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Z.Fiser > Fiser.05.Infection > Flashcards

Fiser.05.Infection Flashcards

1
Q

What is the MCC of immune deficiency?

A

malnutrition leading to infection

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2
Q

What is the microflora in the stomach?

A

virtually sterile, some yeast, some GPCs

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3
Q

what is the microflora of the distal small bowel (include concentrations)

A

10^7 bacteria with GPCs, GNRs, and GPRs

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4
Q

What is the microflora of the proximal small bowel (include concentrations)

A

10^5 bacteria, mostly GPCs

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5
Q

what is the microflora of the colon? (include concentrations)

A

10^11 bacteria, almost ALL anaerobes, some GNRs and GPCs

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6
Q

what is the MC anaerobic bacteria in the colon?

A

Bacteroides fragilis

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7
Q

What is the ratio of aerobic to anaerobic bacteria in the colon?

A

1:1000

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8
Q

What is the MC aerobic bacteria in the colon?

A

E. coli

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9
Q

What is the MC organism in the GI tract?

A

anaerobic bacteria

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10
Q

What is the MCC of fever 48 hours postop?

A

atelectasis

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11
Q

What is the MCC of fever 48hrs - 5 days postop?

A

UTI

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12
Q

What is the MCC of fever > 5 days postop?

A

wound infection

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13
Q

What is the MCC of gram negative sepsis?

A

E. coli

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14
Q

What is the endotoxin released by E. coli and how does it trigger sepsis?

A

the endotoxin = lipopolysaccharide lipid A –> triggers macrophages to release TNF-alpha –> complement activation –> coagulation cascade activation

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15
Q

what is the insulin / glc picture in EARLY gram negative sepsis and why?

A

low insulin and elevated glucose 2/2 impaired utilization

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16
Q

What is the insulin / glucose picture in late gram negative sepsis and why?

A

elevated insulin and elevated glucose 2/2 insulin resistance

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17
Q

when does hyperglycemia present in a septic patient?

A

just before the patient becomes clinically septic

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18
Q

What is the optimal glucose level in a septic patient?

A

100-120 mg/dL

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19
Q

what is the PO/IV regimen for C dif colitis? What about abx already on board?

A

PO: vanc or Flagyl +/- Lactobacillus; IV: Flagyl for other abx, discontinue or change

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20
Q

What percentage of abdominal abscesses have anaerobes?

A

90%

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21
Q

What percentage of abdominal abscesses have aerobes AND anaerobes?

A

80%

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22
Q

How far out postop do abdominal abscesses present?

A

7-10 days postop

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23
Q

what is the treatment for abdominal abscesses?

A

drainage

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24
Q

what SIX underlying conditions merit the use of antibiotics for patients with abdominal abscesses?

A

DM; cellulitis; clinical S/Sx of sepsis; fever; elevated WBC; bioprosthetic hardware (mech valve, hip replacement)

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25
Q

what is the rate of SSI with a CLEAN case?

A

2% (ex: inguinal hernia repair)

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26
Q

what is the rate of SSI with a CLEAN-CONTAMINATED case?

A

3-5% (ex: elective colon resection with a prepped bowel)

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27
Q

what is the rate of SSI in a CONTAMINATED case?

A

5-10% (ex: GSW to the colon with repair)

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28
Q

what is the rate of SSI in a GROSSLY CONTAMINATED case?

A

30% (ex: abscess)

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29
Q

How do you define a CLEAN case? Give examples

A

uninfected, no inflammation; respiratory/GI/GU tracts are not entered; closed primarily ex: exlap, mastectomy, neck dissection, thyroid, vascular, hernia, splenectomy

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30
Q

How do you define a CLEAN-CONTAMINATED case? Give examples

A

respiratory/GI/GU tracts are entered under CONTROLLED conditions, no unusual contamination. Ex: chole, SBR, whipple, liver txp, gastric surgery, bronch, colon surgery

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31
Q

How do you define a CONTAMINATED case? Give examples

A

open fresh, accidental wounds; major break in sterile technique; gross spillage from GI tract; acute non-purulent inflammation. Ex: inflamed appy; bile spillage in chole; diverticulitis; rectal surgery; penetrating wounds

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32
Q

How do you define a DIRTY case? Give examples

A

old traumatic wounds with devitalized tissue; existing infection or perforation; organisms present BEFORE procedure. ex: abscess I&D, perforated bowel, peritonitis, wound debridement, positive cultures preop

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33
Q

Why are prophylactic abx administered during surgery?

A

prevent SSI

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34
Q

What is the stop time for prophylactic abx for regular and cardiac cases?

