HAI & Abx Flashcards
What is the most common cause of HAI?
Surgical site infections
Where does a SUPERFICIAL INCISIONAL SSI (surgical site infection) occur?
Just in the area of incision
What are the 3 most common types of bacteria associated with SSI?
Staphylococcus
Streptococcus
Pseudomonas
Where does a DEEP INCISIONAL SSI occur?
Beneath the incision area in muscle and area surrounding muscle
Where does an ORGAN/SPACE SSI occur?
Any area other than skin or muscle
SSI Wound Types: Clean
No evidence of infection
Does not involve organ
SSI Wound Types: Clean-contaminated
No evidence of infection
DOES involve internal organ
SSI Wound Types: Contaminated
Involves organ with spillage of contents from organ
SSI Wound Types: Dirty
Known infection at time of surgery
Ex: Trauma
What length of surgery is associated with increased chance of SSI?
> 2 hrs
Grading Categories of Evidence: 1A
Strong Recommendation
Mod-High quality evidence
What comorbidities are most associated with increased risk of SSI?
Immunocompromised
Obesity
DM
CA
Smoker
What 2 kinds of surgeries are most associated with SSI?
Abdominal
Emergency
Grading Categories of Evidence: 1B
Strong Recommendation
Low quality evidence
Grading Categories of Evidence: 1C
Strong Recommendation
Required by state/federal regulation
Recommendations & Evidence:
Parenteral Abx
Admin only when indicated (1B)
Timing so Abx in tissue upon incision (1B)
Grading Categories of Evidence: 2
Weak Recommendation
(These still occur on person-by-person basis d/t preference)
Recommendations & Evidence:
Non-parenteral Abx
Do not apply Abx ointment to incision (1B)
Recommendations & Evidence:
Glycemic Control
Perioperative Control (1A)
Glucose Target <200 mg/dL (1A)
Recommendations & Evidence:
Normothermia
Maintain perioperative normothermia (1A)
Recommendations & Evidence:
Oxygenation
No Recommendation
Recommendations & Evidence:
Antiseptic Prophylaxis
Bathe PM before (1B)
ETOH based skin prep intraop (1A)
Recommendations & Evidence:
Systemic Immunosuppressive Therapy
Risk vs Reward per surgeon
Avoid if pt has multiple SSI risks
Recommendations & Evidence:
Blood Transfusion
DO NOT withhold necessary transfusion to prevent possible SSI (1B)
What is the most common reason for TKA revision?
Infection
When should Abx be initiated before surgery?
30-60 minutes
Before torniquet use
What 2 kinds of Abx need to be initiated earlier than the standard time?
How much earlier?
Vanco & Fluoroquinolones
2 hrs
What are the 3 common subclasses of Beta Lactams used perioperatively?
PCNs
Cephalosporins
Carbapenems
When should Abx be redosed?
2 half lives (while in OR)
Excessive blood loss
What are the 5 common surgical Abx classes?
Beta Lactams
Aminoglycosides
Fluroquinolones
Vanco
Metronidazole
How do Beta Lactams work?
Inhibit cell wall synthesis
What bacterial enzyme inhibits Beta Lactam? Where on the bacteria is it located?
Beta-lactamase
Outer surface of cytoplasmic membrane
What kind of infections are PCNs most commonly used for (3)?
Skin
Catheter
Upper Respiratory
What kind of coverage do PCNs have?
Mostly Gram +
What kind of bacteria are PCNs the DOC for (3)?
Streptococci
Meningococci
Pneumococci
Does Cefazolin (Ancef) cross the BBB?
No
What are the 2 most common adverse reactions to PCNs (2)?
GI Upset
Vaginal Candidiasis
What is the DOC for surgical prophylaxis?
What drug class is it?
Cefazolin (Ancef)
Is there cross-reactivity between PCNs and Cephalosporins?
No, unless true anaphylaxis
What coverage does Cefazolin (Ancef) have?
Gram +
What 2nd Gen Cephalosporin is sometimes used?
What added coverage does it have in addition to Cefazolin (Ancef)
Cefoxitin (Mefoxin)
Better Gram – coverage
What cephalosporin is reserved for multi-resistant organisms?
Does it penetrate the BBB?
Cefepime (Maxipime)
Yes
What are 5 adverse reactions to cephalosporins?
Rash
Nephritis
Vit K deficit
Fever
Colitis (3rd gen)
If someone has a true anaphylactic reaction to cephalosporins and/or PCNs, what other Abx should be used (2)?
Vancomycin
Clindamycin
What Beta-Lactam Abx has the broadest coverage of Gram+ and Gram–?
Carbapenems
What type of bacteria is Carbapenems MOST effective against?
Gram –
What makes carbapenems so effective?
They inhibit beta-lactamase enzyme in bacteria
Do carbapenems penetrate the BBB?
Yes
What Abx is representative of carbapenems?
Meropenem (Merrem)
What are 3 adverse reactions to carbapenems?
N/V/D
Rash
Injection site reactions
What medication is a contraindication to administering carbapenems?
Why?
Valproic Acid (Depakote)
Decreases levels up to 90%
How does Vancomycin act against bacteria?
Inhibits cell wall synthesis
What coverage does Vanco have?
Why?
Only Gram +
Too large to penetrate Gram- cell wall
What is unique about how Vancomycin works?
What is the consequence of it?
Only works if bacteria is actively dividing
Action against bacteria is very slow
What are adverse reactions to Vanco?
Are they common?
Phlebitis at injection site
Nephro/Oto toxicity
Red Man syndrome
Chills/Fever
YES 10%
What 2 infections is Vanco best at treating?
What is the usually the offending bacteria?
BSI (blood stream infection)
Endocarditis
MRSA
What is the MOA of aminoglycosides?
Inhibit ribosomes –> misreading mRNA
What Abx are aminoglycosides synergistic with?
What infection is this synergy effective against?
Beta-Lactams
Enterococcal Endocarditis
What is the class example of aminoglycosides?
Gentamycin
What are 3 adverse reactions to aminoglycosides?
Ototoxicity
Nephrotoxicity
Curare-like effect
What increases the risk (5) of nephrotoxicity from aminoglycosides?
Renal Insufficiency
Concurrent loop diuretics
High doses
Dosing for >5 days
Elderly
What is the MOA of Fluroquinolones?
Inhibition of gyrase –> inhibition of transcription and replication
What is the coverage of Fluroquinolones?
Gram-
What are 2 examples of Fluroquinolones?
Ciprofloxacin (Cipro)
Levofloxacin (Levaquin)
What are 3 adverse reactions to fluroqinolones?
N/V/D
Prolonged QT
Cartilage damage/Tendon rupture
What increases the risk of cartilage damage/tendon rupture from fluroquinolones?
Renal insufficiency
Concurrent steroid use
Elderly
What is the MOA of Metronidazole (Flagyl)?
Toxic byproducts result in unstable DNA molecules
What are the targets of Metronidazole (Flagyl)?
Anerobic bacteria
Protazoa
What is the indication for Metronidazole (Flagyl)?
Abdominal infection
C-diff
Vaginitis
What are adverse reactions to Metronidazole (Flagyl)?
Disulfiram Effect w/ ETOH
Peripheral Neuropathy (Prolonged use)
Nausea
What are the weight ranges and doses for Cefazolin (Ancef) administration?
<80kg = 1g
80-120kg = 2g
>120kg = 3g
