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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
Q

Central line infection dx and tx

A

Dx: >15 CFU or site looks bad
Tx: move to new site, or just PIV if possible

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26
Q

NSTI organisms

A

Beta-hemolytic GAS (exotoxin)
C perfringens
Mixed

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27
Q

NSTI clinical findings

A 
Pain out of proportion
WBC >20
Thin gray drainage
Skin blistering/necrosis
Induration and edema
Crepitus or ST gas on XR
Sepsis +/-
28
Q

Overlying skin pale red, progressing to purple with blister or bullae

A

NSTI

29
Q

NSTI tx

A

Early debridement
High dose PCN
Broad spectrum abx if poly-organismal

30
Q

Necrotic tissue, pain out of proportion, gram stain shows GPRs without WBCs –> myonecrosis and gas gangrene

A

C perfringens NSTI
Farming injury -> necrotic tissue decreases redox -> good environment for C perfringens -> alpha toxin -> myonecrosis and gas gangrene

31
Q

C perfringens tx

A

High dose PCN and early debridement

32
Q

Perineal and scrotal severe infection

A
  • Fournier’s gangrene
  • GPCs, GNRs, anaerobes
  • Tx: early debridement, try to preserve testicles, antibiotics
33
Q

Tortuous abscess in cervical, thoracic, or abdominal area

A

Actinomyces

Tx: drain and PCN G

34
Q

Actinomyces abx

A

Penicillin G

35
Q

Pulmonary and CNS symptoms, branching bacteria

A

Nocardia

Drain and bactrim

36
Q

Nocardia abx

A

Bactrim

37
Q

Candida abx

A

Fluconazole; sometimes anidulafungin for severe infections

38
Q

Aspergillosis abx

A

Voriconazole

39
Q

Histoplasmosis abx

A

Mississippi and Ohio River valley
Pulmonary symptoms
Tx: liposomal amphotericin for severe infection

40
Q

Cryptococcus

A

CNS symptoms in AIDS

Tx: liposomal amphotericin for severe infection

41
Q

Coccidioidomycosis

A

Southwest, pulm symptoms

Tx: liposomal amphotericin for severe infection

42
Q

Primary SBP risk factor

A
43
Q

SBP organisms

A 
E coli
Streptococcus
Klebsiella
Fluid cultures often negative
PMNs>500 cells/cc diagnostic

Secondary bacterial peritonitis: polymicrobial (B frag, E coli, enterococcus)

44
Q

SBP ppx and tx

A

ppx: Fluoroquinolones (norfloxacin)
tx: Ceftriaxone

45
Q

Secondary bacterial peritonitis

A

Perforated viscus
Polymicrobial
Need ex-lap

46
Q

Risk of HIV if needle stick from positive patient

A

0.3%

47
Q

Risk of HIV if mucous membrane exposure

A

0.1%

48
Q

HIV exposure ppx

A

Zidovudine and ritonavir (RTI and PI)

49
Q

Most common causes for ex-lap in HIV patients

A
  1. Opportunisitic infection (CMV)

2. Neoplastic disease

50
Q

AIDS patient with pain, bleeding, and perforation

A

CMV colitis

Most common intestinal manifestation of AIDS

51
Q

Most common neoplasm in AIDS

A

Kaposi’s sarcoma

52
Q

HIV lymphoma sites

A
  1. Stomach
  2. Rectum
    Mostly NHL (B cell)
    Tx: chemo
53
Q

GIB in HIV patient

A

LGIB more common: CMV, bacterial, HSV

UGIB: Kaposi’s sarcoma, lymphoma

54
Q

CD4 counts

A

Normal: 800-1200
Symptomatic HIV: 300-400
Opportunistic infection:

55
Q

Risk of HepC with blood transfusion

A

.0001%

56
Q

HepC infection types

A

Chronic 60%
Cirrhosis 15% (interferon may help prevent)
HCC 1-5%

57
Q

Brown recluse spider bite infection tx

A

Dapsone

May need resection of area and skin graft for large ulcers later

58
Q

Acute septic arthritis bacteria and empiric tx

A

Gonococcus, staph, H influenzae, strep
Drainage
Vanc/ceftriaxone

59
Q

DM foot infection bacteria and tx

A

Mixed staph, strep, GNRs, anaerobes

Tx: Broad spectrum abx, e.g. Unasyn

60
Q

Cat/dog/human bite bacteria and tx

A

Polymicrobial
Eikenella only in human bites -> permanent joint injury
Pasteurella multocida in cat and dog bites
Tx: broad spectrum abx, e.g. Augmentin

61
Q

Impetigo, erysipelas, cellulitis, folliculitis organism

A

staph and strep most commonly

62
Q

Furuncle boils organism and tx

A

S epidermidis or S aureus

Tx: drainage +/- abx

63
Q

Carbuncle

A

multiloculated furuncle

64
Q

Peritoneal dialysis catheter infection bacteria and tx

A
  • 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
Q

Sinusitis risk factors, bacteria, dx, tx

A

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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