Fiser Chapter 5: Infection Flashcards
Most common immune deficiency leading to infection.
Malnutrition
Microflora in:
Stomach; proximal small bowel; distal small bowel; colon
Stomach: sterile, some GPC, some yeast
Proximal small bowel: GPC (10^5)
Distal small bowel: GPC, GPR, GNR (10^7)
Colon: 10^11 (anaerobes; some GNR, GPC)
Most common anaerobe in the colon
Bacteroides fragilis
Most common aerobic bacteria in the colon
E. coli
Which are more common organisms in the GI tract: aerobic or anaerobes?
Anaerobes
Anerobes lack these enzymes making them vulnerable to oxygen radicals.
Superoxide dismutase
Catalase
Most common organism that causes GN sepsis
E. coli
Pathophysiology of GN sepsis
Endotoxin (Lipopolysaccharide lipid A) is released; triggers release of TNF-alpha; released from macrophages, triggers inflammation, activates complement, actives coagulation cascade
Describe hyperglycemia in early vs. late GN sepsis
Early: Decreased insulin; impaired utilization
Late: insulin resistance
T/F Hyperglycemia occurs just before the patients becomes clinically septic.
True
Optimal glucose level in a septic patient
80-120
Diagnostic test for C. diff
ELISA for Toxin A
What do you use to treat C. diff in pregnancy?
PO Vanc
Treatment for fulminant C. diff colitis?
Total colectomy with end ileostomy
What percentage of abdominal abscesses have anaerobes?
90%
What percentage of abdominal abscesses have both anaerobes and aerobes?
80%
When do intra-abdominal abscesses usually occur?
7-10 days post-op
When are antibiotics indicated for intra-abdominal abscesses?
Diabetes, cellulitis, sepsis, fever, prosthetic hardware
4 classes of surgical operation
Clean: hernia (2%)
Clean-contaminated: elective colon-resection with prepped bowel (3-5%)
Contaminated: GSW colon with repair (5-10%)
Gross contaminated: abscess (30%)
Most common SSI organism
Staph aureus (coag-positive)
Is staph epi coag positive or negative?
Negative
What is the exoslime released by staph species?
Exo-polysaccharide matrix
Most common GNR in surgical wounds?
E. coli
Most common anerobe in surgical wound infection?
B. fragilis
What does recovery of B. fragilis from surgical wound infection indicate?
Necrosis, abscess, gut translocation
How many bacteria required for SSI?
10^5 (less if foreign body)
Risk factors for wound infection
Long operation; hematoma or seroma formation; advanced age; chronic disease (COPD, ESRD, liver failure, DM), malnutrition, IS drugs
Most common infection in surgery patients
UTI; biggest risk factor is urinary catheter; most commonly E. coli (GNR)
Leading cause of infectious death after surgery; most common organisms
Nosocomial pneumonia
- Related to length of ventilation, aspiration
- S. aureus, Pseudomonas, E. coli
- GNR #1 cause in ICU patients
3 most common line infections
- S. epi
- S. aureus
- Yeast
What % of infected lines can be salvaged?
50%
2 most common causes of necrotizing soft tissue infections
GAS; MRSA (exotoxins); C. perf
Or mixed
Risk factors for necrotizing soft tissue infections
DM, poor Q, immunocompromised