A

regular cases: abx stop within 24 hours of the end of operation time. cardiac cases: abx stop within 48 hours of the end of operation time

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35
Q

What is the MCC of SSI? (organism)

A

staph aureus

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36
Q

is staph aureus coagulase positive or negative?

A

coagulase positive

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37
Q

is staph epidermidis coagulase positive or negative?

A

coagulase negative

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38
Q

what is the function of the EXOSLIME released by the staph spp?

A

exopolysaccharide matrix

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39
Q

what is the MC GNR in SSI?

A

E. coli

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40
Q

What is the MC anaerobe in SSI?

A

Bacteroides fragilis

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41
Q

if you isolate B. fragilis from a surgical wound, what are THREE things on your Ddx and why?

A

necrosis / abscess b/c B. fragilis only grows in a low redox state; translocation from the gut

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42
Q

What [x] of bax is needed to cause a wound infection?

A

> or = 10^5 bax are needed for a wound infection

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43
Q

What can lower the [x] of bax needed to cause a wound infection?

A

less than 10^5 bacteria are needed to cause a wound infection if a foreign body is present

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44
Q

Name five risk factors for wound infection

A

long operations; hematoma/seroma formation; chronic disease (COPD, renal failure, liver failure, DM); malnutrition; immunosuppression

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45
Q

What are the pathogens (2) and MOA of invasive soft tissue infection?

A

Causes: clostridium perfringens & beta hemolytic strep. MOA: produces exotoxins

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46
Q

What are two surgical site infections that can occur within 48 hours of the procedure

A

1) injury to the bowel with leak; 2) invasive soft tissue infection with C. perfringens / Beta-hemolytic strep

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47
Q

What is the most common postop infection?

A

UTI

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48
Q

What is the biggest risk factor for UTI? Which bacteria is the MCC?

A

biggest risk factor: Foley; MCC: E. coli

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49
Q

What is the MCC of postop infectious death?

A

Nosocomial PNA

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50
Q

What are the two underlying causes (clinical) of nosocomial PNA?

A

number of vent days; duodenal aspiration

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51
Q

What are the 2 MCC (bax) of ICU nosocomial PNA

A

1) Staph aureus; 2) Pseudomonas

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52
Q

What is the #1 class (bax) of organisms in ICU PNA?

A

GNRs

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53
Q

What are the 3 MCC of line infections?

A

1) staph epidermidis; 2) stap aureus; 3) yeast

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54
Q

What percent of CVLs are salvaged with antibiotics?

A

50%

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55
Q

Which organism is least likely to be salvaged with antibiotics 2/2 CVL infection?

A

much less likely with yeast infections

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56
Q

how many CFUs indicate a CVL infection?

A

> 15 CFUs

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57
Q

What is the management of a CVL that shows S/Sx of infection?

A

discontinue the line and either move it to a new site or use PIVs

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58
Q

Name the 3 MCC of NSTIs

A

1) group A beta hemolytic strep; 2) Clostridium perfringens; 3) mixed organisms

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59
Q

what are the two underlying risk factors for NSTI?

A

immunocompromised; poor blood supply

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60
Q

name 6 s/sx a/w NSTI

A

pain out of proportion to skin exam; WBC > 20; thin, gray drainage; skin blistering / necrosis; induration / edema; crepitus / soft tissue gas on XR all +/- sepsis

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61
Q

What is the MCC of necrotizing fasciitis? (pathogen)

A

beta hemolytic group A strep, some polymicrobials

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62
Q

What are the skin changes (over time) seen with necrotizing fasciitis? What are 2 other S/Sx on skin exam?

A

overlying skin is normal in early stages –> pale red –> purple –> blisters / bullae. Eventually will lead to crepitus with thin-gray & foul smelling fluid

63
Q

Why does necrotizing fasciitis move so quickly?

A

secretes exotoxin; moves along fascial planes

64
Q

What are the abx and surgical tx for necrotizing fasciitis

A

high dose PCN, can make it broad spectrum because it can sometimes be polymicrobial. Surgical tx: early debridement

65
Q

What is the MOA of clostridium perfringens in skin infections?

A

produces alpha toxin

66
Q

why is necrotic tissue a/w C. perfringens infection?

A

necrotic tissue = reduced oxidation and reduction potential; sets up environment for clostridium perfringens

67
Q

What skin findings are seen with C. perfringens infection? Name three other physical exam findings

A

May not have changes in skin with deep infections. You get pain out of proportion to exam; myonecrosis; and gas gangrene

68
Q

What NSTI organism is a/w farming injuries?

A

Clostridium perfringens

69
Q

What does the Gram Stain show with C. perfringens

A

GPRs without WBCs

70
Q

What is the abx and surgical treatment for NSTI 2/2 C. perfringens

A

high dose PCN; early debridement

71
Q

What is Fournier’s gangrene and 3 MC underlying organisms?

