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Mar: Sem 4 - Principles II > Exam 2: HAI & Antibiotics > Flashcards

Exam 2: HAI & Antibiotics Flashcards

1
Q

What are hospital acquired infections? (nosocomial)

A

infections that happen in the hospital - they were not present and not incubating at the time of admission

S2

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2
Q

____ in ____ hospital patients develop a nosocomial infection

A

1 in 31 pts

S3

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3
Q

What are sources of hospital-acquired infections?

A
  • CVL sepsis
  • UTI 13%
  • Surgical ste infection 22%
  • Hospital acquired PNA 22%
  • Vent associated PNA (long term vent)
  • C-diff 12%

S4

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4
Q

Risk factors in developing a HAI?

A
  • Patient’s immune status
  • Infection control practices
  • Prevalence of certain pathogens in community
  • Older age
  • Longer hospital stays
  • Multiple chronic illnesses
  • Mechanical ventilatory support
  • Critical care unit stays

S5

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5
Q

How is the infection transmitted?

A
  • direct contact with healthcare workers
  • Contaminated environments
  • Extraluminal migration

what the HEC

S6

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6
Q

What are examples of contaminated environments that increase susceptibility to HAI’s?

A
  • Inguinal
  • Perineal
  • Axilla

Gloves dont prevent contamination

S6

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7
Q

What H&P symptoms suggest a pre-existing infection? (common sense)

A
  • Subjective fever
  • Chills
  • Night sweats
  • Altered mental status
  • Productive cough
  • Shortness of breath
  • Rebound tenderness
  • Suprapubic pain
  • Dysuria
  • CVA tenderness (costovertebral tenderness)
  • Vital Signs (HoTN, tachypnea, low sats, tachycardia)

S7

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8
Q

Labs that you can get to look for the evidence of organ dysfunction (duh)

A

Lactic acid
Prothrombin time
BUN/Creatinine
Elevated WBC
Hypo/hyperglycemia
Cultures

S9

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9
Q

What bacteria are your skin flora?

A

Coagulase-negative staphylococci

Lecture

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10
Q

Surgical site infections typically occur within ___ days of surgery.

A

30

S11

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11
Q

What are the categories for surgical site infection?

A
  • Superficial = skin & SC
  • Deep = fascia & muscle
  • Organ/Space

S12

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12
Q

Signs of a Surgical Site infection

A

Redness
Delayed healing
Fever
Pain
Warmth
Swelling
Drainage of pus (abscess)

S13

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13
Q

What are the three most common types of bacteria associated with surgical site infections?

A
  • Staphylococcus
  • Streptococcus
  • Pseudomonas

S14

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14
Q

How would a Clean wound be described?

A

Clean: not inflamed or contaminated and does not involve internal organs

S15

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15
Q

How would a Clean-contaminated wound be described?

A

Clean-Contaminated: no outward signs of infection but does involve internal organs

S15

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16
Q

How would a contaminated wound be described?

A

Contaminated: involves internal organ infection along with spillage of contents into surrounding tissue
i.e. ruptured appendix

S15

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17
Q

How would a dirty wound be described?

A

Dirty: known infection at the time of surgery

S15

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18
Q

What are risks factors for SSI?

A
  • > 2hr surgery
  • Comorbidities (smoker, DM, cancer, obese, immunocompromised etc)
  • Elderly
  • Emergency surgery
  • Abdominal surgery

ACEE’S

S15

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19
Q

Potentially ___% of SSI’s are preventable.

A

50%

S16

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20
Q

What is a category 1A recommendation?

A

1A = Strongly recommended; moderate to high quality of evidence

S18

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21
Q

What is a category 1B recommendation?

A

1B = Strongly recommended; low quality evidence

S18

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22
Q

What is a category 1C recommendation?

A

1C = Strong recommendation based on state/federal regulation

S18

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23
Q

What is a category II recommendation?

A

Weak recommendation

S18

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24
Q

What exclusions were there to the Guideline for Prevention of SSI’s?

A
  • SSI not a reported outcome
  • All patients w/ “dirty procedures”
  • No dental or oral health procedures
  • Procedure did not have primary closure
  • Study included wound protectors post-incision

They eliminated studies where interventions were already in place that woulld skew the results

S19

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25
Q

What are the recommendations for parenteral antibiotics?

A

1B - Administer only when indicated
1B - Time so that agent is active on tissue incision

S20

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26
Q

What are the recommendations for non-parenteral antibiotics?

