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ABSITE > Fiser Chapter 5 INFECTION > Flashcards

Fiser Chapter 5 INFECTION Flashcards

1
Q

Stomach microflora

A

Virtually sterile, some GPCs and yeast

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2
Q

Proximal small bowel microflora

A

10^5 bacteria, mostly GPCs

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3
Q

Distal small bowel microflora

A

10^7 bacteria, GPCs, GPRs, GNRs

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4
Q

Colon microflora

A

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

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5
Q

Most common bacteria in GI tract

A

Bacteroides fragilis (anaerobe)

Most common aerobe: E coli

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6
Q

Postop fever and infection

A

Hours: NSTI
2 days: atelectasis
2-5 days: UTI (most common postop infection)
>5 days: wound infection
If within 2 days, its because of injury to bowel or invasive STI (C perfringens or beta-hemolytic strep)
7-10 days abscess

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7
Q

GN sepsis

A

E coli -> endotoxin (LPS lipid A) -> TNF-alpha release from macrophages -> complement activation -> coagulation cascade

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8
Q

Infection and blood glucose

A

Hyperglycemia often just before clinical sepsis

Early GN sepsis: decreased insulin, increased glucose
Late GN sepsis: increased insulin and glucose

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9
Q

Optimal blood glucose in sepsis

A

100-120 mg/dL

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10
Q

C diff colitis treatment

A

Oral vanc or flagyl
IV flagyl
Lactobacillus can also help
Stop or change other abx

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11
Q

Abscess bacteria

A

90% anaerobes

80% both anaerobes and aerobes

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12
Q

Abscess tx

A

I&D

Antibiotics if DM, cellulitis, clinical sepsis, fever, leukocytosis, or bioprosthetic hardware (valve, hip)

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13
Q

Expected wound infection rates

A

Clean: 2%
Clean contaminated 3-5%
Contaminated 5-10%
Gross contamination 30%

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14
Q

Prophylactic abx timing

A

24hr after OR

48hr after OR for cardiac cases

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15
Q

SSI bacteria

A
  • Definition >/= 10^5 bacteria. Less if foreign body present.
  • Most common organism S aureus (coagulase positive)
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16
Q

COPS

A

S aureus

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17
Q

CONS

A

S epidermidis

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18
Q

Exoslime

A

Exopolysaccharide matrix released by Staph species

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19
Q

B frag in SSI

A

indicates necrosis or abscess (only grows in low redox state) and/or translocation from gut

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20
Q

Risk factors for SSI

A 
Long operation
Hematoma or seroma
Old
Chronic disease (COPD, RF, LF, DM)
Malnutrition (most common immunodeficiency)
Immunosuppression
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21
Q

Leading cause of infectious death after surgery

A

nosocomial PNA

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22
Q

Nosocomial PNA bacteria

A
  1. Staph aureus
  2. Pseudomonas
    But GNRs #1 class of organisms in ICU PNA?
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23
Q

Line infection bacteria

A
  1. Staph epidermidis
  2. Staph aureus
  3. Yeast
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24
Q

