3/17/17 DOBY Pediatric infections TEST #3 Flashcards
If a child has sepsis what might the core temperature be?
- > 38.5
- < 36
If a child has sepsis what type of heart rate might they have?
-Tachycardia
If a child has sepsis what will happen to the respiratory rate?
-It will be elevated
T/F A high and low WBC can be a sign of sepsis
True
What is one of the key differences between SIRS in children versus adults?
-In adults you look for blood pressure, but not in children (they can still have a normal blood pressure)
Which of the following make neonates (babies less than a month) more susceptible to infections? A) Less IgG production B) Declining maternal IgG C) Less cytokine production D) Decreased function of neutrophils E) all of the above
-E) all of the above
The T and B cells present in utero have to coexist with who’s immune system?
-The mothers
In babies the anti-inflammatory cytokine production (T cells) is increased in diminished?
-Diminished
In babies immunoglobulin synthesis (B cells) is more or less?
-Less
T/F In babies neutrophils differ from adult functional capacity.
True
What is an SBI?
-Serious bacterial infection
What is a fever in a neonatal?
38.0 (100.4) in rectal
Globally SBI is responsible for how many neonatal deaths?
-1/3 to 1/4 of deaths
What are seven SBIs found in neonatals?
- Meningitis
- bactermia
- UTIs
- Pneumonia
- Osteomyelitis/septic arthiritis
- SSTI
- bacterial gastroenteritis
What SBI accounts for most the infections in infants < 90 days old?
-UTIs
When is meningitis most common in infants?
-Within the first 30 days
What are the most common causes of neonatal SBI?
A) GBS, Salmonells sp., and E. coli
B) GBS, Staphylococcus aureus, and E. coli
C) GBS, listeria, and E. coli
D) Staphylococcus aureus, E. coli, and Listeria
E) GBS, Listeria, and Streptococcus pneumoniae
C) GBS (group B strep), Listeria, and E. coli
What are viral causes of neonatal sepsis?
- HSV 1 and 2
- VZV
- Enteroviruses
- Influenza
- Adenoviruses
- RSV
Group B strep is what type of gram stain?
-Gram + cocci
What hemolysis is Group B strep?
-Beta hyemolytic
What are the bacterial pathogens of neonatal SBIs?
- Group B strep ( S. agalactiae)
- E. coli and other Gram - enteric bugs
- Listeria monocytogenes
T/F Group B strep is a common colonizer of GI and GU tracts
True
What is the colonization rate of pregnant women?
-15-40%
Group B strep early onset disease occurs within what time frame?
< 7 days
Group B strep late-onset disease occurs within what time frame?
-7-89 days
Group B strep late late onset disease occurs within what time frame?
-90 + days
Early onset disease for group B strep is commonly associated with what?
-Maternal OB complications
Which onset of group B strep has the highest mortality?
Early onset
What are some symptoms of early onset group B strep?
- Respiratory distress
- Poor feeding
- Lethargy
- apnea/bradycardia
What is the #1 cause of early neonatal morbidity and mortality in the US?
-Group B strep
What is the drug of choice for Group B Strep treatment?
-Penicillin G (1 dose four hours before birth of baby)
Intrapartum Antimicrobial Prophylaxis (IAP) reduces what type of onset of group B strep in infants?
-Early onset
Today we do a universal screening of pregnant women at what week in gestation?
-35-37 weeks
When should you use clindamycin to treat group B strep?
-Only if you know the isolate is susceptible
What is the gram stain of Listeria monocytogenes?
-Gram + rod
Listeria monocytogenes is ______ anaerobic and is _______?
- Facultatively
- Nonsporulating
What type of hemolysis is Listeria monocytogenes?
-Incomplete beta-hemolysis
What temperature does Listeria monocytogenes grow well at?
-refrigerator temps
What food is Listeria monocytogenes associated with?
- Milk
- Soft cheeses
- Ready to eat pork
- Deli meat
- hot dogs
- cantelopes
If you have in utero infection of Listeria while pregnant what might happen?
- Still birth
- abortion
What is the drug of choice to treat Listeria infections?
-Ampicillin (plus gentamicin for synergy in certain cases)
T/F E. coli is non lactose fermenting
False
-It is lactose fermenting
What is the drug of choice for E. coli that textbooks say?
-Ampicillin (but they really use extended spectrum cephalosporin)
T/F Think galactosemia with E. coli sepsis
True
What is the best choice for empiric antimicrobial therapy for a febrile neonate?
A) Ampicillin and gentamicin
B) Ampicillin, cefotaxime, gentamicin
C) Vancomycin, cefotaxime, and gentamicin
D) Ceftriaxone and gentamicin
E) Vancomycin and Ampicillin
B) Ampicillin, cefotaxime, and gentamicin
What empiric treatment of febrile infants do you use for Gram + infection of Group B strep and listeria and is the only active agent for listeria?
-Ampicillin
What empiric treatment of febrile infants do you use as synergy for listeria and group B strep?
-Gentamicin
What empiric treatment of febrile infants do you use if > 1 month old and dealing with E. coli or gram - coverage and is especially important if suspecting meningitis?
-Cefotaxime