A

1B - no antibiotic ointment on incision
Dry incisions are better.

S21

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27
Q

What recommendations are there for antibiotic irrigation and prosthetic soaking in antibiotic solution?

A

No recommendations on prosthetic soaking in abx solution or abx irrigation

Dr M says you will still see abx irrigation but it wont hurt anythign

S21

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28
Q

What are the 1A recommendation levels for glycemic control?

A
  • Perioperative control of glucose
  • Target glucose < 200 mg/dL (both intraop and postop)

S22

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29
Q

What is the recommendation level for A1C targets?

A

No recommendation for A1C target

Just acute control of BG.

S22

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30
Q

Maintaining perioperative normothermia is a ___ recommendation.

A

1A
No rec for strategies to maintain normothermia - just use what you have to maintain temp)

S23

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31
Q

What is the 1A recommendation for oxygenation in GETA patients?

A
  • No recommendation for increased FiO2 in normally functioning patients
  • Only increase the FiO2 with…
    • intraoperatively with GETA (i.e. not necessary in Preop with a normal pt)
    • Neuraxial anesthesia
    • Postoperatively by mask or nasal cannula
    • No trials r/t percentage/duration/delivery method

Recommendation is losing credibility as a way to prevent SSI’s - contradictory (Dr. Schaffer’s research).

S24

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32
Q

What are the recommendations for antiseptic prophylaxis?

A

1A - Intraoperative skin prep w/ alcohol-based antiseptic.
1B - Shower or bathe w/ soap/antiseptic the night before surgery.
II - Consider intraoperative Iodine irrigation.
* No benefit intra-peritoneally,
* No benefit with iodine imbedded adhesive drapes
* No benefit soaking prosthetic devices

S25

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33
Q

What is the recommendation for blood transfusion?

A

1B - Do not withhold necessary blood transfusions as a means to prevent SSI.

S26

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34
Q

Should systemic corticosteroids be utilized in a patient with joint arthroplasty?

A

Uncertain. Infection is most common indication for TKA revision however.

S27

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35
Q

What does MIC stand for?

A

Minimum Inhibitory Concentration

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36
Q

What is the goal for preoperative prophylaxis?

A
  • Adequate bactericidal concentration in serum and tissues when incision is made…
  • MIC: Minimum inhibitory concentration within tissues
  • Based on evidence
  • Given by anesthesia

S29

**ancef is 15 min prior to incision - if given an hour before, must redose

**most antibiotics need to be completed within 15 minutes of surgery and intiated under an hour. This is 45 minutes of “working time”

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37
Q

What are the 6 general principles of preoperative antibiotic prophylaxis?

A
  1. Should be active against common SSI pathogens
  2. Proven efficacy by clinical trials
  3. MIC must be achieved
  4. Shortest possible effective course
  5. New ABX reserved for resistant infections
  6. If possible, use oldest/cheapest ABX

Active Ethyl Must Shortlist New Old-people

S30

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38
Q

ABX should be initiated within ____ hour of incision.

A

1 hour (30 min even better)

S31

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39
Q

____ and ____ can be initiated within 2 hours of incision.

A

Vancomycin and Fluoroquinolones (like Cipro)

S31

40
Q

Status of abx prior to trouniquet use?

A

ABX must be completely infused prior to tourniquet use
* may hold abx for cultures

S31

41
Q

Re-dosing of antibiotics is permissible after what conditions?

A
  • 2 ABX half-lives
  • Excessive blood loss
  • Following Cardiac bypass
  • Prolonged procedures (usually 2-4 hours in OR)

Phil Follows Blood Too (2 but yea…)

S32

42
Q

What drugs are β-lactam based?

A
  • Penicillins
  • Cephalosporins
  • Carbapenems

S33

43
Q

What are the 5 major common surgical antibiotics?

A
  • β-lactams
  • Vancomycin
  • Aminoglycosides (gentamycin)
  • Fluoroquinolones (cipro)
  • Metronidazole (flagyl)

S33

44
Q

How do Penicillin β-lactam antibiotics work?

A

Inhibition of bacterial cell wall synthesis

S34

45
Q

Resistance to Penicillin β-lactam antibiotics is based on what?

A

β-lactamase enzyme on outer surface of cytoplasmic membrane

S34

46
Q

Penicillin β-lactams are the drug of choice for what pathogens?