A

severe infection of the perineum and scrotum 2/2 GPCs, GNRs, and anaerobes

72
Q

What is the treatment for Fournier’s gangrene?

A

Early debridement; preserve testicles if possible; antibiotics

73
Q

Name 5 indications (clinical or culture) for fungal coverage

A

positive fungal blood cultures; positive two sites other than blood; +1 site with severe symptoms; endoopthalmitis; patients on prolonged antibacterial abx and fail to improve

74
Q

What are two presentations of Actinomyces infection?

A

pulmonary symptoms (MC); tortuous abscesses in cervical, thoracic, and abdominal areas

75
Q

What is the treatment for actinomyces infection

A

drainage; penicillin G (because not a true fungus)

76
Q

What are the MC presentations of Nocardia infection?

A

pulmonary symptoms; CNS symptoms

77
Q

what is the treatment for nocardia infection? (2)

A

drainage; sulfonamides (Bactrim) because not a true fungus

78
Q

What is the MC presentation of Candida infection?

A

Respiratory (common inhabitant of respiratory tract)

79
Q

What are the two treatments for candida infection?

A

fluconazole (some candida resistant); anidulafungin (Eraxis) for severe infections

80
Q

What is the tx for aspergillosis

A

voriconazole

81
Q

what is the MC presentation of histoplasmosis?

A

pulmonary symptoms

82
Q

where in the US is histoplasmosis endemic?

A

Mississippi and Ohio River Valleys

83
Q

What is the presentation of Cryptococcus infection?

A

CNS sx

84
Q

What is the MC comorbidity a/w cryptococcus infection?

A

AIDS

85
Q

What is the treatment for cryptococcus infection?

A

liposomal amphotericin

86
Q

what is the MC presentation of coccidiodomycosis?

A

pulmonary symptoms

87
Q

Where in the US is coccidiodomycosis endemic?

A

Southwest US

88
Q

What is the treatment for coccidiodomycosis?

A

liposomal amphotericin

89
Q

what is the [x] of protein found in peritoneal fluid in primary spontaneous bacterial peritonitis (SBP)?

A

low protein (< 1g/dL) = risk factor

90
Q

What are the three MCC (pathogens) of primary SBP (include prevalence of each)

A

Monobacterial: 50% E. coli; 30% Strep; 10% Klebsiella

91
Q

What is the underlying pathophysiology of primary SBP?

A

due to reduced host defenses; intrahepatic shunting; impaired bacteriocidal activity in ascites. NOT due to transmucosal migration

92
Q

What gram stain finding is diagnostic of primary SBP?

A

> 500 PMNs per cc

93
Q

What are peritoneal culture findings in primary SBP?

A

fluid cultures are often negative

94
Q

what is the treatment for primary SBP?

A

ceftriaxone (Rocephin) or other third generation cephalosporins

95
Q

What antibiotics can be used for primary SBP prophylaxis?

A

fluoroquinolones. Ex: ciprofloxacin (Cipro), gemifloxacin (Factive), levofloxacin (Levaquin), moxifloxacin (Avelox), norfloxacin (Noroxin), and ofloxacin (Floxin).

96
Q

With primary SBP, what two clinical scenarios are indications to rule out another intraabdominal source?

A

patients is not improving on antibiotics OR fluid cultures are polymicrobial

97
Q

Can you perform a liver transplant in a patient with active primary SBP?

A

nope

98
Q

What is the pathophysiology of secondary bacterial peritonitis?

A

intraabdominal source: implies perforated viscus

99
Q

What are the 3 MCC (pathogens) of secondary bacterial peritonitis?

A

Polymicrobial - bacteroides fragilis; E. coli; enterococcus

100
Q

is primary SBP monobacterial or polymicrobial?

A

monobacterial

101
Q

is secondary bacterial peritonitis monomicrobial or polymicrobial?

A

polymicrobial

102
Q

what is the treatment for secondary bacterial peritonitis?

A

antibiotics; laparotomy to find intraabdominal source

103
Q

what is the HIV exposure risk from an HIV positive blood transfusion?

A

70%

104
Q

What is the HIV exposure risk for vertical transmission?

A

30%

105
Q

What is the HIV exposure risk for a needle stick from an HIV-positive patient?

A

0.3%

106
Q

What is the HIV exposure risk for mucous membrane exposure?

A

0.1%

107
Q

How long after HIV exposure does seroconversion occur?

A

6-12 weeks

108
Q

What is the MOA of AZT (zidovudine)?

A

reverse transcriptase inhibitor

109
Q

What is the MOA of ritonavir?

A

protease inhibitor

110
Q

Why should you take AZT and ritonavir after HIV exposure? When should they be administered?

