HAI & Antibiotics (Mordecai) Exam II Flashcards by Kimberly Diane Hill

What is a nosocomial infection?

a) An infection that occurs after hospital discharge
b) An infection that is acquired in the hospital
c) An infection present at the time of hospital admission
d) An infection caused by patient’s prior medical history

b) An infection that is acquired in the hospital.

Select 2

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True or Flase

A nosocomial infection is when a patient has been admitted to a hospital and a infection is present or incubating at admission.

False

A nosocomial infection is when a patient has been admitted to a hospital and a infection is NOT present or incubating at admission.

Select 2

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According to the CDC, how many hospitalized patients are affected by nosocomial infections?

a) 1 in 10
b) 1 in 31
c) 1 in 100
d) 1 in 50

b) 1 in 31

Select 3

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Which source of hospital-acquired infections is commonly associated with ICU patients?

a) Clostridium difficile infections
b) Surgical site infections
c) Central line-associated sepsis
d) Urinary catheter-associated UTI

c) Central line-associated sepsis

M - central line associated sepsis is a big one…we see a lot of our ICU patients where bacteria colonizes on the lines…on top of that, these patients are immunocompromised and fighting off other illnesses and traumas in their bodies, so they’re associated with a higher rate of infection

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What percentage of hospital-acquired infections is due to urinary catheter-associated UTIs?

a) 12.9%
b) 21.8%
c) 10.5%
d) 15.3%

a) 12.9%

M - not everyone that you put to sleep is going to get a Foley catheter…if the procedure is under two hours, generally, we just have them void before we take them back to surgery and avoid that Foley catheter **altogether.

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Which of the following infections is associated with ventilated ICU patients?

a) Surgical site infections
b) Ventilator-associated pneumonia
c) Urinary catheter-associated UTI
d) Clostridium difficile infections

b) Ventilator-associated pneumonia (VAP)

M- with the ICU long -term ventilated patients, we do a lot of sedation vacations, a lot of things to promote endogenous respiratory effort…the practice has moved more towards the use of dexaminetomidine over propofol to kind of keep that respiratory drive as much as possible and get the patients back and not ventilator dependent.

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Surgical site infections account for approximately what percentage of hospital-acquired infections?

a) 12.9%
b) 22.5%
c) 21.8%
d) 15.4%

c) 21.8%

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Clostridium difficile infections account for what percentage of hospital-acquired infections?

a) 12.1%
b) 21.8%
c) 15.6%
d) 10.2%

a) 12.1%

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What two sources account for approximately 21.8% of hospital-acquired infections? Select 2

a) Surgical site infections
b) Ventilator-associated pneumonia
c) Urinary catheter-associated UTI
d) Clostridium difficile infections
e) Hospital-aquired pneumonia

a) Surgical site infections
e) Hospital-aquired pneumonia

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Which of the following is a major risk factor for hospital-acquired infections?

a) Short hospital stay
b) Infection control practices
c) Younger age
d) Med Surg unit stays

b) Infection control practices

M - Infection control practices, so whether or not PPE is appropriately being utilized… properly donning and dispose of it without contaminating anything

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Which of the following patient populations are at increased risk of contracting a hospital-acquired infection? Select 3

a) Elderly patients
b) Multiple chronic illness patients
c) Young, healthy adults
d) Non-invasive airway support
e) Patients in critical care units
f) Strong immune systems

a) Elderly patients,
b) Patients with multiple chronic illnesses,
e) Patients staying in critical care units

Slide 5

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Which of the following factors can increase the risk of hospital-acquired infections (HAIs) in patients?
(Select 4)

a) Compromised immune system
b) Less prevalent the pathogens
c) Longer hospital stays
d) More prevalent the pathogens
e) Mechanical ventilatory support

a) Compromised immune system
c) Longer hospital stays
d) More prevalent pathogens in the community
e) Mechanical ventilatory support

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Direct contact with ____________ is a common method of transmission of hospital-acquired infections.

a) Contaminated food
b) Healthcare workers
c) Curtains
d) IV poles

b) Direct contact with healthcare workers

M - *at the nurses station.. if there’s contamination, it can just keep on getting passed on and on. It’s kind of hard to stop that cycle. *

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Which of the following areas are particularly prone to contamination in patients with invasive lines?

a) Feet
b) Inguinal
c) Axilla
c) Knees
d) Neck
e) Perineal
f) Scalp

b) Inguinal
c) Axilla
e) Perineal

M - a lot of the body areas where invasive lines are located, lack airflow and or hard to keep clean, the bacteria can start to proliferate. Maintaining clean dressings and keeping the patients bathed and can cut down on that bacterial growth.

