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Principals 2 > HAI & Abx > Flashcards

HAI & Abx Flashcards

1
Q

What is the most common cause of HAI?

A

Surgical site infections

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2
Q

Where does a SUPERFICIAL INCISIONAL SSI (surgical site infection) occur?

A

Just in the area of incision

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3
Q

What are the 3 most common types of bacteria associated with SSI?

A

Staphylococcus
Streptococcus
Pseudomonas

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3
Q

Where does a DEEP INCISIONAL SSI occur?

A

Beneath the incision area in muscle and area surrounding muscle

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4
Q

Where does an ORGAN/SPACE SSI occur?

A

Any area other than skin or muscle

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5
Q

SSI Wound Types: Clean

A

No evidence of infection
Does not involve organ

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6
Q

SSI Wound Types: Clean-contaminated

A

No evidence of infection
DOES involve internal organ

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7
Q

SSI Wound Types: Contaminated

A

Involves organ with spillage of contents from organ

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8
Q

SSI Wound Types: Dirty

A

Known infection at time of surgery
Ex: Trauma

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9
Q

What length of surgery is associated with increased chance of SSI?

A

> 2 hrs

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10
Q

Grading Categories of Evidence: 1A

A

Strong Recommendation
Mod-High quality evidence

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10
Q

What comorbidities are most associated with increased risk of SSI?

A

Immunocompromised
Obesity
DM
CA
Smoker

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11
Q

What 2 kinds of surgeries are most associated with SSI?

A

Abdominal
Emergency

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12
Q

Grading Categories of Evidence: 1B

A

Strong Recommendation
Low quality evidence

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13
Q

Grading Categories of Evidence: 1C

A

Strong Recommendation
Required by state/federal regulation

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14
Q

Recommendations & Evidence:
Parenteral Abx

A

Admin only when indicated (1B)
Timing so Abx in tissue upon incision (1B)

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15
Q

Grading Categories of Evidence: 2

A

Weak Recommendation
(These still occur on person-by-person basis d/t preference)

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16
Q

Recommendations & Evidence:
Non-parenteral Abx

A

Do not apply Abx ointment to incision (1B)

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17
Q

Recommendations & Evidence:
Glycemic Control

A

Perioperative Control (1A)
Glucose Target <200 mg/dL (1A)

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18
Q

Recommendations & Evidence:
Normothermia

A

Maintain perioperative normothermia (1A)

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19
Q

Recommendations & Evidence:
Oxygenation

A

No Recommendation

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20
Q

Recommendations & Evidence:
Antiseptic Prophylaxis

A

Bathe PM before (1B)
ETOH based skin prep intraop (1A)

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20
Q

Recommendations & Evidence:
Systemic Immunosuppressive Therapy

A

Risk vs Reward per surgeon
Avoid if pt has multiple SSI risks

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21
Q

Recommendations & Evidence:
Blood Transfusion

A

DO NOT withhold necessary transfusion to prevent possible SSI (1B)

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22
Q

What is the most common reason for TKA revision?

A

Infection

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22
Q

When should Abx be initiated before surgery?

A

30-60 minutes
Before torniquet use

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23
Q

What 2 kinds of Abx need to be initiated earlier than the standard time?
How much earlier?

A

Vanco & Fluoroquinolones
2 hrs

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24
Q

What are the 3 common subclasses of Beta Lactams used perioperatively?

A

PCNs
Cephalosporins
Carbapenems

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24
Q

When should Abx be redosed?

A

2 half lives (while in OR)
Excessive blood loss

25
Q

What are the 5 common surgical Abx classes?

A

Beta Lactams
Aminoglycosides
Fluroquinolones
Vanco
Metronidazole

26
Q

How do Beta Lactams work?

A

Inhibit cell wall synthesis

27
Q

What bacterial enzyme inhibits Beta Lactam? Where on the bacteria is it located?

A

Beta-lactamase
Outer surface of cytoplasmic membrane

28
Q

What kind of infections are PCNs most commonly used for (3)?

A

Skin
Catheter
Upper Respiratory

28
Q

What kind of coverage do PCNs have?

A

Mostly Gram +

28
Q

What kind of bacteria are PCNs the DOC for (3)?

A

Streptococci
Meningococci
Pneumococci

29
Q

Does Cefazolin (Ancef) cross the BBB?

A

No

29
Q

What are the 2 most common adverse reactions to PCNs (2)?