Central line cx indicative of line infection

A

> 15 colony forming units

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25
Central line infection dx and tx
Dx: >15 CFU or site looks bad Tx: move to new site, or just PIV if possible
26
NSTI organisms
Beta-hemolytic GAS (exotoxin) C perfringens Mixed
27
NSTI clinical findings
``` Pain out of proportion WBC >20 Thin gray drainage Skin blistering/necrosis Induration and edema Crepitus or ST gas on XR Sepsis +/- ```
28
Overlying skin pale red, progressing to purple with blister or bullae
NSTI
29
NSTI tx
Early debridement High dose PCN Broad spectrum abx if poly-organismal
30
Necrotic tissue, pain out of proportion, gram stain shows GPRs without WBCs --> myonecrosis and gas gangrene
C perfringens NSTI Farming injury -> necrotic tissue decreases redox -> good environment for C perfringens -> alpha toxin -> myonecrosis and gas gangrene
31
C perfringens tx
High dose PCN and early debridement
32
Perineal and scrotal severe infection
- Fournier's gangrene - GPCs, GNRs, anaerobes - Tx: early debridement, try to preserve testicles, antibiotics
33
Tortuous abscess in cervical, thoracic, or abdominal area
Actinomyces | Tx: drain and PCN G
34
Actinomyces abx
Penicillin G
35
Pulmonary and CNS symptoms, branching bacteria
Nocardia | Drain and bactrim
36
Nocardia abx
Bactrim
37
Candida abx
Fluconazole; sometimes anidulafungin for severe infections
38
Aspergillosis abx
Voriconazole
39
Histoplasmosis abx
Mississippi and Ohio River valley Pulmonary symptoms Tx: liposomal amphotericin for severe infection
40
Cryptococcus
CNS symptoms in AIDS | Tx: liposomal amphotericin for severe infection
41
Coccidioidomycosis
Southwest, pulm symptoms | Tx: liposomal amphotericin for severe infection
42
Primary SBP risk factor
43
SBP organisms
``` E coli Streptococcus Klebsiella Fluid cultures often negative PMNs>500 cells/cc diagnostic ``` Secondary bacterial peritonitis: polymicrobial (B frag, E coli, enterococcus)
44
SBP ppx and tx
ppx: Fluoroquinolones (norfloxacin) tx: Ceftriaxone
45
Secondary bacterial peritonitis
Perforated viscus Polymicrobial Need ex-lap
46
Risk of HIV if needle stick from positive patient
0.3%
47
Risk of HIV if mucous membrane exposure
0.1%
48
HIV exposure ppx
Zidovudine and ritonavir (RTI and PI)
49
Most common causes for ex-lap in HIV patients
1. Opportunisitic infection (CMV) | 2. Neoplastic disease
50
AIDS patient with pain, bleeding, and perforation
CMV colitis | Most common intestinal manifestation of AIDS
51
Most common neoplasm in AIDS
Kaposi's sarcoma
52
HIV lymphoma sites
1. Stomach 2. Rectum Mostly NHL (B cell) Tx: chemo
53
GIB in HIV patient
LGIB more common: CMV, bacterial, HSV | UGIB: Kaposi's sarcoma, lymphoma
54
CD4 counts
Normal: 800-1200 Symptomatic HIV: 300-400 Opportunistic infection:
55
Risk of HepC with blood transfusion
.0001%
56
HepC infection types
Chronic 60% Cirrhosis 15% (interferon may help prevent) HCC 1-5%
57
Brown recluse spider bite infection tx
Dapsone | May need resection of area and skin graft for large ulcers later
58
Acute septic arthritis bacteria and empiric tx
Gonococcus, staph, H influenzae, strep Drainage Vanc/ceftriaxone
59
DM foot infection bacteria and tx
Mixed staph, strep, GNRs, anaerobes | Tx: Broad spectrum abx, e.g. Unasyn
60
Cat/dog/human bite bacteria and tx
Polymicrobial Eikenella only in human bites -> permanent joint injury Pasteurella multocida in cat and dog bites Tx: broad spectrum abx, e.g. Augmentin
61
Impetigo, erysipelas, cellulitis, folliculitis organism
staph and strep most commonly
62
Furuncle boils organism and tx
S epidermidis or S aureus | Tx: drainage +/- abx
63
Carbuncle
multiloculated furuncle
64
Peritoneal dialysis catheter infection bacteria and tx
- S aureus and S epidermidis most commonly - Fungal (hard to treat) Tx: intraperitoneal vanc/gentamicin; increased dwell time and intraperitoneal heparin may help; removal if peritonitis lasts >4-5 days
65
Sinusitis risk factors, bacteria, dx, tx
Nasoenteric tubes Intubation Severe facial fractures Usually polymicrobial HCT air-fluid levels in sinus Tx: Broad-spectrum abx, rarely percutaneous tap

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