A

Gram + Bacterium (Cocci)

  • Streptococci
  • Meningococci
  • Pneumococci

+ about PMS

S34

47
Q

β-lactams are good for which HAI’s?

Locations throughout body

A

skin, catheter, and upper respiratory infections

S34

48
Q

What four examples of penicillin based antibiotics were given?

A
  • Penicillin G
  • Methicillin
  • Nafcillin
  • Amoxicillin

S34

49
Q

What are the common adverse reactions to penicillin β-lactams?

A
  • Hypersensitivity (includes anaphylaxis at 0.05%)
  • GI upset with large doses
  • Vaginal Candidiasis

S35

50
Q

Cephalosporin - β-lactams are more stable against ____.

A

β-lactamases (broader spectrum)

S36

51
Q

MOA for cephalosporin-beta lactams

A

Beta-lactam rings bind to Penicillin-binding protein and inhibit the normal activity of the protein (can’t synthesize a bacterial cell wall)

S36

52
Q

Cephalosporin β-lactam antibiotics are the drug of choice for what?

A
  • Surgical prophylaxis
  • PCN allergy patients (except true anaphylaxis)

S36

can give a test dose of ancef because 99.9% of the time these reactions aren’t anaphylactic

53
Q

Cefazolin is generation ____ with trade name(s) ____ and ____ and best at treating?

A
  • 1st generation
  • Ancef, Kefzol
  • Does not penetrate BBB, Most gram + (staph and streptococci), Cellulitis, abscesses, URI, UTI

S37

54
Q

Cefuroxime is generation ____ with trade name(s) ____ and ____ and best at treating?

A
  • 2nd generation
  • ceffin, Zinacef
  • Better gram – coverage
    H-influenzae pneumonia, UTI, otitis media

S37

55
Q

Cefoxitin is generation ____ with trade name(s) ____ and ____.

A
  • 2nd generation
  • Metoxin

S37

56
Q

Cefotetan is generation ____ with trade name(s) ____ and ____ .

A
  • 2nd generation
  • Cefotan

S37

57
Q

Cefotaxime is generation ____ with trade name(s) ____ and ____ and best at treating?

A
  • 3rd generation
  • Claforan
  • Some cross BBB, Better gram – than before; treats resistance
    Meningitis

S37

58
Q

Ceftriaxone is generation ____ with trade name ____ and best at treating?

A
  • 3rd generation
  • Rocephin
  • Gonorrhea

S37

59
Q

Ceftazidime is generation ____ with trade name(s) ____.

A
  • 3rd generation
  • Fortaz

S37

60
Q

Cefepime is generation ____ with trade name ____ and best at treating?

A
  • 4th generation
  • Maxipime
  • Most resistant to hydrolysis by beta lactamases, Usually reserved for multi-resistant organisms
    Penetrates BBB well

S37

61
Q

What cephalosporins do not penetrate the blood brain barrier?

A

Generation 1: Cefazolin
Generation 2: Cefuroxime, Cefoxitin, Cefotetan

Zol, Rox, Fox, Tetan

S37

62
Q

What generation of cephalosporins penetrate the blood brain barrier well (the best)?

A

Generation 4: Cefepime (Maxipime)

Most resistant to β-lactamase.
Reserved for multi-resistant organisms.

S37

63
Q

Adverse reactions to cephalosporins

A

Hypersensativity is uncommon
* rashes
* fever
* nephritis
* anaphylaxis
* potential production deficit of Vit K (be aware with clotting disorders)

S38

64
Q

What drugs should be used if true anaphylaxis to penicillin exists?

A

Vancomycin or clindamycin

S38

Listen clinda...
65
Q

What drugs are a common cause of colitis?

A

3rd generation cephalosporins

S38

66
Q

Carbapenem β-lactams have good activity against ____ and ____.

A

Gram - rods (Pseudomonas Aeruginosa) and enterobacter

S39

67
Q

What β-lactam drug class has the broadest spectrum of activity and can inhibit the β-lactamase enzyme? MOA?

A

Carbapenems
* inhibit the beta-lactamase enzyme and binds to penicillin-binding protein

S39

68
Q

What type of infections are carbapenems saved for?

A

Intra-abdominal, resistant UTIs, and pneumonia
most penetrate BBB

S39

69
Q

What examples of carbapenems were given?

A
  • Ertapenem (Invanz)
  • Meropenem (Merrem)
  • Imipenem (Primaxin)
70
Q

IM formulations of carbapenems contain ____.