A

GI Upset
Vaginal Candidiasis

30
Q

What is the DOC for surgical prophylaxis?
What drug class is it?

A

Cefazolin (Ancef)

31
Q

Is there cross-reactivity between PCNs and Cephalosporins?

A

No, unless true anaphylaxis

31
Q

What coverage does Cefazolin (Ancef) have?

A

Gram +

32
Q

What 2nd Gen Cephalosporin is sometimes used?
What added coverage does it have in addition to Cefazolin (Ancef)

A

Cefoxitin (Mefoxin)
Better Gram – coverage

33
Q

What cephalosporin is reserved for multi-resistant organisms?
Does it penetrate the BBB?

A

Cefepime (Maxipime)
Yes

34
Q

What are 5 adverse reactions to cephalosporins?

A

Rash
Nephritis
Vit K deficit
Fever
Colitis (3rd gen)

34
Q

If someone has a true anaphylactic reaction to cephalosporins and/or PCNs, what other Abx should be used (2)?

A

Vancomycin
Clindamycin

35
Q

What Beta-Lactam Abx has the broadest coverage of Gram+ and Gram–?

A

Carbapenems

36
Q

What type of bacteria is Carbapenems MOST effective against?

A

Gram –

37
Q

What makes carbapenems so effective?

A

They inhibit beta-lactamase enzyme in bacteria

38
Q

Do carbapenems penetrate the BBB?

A

Yes

39
Q

What Abx is representative of carbapenems?

A

Meropenem (Merrem)

40
Q

What are 3 adverse reactions to carbapenems?

A

N/V/D
Rash
Injection site reactions

41
Q

What medication is a contraindication to administering carbapenems?
Why?

A

Valproic Acid (Depakote)
Decreases levels up to 90%

42
Q

How does Vancomycin act against bacteria?

A

Inhibits cell wall synthesis

43
Q

What coverage does Vanco have?
Why?

A

Only Gram +
Too large to penetrate Gram- cell wall

44
Q

What is unique about how Vancomycin works?
What is the consequence of it?

A

Only works if bacteria is actively dividing
Action against bacteria is very slow

45
Q

What are adverse reactions to Vanco?
Are they common?

A

Phlebitis at injection site
Nephro/Oto toxicity
Red Man syndrome
Chills/Fever

YES 10%

45
Q

What 2 infections is Vanco best at treating?
What is the usually the offending bacteria?

A

BSI (blood stream infection)
Endocarditis

MRSA

46
Q

What is the MOA of aminoglycosides?

A

Inhibit ribosomes –> misreading mRNA

47
Q

What Abx are aminoglycosides synergistic with?
What infection is this synergy effective against?

A

Beta-Lactams

Enterococcal Endocarditis

48
Q

What is the class example of aminoglycosides?

A

Gentamycin

49
Q

What are 3 adverse reactions to aminoglycosides?

A

Ototoxicity
Nephrotoxicity
Curare-like effect

50
Q

What increases the risk (5) of nephrotoxicity from aminoglycosides?

A

Renal Insufficiency
Concurrent loop diuretics
High doses
Dosing for >5 days
Elderly

51
Q

What is the MOA of Fluroquinolones?

A

Inhibition of gyrase –> inhibition of transcription and replication

52
Q

What is the coverage of Fluroquinolones?

A

Gram-

53
Q

What are 2 examples of Fluroquinolones?

A

Ciprofloxacin (Cipro)
Levofloxacin (Levaquin)

54
Q

What are 3 adverse reactions to fluroqinolones?

A

N/V/D
Prolonged QT
Cartilage damage/Tendon rupture

55
Q

What increases the risk of cartilage damage/tendon rupture from fluroquinolones?

A

Renal insufficiency
Concurrent steroid use
Elderly

56
Q

What is the MOA of Metronidazole (Flagyl)?

A

Toxic byproducts result in unstable DNA molecules

57
Q

What are the targets of Metronidazole (Flagyl)?

A

Anerobic bacteria
Protazoa

58
Q

What is the indication for Metronidazole (Flagyl)?

A

Abdominal infection
C-diff
Vaginitis

59
Q

What are adverse reactions to Metronidazole (Flagyl)?

A

Disulfiram Effect w/ ETOH
Peripheral Neuropathy (Prolonged use)
Nausea

60
Q

What are the weight ranges and doses for Cefazolin (Ancef) administration?

A

<80kg = 1g
80-120kg = 2g
>120kg = 3g

Principals 2 (2 decks)

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