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OB Gyn Oral Boards Topics > Columbus: bacterial infections in pregnancy > Flashcards

Columbus: bacterial infections in pregnancy Flashcards

0
Q

What is the term fatality rate for GBS infected neonates?
For infants infected less than 33 weeks?

What are common maternal sites of GBS infection?
And in neonates?

A

2%
30%

UTI, amnionitis, endometritis
Sepsis, meningitis, Pneumonia

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1
Q

What percentage of women have lower G.I. tract colonization of GBS?

A

20-25%

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2
Q

What are risk factors for early-onset GBS infection?

A 
Maternal colonization
GBS bacteriuria
Preterm birth
Intrapartum fever
Prolonged PROM
African-American and Hispanic women
Prior GBS-affected neonate
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3
Q

What is the early-onset neonatal infection rate for GBS?

How is late onset neonatal GBS infection transmitted?

A

0.37 per 1000

Vertical or nosocomial; lower fatality rate

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4
Q

Antibiotics given prior to delivery reduce the early onset GBS by what percentage?

A

70%

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6
Q

What threshold of GBS bacteriuria necessitates antibiotic treatment in labor?

A

Greater than or equal to 10^4 CFU/mL

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7
Q

What is first-line treatment for GBS prophylaxis?

What regimen is recommended for penicillin allergy with low-risk of anaphylaxis?

What is recommended for penicillin allergy with high-risk of anaphylaxis?

A

Penicillin 5 million units IV then 2.5 million units every 4 hours

Cefazolin 2 g IV than 1 g every 8 hours

Clindamycin 900 mg IV every 8 hours or Vancomycin 1 g IV every 12 hours if clindamycin and erythromycin resistant

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8
Q

When is GBS prophylaxis indicated besides positive culture or bacteriuria?

A

Delivery less than 37 weeks
Rupture of membranes greater than or equal to 18 hours
Intrapartum fever
Intrapartum PCR positive

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8
Q

What is the cause of listeriosis?

What type of organism is this?

A

Listeria monocytogenes

Motile, non-spore forming, gram-positive Bacillus

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9
Q

When should GBS culture be repeated after PPROM with long latency?

A

Greater than 5 weeks

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10
Q

How is listeriosis acquired and spread to the fetus?

A

Unpasteurized cheese, smoked deli meats, hot dogs

Hematogenous spread with cystic placental abscesses

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11
Q

How does listeriosis present less than 32 weeks?

Greater than 32 weeks?

A

Diffuse sepsis, high mortality rate

Fetal meningitis, hydrocephalus and mental retardation; most mothers asymptomatic

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12
Q

How is listeriosis treated?

A

Ampicillin 1-2 g IV Q6 hours and gentamicin 2 mg per kilogram IV Q8 hours for one week

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13
Q

What is the proper way to remove a tick that is embedded?

A

Tweezers or string

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14
Q

What is the causative agent of Lyme disease?

How is it transmitted?

A

Spirochete Borrelia burgdorferi

Deer tick

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15
Q

Describe the first stage of Lyme disease.

Second stage.

Third stage

A

Erythema chronicum migrans or target lesion

Neurologic and cardiac manifestations such as meningitis, cranial nerve palsy, first-degree AV heart block

Joint pain especially knee, effusions, chronic neurologic damage and fatigue

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16
Q

What are the perinatal complications of Lyme disease?

A

Transplacental passage leads to infection of fetal lymphoreticular system, CNS, myocardium with septal and aortic defects described; intrauterine and neonatal demise if untreated

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17
Q

In Lyme disease, what is the timing of tick attachment?
Target lesion?
Serologic changes?

A

24-36 hours
Four days to three weeks in up to 80%
ELISA positive IgM 2-4 weeks after rash up to six months; IgG 6-8 weeks after rash with peak at six months

18
Q

How is Lyme disease treated?

What medication is recommended for pregnancy?

A

Doxycycline 100 mg twice daily for 10-21 days; longer duration recommended for meningitis or other neurologic manifestations

Amoxicillin 500 mg every 8 hours for 21-30 days

19
Q

What is posttreatment Lyme disease syndrome?

What is the prevalence?

A

Chronic relapsing episodes of fatigue, joint pain, myalgia lasting six months despite adequate antibiotic therapy

10-20%

21
Q

What is the causative agent of toxoplasmosis?

What are the three phases of the lifecycle?

A

Toxoplasma gondii, intracellular parasite

Trophozoite: invasive form
Cyst: latent form found within liver and muscle
Oocyst: reproductive form in cat feces

21
Q

How does toxoplasmosis typically present?

A

Most are asymptomatic. If symptoms occur they include fever, night sweats, malaise, myalgias, hepatosplenomegaly

Encephalitis is possible in immunocompromised individuals.

