugs cause sinusitis?

A

polymicrobial

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33
Q

what do you do if you grow fungus, TB, or pseudomonas from peritoneal dialysis catheter?

A

remove peritoneal dialysis catheter

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34
Q

what bugs cause diabetic foot infections?

A

mixed staph, strep, GNRs, anaerobes

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35
Q

what is a furuncle and what bug?

A

it is a boil caused by s. epidermidis or s. aureus

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36
Q

what causes fournier’s gangrene?

A

Next organisms (GPC’s, GNRs, anaerobes)

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37
Q

what is the 2nd most common reason for laparotomy?

A

neoplastic disease

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38
Q

Is actinomyces a true fungus?

A

no

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39
Q

what is the most common intestinal manifestation of AIDS? how does it present?

A

CMV colitis. Presents w/ pain, bleeding, or perforation

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40
Q

What are the signs and symptoms of c. perfringens infection?

A

Pain out of proportion to exam, may not show skin signs with deep infection. commonly myonecrosis and gas gangrene.

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41
Q

what are the different ways you can get HIV, and what is the risk of contracting?

A

HIV blood transfusion (70%), infant from positive mom (30%), needle stick from positive pt (0.3%), mucous membrane exposure (0.1%)

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42
Q

what is the most common opportunistic infection in HIV pts?

A

CMV

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43
Q

Is Nocardia a true fungus?

A

no

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44
Q

What is the treatment for aspergillosis?

A

Voriconazole for severe infections

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45
Q

What is the treatment for SBP?

A

Ceftriaxone or other third-generation cephalosporin

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46
Q

what is the most common neoplasm in AIDS pts?

A

kaposi’s sarcoma

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47
Q

What is the treatment for Cryptococcus?

A

Liposomal amphotericin for severe infections

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48
Q

What are the findings of histoplasmosis?

A

Pulmonary symptoms are usual, Mississippi and Ohio River valleys

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49
Q

What is the treatment for necrotizing fasciitis?

A

Early debridement, high-dose penicillin, broad spectrum if poly-organismal

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50
Q

What is the treatment for histoplasmosis?

A

Liposomal amphotericin for severe infections

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51
Q

What are the findings of Cryptococcus and who gets it?

A

CNS symptoms most common, usually in AIDS patients

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52
Q

what are the most common bugs in secondary bacterial peritonitis?

A

B. fragilis, e. coli, enterococcus

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53
Q

when should antivirals be given after exposure?

A

1-2hrs

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54
Q

What are the risk factors for fournier’s gangrene?

A

Diabetes mellitus and immunocompromised state

55
Q

What causes spontaneous bacterial peritonitis?

A

Decreased host defenses (intrahepatic shunting, impaired bactericidal activity in ascites), not due to transmucosal migration

56
Q

What is the treatment for actinomyces infection?

A

Drainage and penicillin G

57
Q

What is a major risk factor for spontaneous bacterial peritonitis?

A

low protein (<1 g/dL) in peritoneal fluid

58
Q

What bacteria causes necrotizing fasciitis?

A

beta-hemolytic group A strep, can be poly organismal

59
Q

What are fluid cultures in SBP?

A

negative in many cases

60
Q

What are the findings of coccidioidomycosis? where in the USA is it located?

A

pulmonary sx, southwest.

61
Q

how many weeks after exposure does seroconversion occur?

A

6-12 weeks

62
Q

What toxin does C. perfringens have?

A

alpha toxin

63
Q

what is the treatment for fournier’s gangrene?

A

early debridement, preserve testicles, antibiotics

64
Q

What are the findings in necrotizing tissue infection?

A 
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
Q

What are the findings of nocardia infection?

A

Pulmonary and CNS symptoms most common

66
Q

What is the treatment for c. perfringens infections?

A

Early debridement, high-dose penicillin

67
Q

what is treatment for secondary bacterial peritonitis?

A

usually need laparotomy to find source

68
Q

what is the treatment for coccidioidomycosis?

A

liposomal amphotericin for severe infections.

69
Q

what meds do you use to decrease seroconversion after exposure?

A

AZT (zidovudine, reverse transcriptase inhibitor), and ritonavir (protease inhibitor)

70
Q

is surgery needed for kaposi’s sarcoma?

A

No

71
Q

what does the gram stain show in c. perf infections?

A

GPRs without WBCs.

72
Q

How many PMNs in ascitic fluid is diagnostic of SBP?

A

> 500cells/cc

73
Q

What bacteria are present in spontaneous bacterial peritonitis?

A

monobacterial (50% e.coli, 30% strep, 10% kleb)

74
Q

what causes necrotizing fasciitis?

A

beta-hemolytic group A strep has exotoxin

75
Q

What is the treatment for Candida infection?

A

Fluconazole, anidulafungin for severe infections

76
Q

What are the findings in necrotizing fasciitis?

A

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
Q

In a patient with active infection, can you give liver transplantation?

A

No

78
Q

What symptoms does Actinomyces cause?

A

pulmonary symptoms most common; can cost tortuous abscesses in cervical, thoracic, and abdominal areas.

79
Q

What is a good antibiotic for prophylaxis for SBP?

A

fluoroquinolones (norfloxacin)

80
Q

When is a fungal infection real?

A

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
Q

What is the treatment for nocardia infection?

A

Drainage and sulfonamides (bactrim)

82
Q

what is the most common cause for laparotomy in HIV pts?

A

opportunistic infections

83
Q

what is fournier’s gangrene?

A

Severe infection in perineal and scrotal region

84
Q

How does the patient get c. perfringens infection?