A

reduce the risk of seroconversion; should be administered within 1-2 hours of exposure

111
Q

What is the MCC of laparotomy in HIV patients?

A

opportunistic infections (especially CMV infection = MCC of laparotomy)

112
Q

what is the 2nd MCC of laparotomy in HIV+ patients

A

neoplastic disease

113
Q

What is the MC intestinal manifestation of AIDS and how does it present?

A

CMV colitis p/w bleeding & perforation

114
Q

what is the MC neoplasm in AIDS patients?

A

Kaposi’s sarcoma

115
Q

Where are the two MC locations for lymphoma in HIV patients?

A

1) stomach; 2) rectum

116
Q

What is the MC subtype of lymphoma in HIV patients?

A

non-Hodgkins B-cell

117
Q

How do you treat lymphoma in HIV patients?

A

chemotherapy +/- surgery (if significant bleeding or perforations)

118
Q

Are upper or lower GI bleeds MC in HIV patients?

A

LGI bleeds more common

119
Q

what are the 2 MCC of UGI bleeding in HIV patients?

A

1) Kaposi’s sarcoma; 2) lymphoma

120
Q

what are the 3 MCC of LGI bleeds in HIV+ patients?

A

1) CMV; 2) bacterial; 3) HSV

121
Q

what are the normal, symptomatic, and opportunistic CD4 counts in HIV patients?

A

normal: CD4 800-1200; symptomatic: CD4 300-400; opportunistic infections: CD4 < 200

122
Q

What is the rate of hepC transmission via blood transfusion?

A

0.0001% / unit

123
Q

What is the prevalence of HepC?

A

1-2%

124
Q

What percent of HepC patients have chronic infection?

A

60%

125
Q

What percent of HepC patients develop cirrhosis?

A

15%

126
Q

What percent of HepC patients develop hepatocellular carcinoma?

A

1-5%

127
Q

Is fulminant hepatic failure in Hep C patients common?

A

No, its rare

128
Q

What med can help prevent cirrhosis in HepC patients?

A

interferon

129
Q

What is the treatment for brown recluse spider bites?

A

first line: dapsone; treat by resection with skin grafts for large ulcers later

130
Q

What are the four MCC of acute septic arthritis

A

1) Gonococcus; 2) Staph; 3) H. influenzae; 4) strep

131
Q

What is the treatment for acute septic arthritis

A

drainage; third generation cephalosporins + vancomycin –> narrow with cultures

132
Q

What are the four MCC of diabetic foot infections?

A

MIXED CAUSES staph; strep; GNRs; anaerobes

133
Q

What organism is only found in human bites? What can it cause?

A

Eikenella –> can cause permanent joint injury

134
Q

What organism is found in cat & dog bites?

A

Pasteurella multocida

135
Q

What antibiotics do you use for dog/cat/human bites?

A

Augmentin (broad spectrum - amoxicillin/clavulanic acid)

136
Q

What abx do you use for diabetic foot infections?

A

Unasyn (broad spectrum - ampicillin / sublactam)

137
Q

what are the two MCC (bax) of impetigo?

A

staph / strep

138
Q

what are the two MCC (bax) of erysipelas?

A

staph / strep

139
Q

what are the two MCC (bax) of cellulitis?

A

staph/strep

140
Q

what are the two MCC (bax) of folliculitis?

A

staph/strep

141
Q

What are the 2 MCC (bax) of a furuncle/boil?

A

Staph epidermidis; staph aureus

142
Q

what is the treatment for a furuncle

A

drainage +/- abx

143
Q

What is a carbuncle?

A

a multiloculated furuncle

144
Q

What are the 2 MCC of PD catheter infections?

A

staph aureus; staph epidermidis

145
Q

What are the most challenging subtype of PD catheter infections to treat?

A

fungal

146
Q

what is the tx for PD catheter infections? (3)

A

intraperitoneal vanc + gent; increase dwell time; intraperitoneal heparin

147
Q

when is the removal of the PD catheter indicated for PD catheter infections? (4)

A

peritonitis that lasts 4-5 days; all fungal, TB, and pseudomonas infections

148
Q

What is the treatment for PD catheter infection a/w fecal peritonitis?

A

laparotomy to find perforation

149
Q

name three risk factors for sinusitis

A

NGT; intubation; severe facial fx

150
Q

what is the underlying cause (bax) of sinusitis?

A

usu polymicrobial

151
Q

what are the CT head findings a/w sinusitis?

A

air-fluid levels in the sinuses

152
Q

what is the tx for sinusitis?

A

broad-spectrum abx; +/- percutaneosly tap the sinus if systemic illness

153
Q

why do you use clippers instead of razors preop?

A

reduce the risk of wound infection

Z.Fiser (22 decks)

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