22
Q

How do people become infected with toxoplasmosis?

A

Contact with oocysts from cat feces or contaminated soil.

23
Q

How is toxoplasmosis diagnosed?

A

ELISA IgM titers that show a four-fold rise over three weeks indicates an acute infection. IgM may last for years.

24
Q

What are the features of congenital toxoplasmosis?

What percentage developed sequelae by one year?

A

Chorioretinitis, hearing loss, mental retardation, petechiae, hepatosplenomegaly, ventriculomegaly, cerebral calcifications, seizures, Fetal growth restriction

85%

25
Q

What is the rate of congenital toxoplasma infection by trimester?

Comment on the severity of disease by trimester.

A

First trimester: 15%
Second trimester: 25%
Third trimester: greater than 60%

Severity is inversely related to gestational age at infection

26
Q

Ultrasound findings for congenital toxoplasmosis are rare and late appearing. How can diagnosis be confirmed?

A

Amniocentesis for T. gondii by PCR or PUBS for T. gondii or IgM if greater than 20 weeks

27
Q

What does ACOG recommend for toxoplasmosis prevention?

A

Avoid undercooked meat
Wear gloves and wash hands if working in soil
Avoid cat litter boxes

28
Q

What does ACOG recommend for prevention and treatment of toxoplasmosis in pregnancy?

Fetal monitoring?

A

For acute maternal infection, spiramycin decreases fetal transmission by 60%

For known fetal infection, pyrimethamine, sulfadiazine, folinic acid.

Fetal ultrasound every four weeks and NST weekly at 32 weeks

30
Q

What is the general recommendation for spontaneous bacterial endocarditis prophylaxis in OB/GYN procedures?

A

Due to low risk of bacteremia routine antibiotic prophylaxis is not recommended. Patients with high-risk cardiac conditions should have enterococcus coverage if they also have an established infection that could cause bacteremia (such as chorioamnionitis or pyelonephritis)

30
Q

What antibiotic regimen is recommended for infective endocarditis prophylaxis?

A

Amoxicillin 2 g, ampicillin 2 g or vancomycin 1000 mg plus gentamicin 1.5 mg/kg one hour before surgery

31
Q

What cardiac conditions are deemed high-risk for infective endocarditis?

A

Prosthetic heart valves
Previous infective endocarditis
Unrepaired cyanotic congenital heart disease
Repaired congenital heart disease within 6 months
Valve disease in cardiac transplant patient

32
Q

What prophylactic antibiotics are given at Meriter hospital prior to cesarean?

A

Cefazolin 2 g IV or 3 g for 100 kg or more

33
Q

What are the benefits of prophylactic antibiotics before C-section?

Comment on the risk of NICU admission and neonatal sepsis?

A

60-70% reduction in endometritis
30-65% reduction in wound infection

No change in neonatal sepsis or NICU admission

34
Q

Should antibiotic prophylaxis be given for third or fourth degree perineal lacerations?

A

Limited evidence to support routine use. Pearls of exxcellence indicates that antibiotic treatment has been shown to decrease the incidence of perineal infection following repair based on one small study with high loss to follow up

35
Q

What percentage of people have MRSA colonization by rectovaginal swab? By nasal swab?

Should any additional prophylaxis be given before C-section?

A

10%. 2%.

Add vancomycin for documented MRSA carriers

36
Q

Should antibiotic prophylaxis be given for manual placenta extraction?

A

No data to support or refute this practice but WHO recommends a single dose of prophylactic broad-spectrum antibiotic.

37
Q

How should non-puerperal mastitis be evaluated and treated?

A

Must rule out inflammatory breast cancer

Biopsy indurated tissue and send for culture and pathology

38
Q

What are the causative agents for puerperal mastitis?

What percentage will develop breast abscess?

A

Staph aureus, Streptococcus, E. coli

10%

39
Q

How is simple mastitis treated?

What if MRSA is suspected?

What if there is an incomplete or failed response?

A

Dicloxacillin 500 mg four times daily

Clindamycin 300 mg four times daily

Consider midstream milk culture. Amoxicillin with clavulanate or vancomycin

40
Q

How should suspected breast abscess be managed?

A

Breast ultrasound
Needle aspiration or I&D
Broad-spectrum antibiotics

42
Q

What general counseling recommendations should be given for women with mastitis?

A

Complete full course of antibiotics due to high risk of abscess for partial treatment
Ibuprofen as needed
Continue nursing/pumping

43
Q

How should candidal mastitis be treated?

What other recommendations should be made?

A

Fluconazole 150 mg daily for 14 days

Keep nipples clean and dry and evaluate neonate for thrush

OB Gyn Oral Boards Topics (82 decks)

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