A

Necrotic tissue decreases oxidation-reduction potential, setting up environment for bacteria

85
Q

When do you know you need a new central line and that this line is currently infected?

A

> 15 colony forming units

86
Q

What percent of abdominal abscesses have both anaerobic and aerobic bacteria?

A

80%

87
Q

What percentage of clean surgeries get infected? And what is an example of the surgery?

A

2%, hernia

88
Q

When you have to give antibiotics for abscesses?

A

Give antibiotics for patients with diabetes, cellulitis, clinical signs of sepsis, fever, elevated WBC, or who have bioprosthetic hardware

89
Q

what does endotoxin do?

A

endotoxin triggers release of TNF-a from macrophages, activates, complement, and activates coagulation cascade.

90
Q

What is the definition of line infection?

A

> 15 CFU

91
Q

list the parts of GI tract with types of bacteria.

A

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
Q

what is the most common organism in the GI tract?

A

anaerobes, 1000:1

93
Q

what causes c.diff colitis?

A

c.diff toxin

94
Q

What percentage of gross contamination surgeries get infected? What are examples of these surgeries?

A

30%, abscess

95
Q

What is the most common anaerobe in the colon?

A

bacteroides fragilis

96
Q

How do you treat abscess?

A

drainage

97
Q

What are the risk factors for wound infection?

A

Long operations, hematoma or seroma around that formation, advanced age, chronic disease, malnutrition, immunosuppressive drugs.

98
Q

What happens just before the patient becomes clinically septic?

A

hyperglycemia

99
Q

When do necrotizing soft tissue infections present?

A

Very quickly after surgical procedures, within hours

100
Q

What bacteria are the most common causes of line infection?

A

1 s. epi, #2 s. aureus, #3. yeast

101
Q

What is the most common gram-negative rod in surgical wound infections?

A

E. coli

102
Q

what is nosocomial pneumonia related to?

A

length of time on vent, aspiration from duodenum thought to have role

103
Q

What is the most common infection in surgery patients?

A

Urinary tract infection. The most common risk factor is urinary catheters, commonly e. coli

104
Q

What percentage of contaminated surgeries get infected? What are examples of these surgeries?

A

5 to 10%, gunshot wound to colon with repair

105
Q

What is the optimal glucose level in the septic patient?

A

100-120 mg/dL

106
Q

What endotoxin is released from gram-negative sepsis?

A

lipopolysaccharide lipid A

107
Q

How many bacteria are needed for wound infection?

A

> 10^5

108
Q

What is exoslime?

A

released by staph species, a exopolysaccharide matrix

109
Q

What are the time periods for fever? What are the sources of infection?

A

Atelectasis: 2d
UTI: 2-5d.
Wound: >5d

110
Q

What are the risk factors for necrotizing soft tissue infection?

A

Immunocompromised, diabetes mellitus, patients who have poor blood supply

111
Q

What should you do if you’re worried about line infection?

A

Pull the central line in, place IVs if central lines not needed

112
Q

Which bacteria can cause infection within hours postoperatively? How does it do it?

A

c. perfringens and beta-hemolytic strep can present within hours postop by producing exotoxins

113
Q

When should your central line be moved to a new site?

A

Site shows signs of infection, >15 CFU

114
Q

What is the most common anaerobe in surgical wound infections?

A

B. fragilis

115
Q

What percent of abdominal abscesses have anaerobes?

A

90%

116
Q

What bacteria cause necrotizing soft tissue infection?

A

beta hemolytic strep (group A), C. perfringens, or mixed organisms.

117
Q

what is the treatment for c. diff colitis?

A

oral: vanc or flagyl. IV: flagyl. lactobacillus can help. stop other antibiotics or change them

118
Q

What is the line salvage rate with anabiotics?

A

50%, less with yeast infection

119
Q

What are the most common organisms in ICU pneumonia?

A

1 s. aureus, #2 PSA. GNRs are #1 class of organisms in ICU PNA

120
Q

if there is b. fragilis in wound, what does it imply?

A

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
Q

What percent of clean-contaminated surgeries get infected? What are some examples of surgeries?

A

3 to 5%, elective colon resection with prepped bowel.

122
Q

What happens to insulin and glucose in early gram-negative sepsis?

A

dec insulin, inc glucose (impaired utilization)

123
Q

how long do you give postop prophylactic antibiotics? Which type of surgery is there an exception?

A

Stop within 24 hours of and operation time, except cardiac, which is Stotzer than 48 hours of an operation time

124
Q

what is the most common cause of immune deficiency?

A

malnutrition

125
Q

What is the most common cause of gram-negative sepsis?

A

e.coli

126
Q

Of Staphylococcus aureus and staphylococcus epidermidis, which are coagulase positive in which I coagulase negative?

A

s. aureus is coag+, s. epi is coag-

127
Q

What is the most common organism in surgical wound infections?

A

Staphylococcus aureus

128
Q

What kind of line is at highest risk for infection?

A

femoral lines

129
Q

When do abscesses occur after operation?

A

7-10d

130
Q

What surgical infections occur within 48 hours of procedure?

A

Injury it’s a bell with leak, invasive soft tissue infection.

131
Q

What happens to an slim and glucose in late gram-negative sepsis?

A

inc insulin, inc glucose secondary to insulin resistance

132
Q

What are the different types of contaminations during surgery?

A

Clean, clean contaminated, contaminated, gross contamination

133
Q

What is the most common aerobic bacteria in the colon?

A

e. coli

134
Q

What is the leading cause of infectious death after surgery?

A

nosocomial pneumonia

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