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ABSITE > Ch. 5 > Flashcards

Ch. 5 Flashcards

1
Q

Problems assoc. with malnutrition?

A

MC immune deficiency; leads to infection

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2
Q

Microflora within stomach?

A

Virtually sterile; some GPCs, some yeast

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3
Q

Microflora within proximal small bowel?

A

10^5 bacteria, mostly GPCs

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4
Q

Microflora within distal small bowel?

A

10^7 bacteria, GPCs, GPRs, GNRs

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5
Q

Microflora within colon?

A

10^11 bacteria, almost all anaerobes, some GNRs, GPCs,

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6
Q

Most common organism in GI tract?

A

Anaerobes; MC than aerobic bacteria in the colon (1,000:1)

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7
Q

What makes bacteria anaerobic?

A

Needing a low-oxygen environment (lack superoxide dismutase and catalase, making them vulnerable to oxygen free radicals)

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8
Q

MC anaerobe in the colon?

A

Bacteroides fragilis

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9
Q

MC aerobic bacteria in colon?

A

E. Coli

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10
Q

MC fever source within 48 hours?

A

Atelectasis

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11
Q

MC fever source within 48 hours - 5 days?

A

UTI

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12
Q

MC fever source after 5 days?

A

Wound infection

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13
Q

MC cause of Gram (-) sepsis?

A

E. coli

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14
Q

Pathophysiology of Gram (-) sepsis?

A

Endotoxin triggers the release of TNF-alpha (most potent stimulus; released from macrophages, triggers inflammation), activates complement, and activates coagulation cascade

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15
Q

What is the cause of Gram (-) sepsis)

A

Release of endotoxin (lipopolysaccharide lipid A)

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16
Q

Metabolic findings in Early gram (-) sepsis?

A 
low insulin
elevated glucose (impaired utilization)
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17
Q

Metabolic findings in Late gram (-) sepsis?

A 
elevated insulin
elevated glucose (secondary to insulin resistance)
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18
Q

What often occurs just before a patient becomes clinically septic?

A

Hyperglycemia

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19
Q

What is the optimal glucose level in a septic patient?

A

80-120 mg/dL

20
Q

What are the signs of C. diff?

A

foul-smelling diarrhea; leukocytosis (often in 30-40’s); nursing home or ICU patients

21
Q

How to diagnose C. diff?

A

ELISA for toxin A

22
Q

Treatment for C. diff?

A 
Oral - vamcomycin or Flagyl
IV - Flagyl
Fluid resuscitation
Stop other antibiotics or change them
Lactobacillus can also help
23
Q

Treatment of C. diff in pregnancy?

A

oral vancomycin ( no systemic absorption)

24
Q

What is fulminant pseudomembranous colitis? Treatment?

A

C. diff with severe sepsis, perforation

Tx: total colectomy with ileostomy

25
Q

What percentage of abdominal abscesses have anaerobes?

A

90%

26
Q

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

A

80%

27
Q

How are abscesses treated?

A

Drainage

28
Q

When do abscesses normally occur following an operation?

A

7-10 days

29
Q

When are antibiotics indicated for abscesses?

A

Patients with diabetes, cellulitis, clinical signs of sepsis, fever, or who have bioprosthetic hardware (mechanical valves, hip replacements)

30
Q

Example of clean operation; percentage surgical site infection?

A

Hernia; 2%

31
Q

Example of clean contaminated operation; percentage surgical site infection?

A

elective colon resection with prepped bowel; 3-5%

32
Q

Example of contaminated operation; percentage surgical site infection?

A

gunshot wound to colon with repair; 5-10%

33
Q

Example of grossly contaminated operation; percentage surgical site infection?

A

abscess; 30%

34
Q

What is done to prevent surgical site infections?

A

Prophylactic antibiotics given within 1 hour of incision; stop within 24 hours of end operation time (except cardiac - stopped within 48 hours)

35
Q

MC organism involved in surgical site infections?

A

Staph aureus - coagulase (+)
vs.
Staph epidermidis - coagulase (-)

36
Q

What is released by Staph species that makes them stick around?

A

Exoslime (exopolysaccharide matrix)

37
Q

What is the MC GNR in surgical wound infections?

A

E. coli

38
Q

What is the MC anaerobe in surgical wound infections?

A

B. fragilis

39
Q

What is the concern if B. fragilis is recovered from tissue?

A

Indicates necrosis or abscess ( only grows in low redox state); also implies translocation from gut

40
Q

How many organisms needed for a wound infection?

A

> = 10^5 bacteria; less needed if a foreign body present

41
Q

What are some risk factors for wound infections?

A 
long operations
hematoma or seroma formation
advanced age
chronic disease (eg, COPD, liver/renal failure, DM)
malnutrition
immunosupressive drugs
42
Q

Considerations if have a surgical infection within 48 hours of procedure?

A

Injury to bowel - with a leak
Invasive soft tissue infection - Clostridium perfringens and beta-hemolytic strep can present within hours post op ( produce endotoxins)

43
Q

MC infection in surgery patients?

A

UTI

  • biggest risk factor are urinary catheters
  • MC E. Coli (GNRs)
44
Q

What is the leading cause of infectious death after surgery?

A

Nosocomial pneumonia

45
Q

What is the biggest risk factor for nosocomial pneumonia following surgery?

A

Length of ventilation

Aspiration from duodenum thought to have a role

46
Q

What are the most common organisms in ICU PNA?

A 
#1 Staph aureus
#2 Pseudomonas
#3 E. Coli
47
Q

What are the #1 class of organisms implicated in ICU PNA?

A

GNRs

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