A

Lidocaine

Consider LA allergies prior to IM administration.

S40

71
Q

Carbapenems can decrease what medication by up to 90%?
What can this precipitate?

A

Valproic Acid (Depakote); and can precipitate seizures

S40

72
Q

How does vancomycin work?

A

Inhibition of cell wall synthesis

S41

73
Q

Vancomycin is active against ____ bacteria but is too large to penetrate ____ bacteria.

A

Active against gram +
too large for gram - bacteria
Vanco only works if the bacteria is actively dividing

S41

74
Q

Vancomycin is most useful against what infections?

A

Blood stream MRSA
MRSA endocarditis

S41

75
Q

What are the most common adverse reactions to vancomycin?

A
  • Phlebitis at site
  • Chills, fever
  • Nephrotoxicity
  • “Red man” syndrome from quick administration

S42

76
Q

How do Aminoglycosides work?

A

Inhibition of ribosomal proteins and cause mRNA misreading

S43

77
Q

Aminoglycosides have a ____ post-antibiotic effect.

A

prolonged (long 1/2 life)

S43

78
Q

Aminoglycosides are ____ w/ β lactams or vancomycin.

A

Synergistic

Especially useful for enterococcal endocarditis.

S43

Gentamycin example

79
Q

What are the adverse reactions associated with gentamycin?

A
  • Ototoxicity
  • Nephrotoxicity: (more than 5 days, elderly, renal insufficiency, high doses and with loop diuretics)
  • Curare-like affect

S44

80
Q

Explain the curare-like effect of gentamycin (aminoglycoside).

A

Gentamycin can interfere with ACh receptors and potentiate effects of NMB drugs. (seen more with depolarizing NMB)

S45

81
Q

What is the treatment for curare-like effects from gentamycin?

A

Ca⁺⁺

Lecture

82
Q

How do fluoroquinolones work?

A

Inhibit bacterial DNA synthesis

S45

83
Q

Fluoroquinolones are best used for what type of bacteria? used on?

A

Gram - organisms:

  • UTI
  • Bacterial diarrhea
  • Bone/joint infections

S45

84
Q

What examples are there of fluoroquinolones?

A
  • Ciprofloxacin
  • Levofloxacin

S45

85
Q

What are the adverse reactions for fluoroquinolones?

A
  • N/V/D
  • QT interval prolongation
  • Cartilage damage / Tendon rupture

S46

Hint: fluroquinolones treat joint infections and diarrhea

86
Q

What three factors will exacerbate cartilage damage and tendon rupture associated with fluoroquinolones?

A
  • Renal insufficiency
  • Concurrent steroids
  • Advanced age

S46

87
Q

What type of antibiotic is metronidazole?

A

Antiprotozoal / Anaerobic antibacterial

S47

88
Q

How does Metronidazole work?

A

Forms toxic byproducts that destabilize bacterial DNA.

S47

89
Q

What is metronidazole (flagyl) indicated for?

A
  • Intra-abdominal infections
  • Vaginitis
  • C-diff

S47

90
Q

What drug should Flagyl not be combined with?

A

EtOH

Disulfiram-like effect induces hangover-like s/s (flushing, dizziness, HA, CP, abd pain)

S48

91
Q

What are the adverse reactions associated with metronidazole?

A
  • Nausea
  • Peripheral neuropathy (w/ prolonged use)
  • Disulfiram-like effect

S48

92
Q

What is (essentially) the first line antibiotic for essentially all surgical prophylaxis?

A

Cefazolin (Ancef)

S49

93
Q

What is the most common alternative to cefazolin for surgical prophylaxis?

A

Clindamycin (or vancomycin)

S49

94
Q

What drug(s) increases the likelihood of nephrotoxicity when paired with aminoglycosides?

A

Loop Diuretics

S44

95
Q

With small intenstinal obstruction, what are the recommended antibiotics?

A

cefazolin + metronidazole, cefoxitin or cefotetan

S49

96
Q

With Small intestine cocorectal surgery, what antibiotics are recommended?

A

Cefazolin +
metronidaxole, cefoxitin, cefotetan, ampicillin-sulbactam or ceftriaxone +
metronidazole or ertapenem

S49

97
Q

Adult dosing for cefazolin

A
  • 1g </= 80kg
  • 2g 81-119kg
  • 3g >/= 120kg

S50

Mar: Sem 4 - Principles II (27 decks)

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