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True or False

Gloves alone don’t prevent contamination

TRUE

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What type of bacteria is commonly associated with extraluminal migration along catheters and invasive lines?

a) Escherichia coli
b) Coagulase-negative staphylococci
c) Streptococcus pneumoniae
d) Bacillus anthracis
e) Methicillin-resistant Staphylococcus aureus

b) Coagulase-negative staphylococci (skin flora)

M - *where bacteria travels along the lines and the catheters. *

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Which of the following symptoms are suggestive of a pre-existing infection?
(Select 5)

a) Chills
b) Dysuria
c) Hypertension
d) Night sweats
e) Altered mental status
f) Productive cough
g) High blood pressure

a) Chills
b) Dysuria
d) Night sweats
e) Altered mental status
f) Productive cough

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Which symptoms could indicate a respiratory infection or pulmonary issue?
(Select 4)

a) Costovertebral tenderness
b) Shortness of breath
c) Clear sputum
d) Night sweats
e) Dysuria
f) Oliguria
g) Suprapubic pain

a) Costovertebral tenderness (CVA) - CVA tenderness can be a sign of: Kidney infections, Inflammation of the tissues around the kidney

b) Shortness of breath
d) Night sweats
g) Suprapubic pain

Slide 7

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True or False

Symptoms suggestive of pre-existing infection could be a runny nose and chills

True

Slide 7

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Which of the following vital signs may indicate infection?
(Select 4)

a) Hypotension
b) Tachycardia
c) High oxygen saturations
d) Tachypnea
e) Normal blood pressure
f) Low oxygen saturations
g) Bradycardia

a) Hypotension
b) Tachycardia
d) Tachypnea
f) Low oxygen saturations

Slide 8

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Which of the following external devices might require evaluation or replacement upon a patient’s admission to the hospital?
(Select 4)

a) Central line
b) Bulb suction drains
c) Foley catheter
d) Insulin pump
e) Chest tube
f) Endotracheal tube
g) Tracheostomy tube

a) Central line
c) Foley catheter
d) Insulin pump
f) Endotracheal tube

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When a patient presents with an already placed IV, it is important to evaluate when and where the line was placed to determine if __________ is necessary.

a) Replacement
b) Removal
c) Tapering
d) Addition of new lines

a) Replacement

M - look at how are they placed, where were they placed, how long have they been placed, and oftentimes, we go ahead and have these lines replaced on admission to ensure sterility in our patients.

Slide 8

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Which of the following laboratory values might indicate organ dysfunction or infection?
(Select 5)

a) Lactic acid
b) Decreased white blood cell count
c) Prothrombin time
d) BUN
e) Creatinine levels
f) Elevated blood pressure
g) Increased white blood cellc count

a) Elevated lactic acid
c) Elevated prothrombin time
d) Increased BUN
e) Creatinine levels
g) Increased white blood cellc count

slide 9

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True or False

Evidence of organ dysfunction could be hypo or hyperglycemia

True

Slide 9

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Which of the following is the most precise laboratory test to identify the specific bacteria causing an infection? a) Lactic acid level b) White blood cell count (WBC) c) Blood cultures d) Blood pressure

c) Blood cultures ## Footnote Slide 9

Surgical site infections typically occur within how many days after surgery? a) 7 days b) 14 days c) 30 days d) 60 days

c) 30 days ## Footnote Slide 11

What percentage of nosocomial infections are surgical site infections? a) 10% b) 25% c) 38% d) 50%

c) 38% ## Footnote Slide 11

How much is estimated to be spent yearly due to prolonged recovery and hospitalization from surgical site infections? a) $1-2 billion b) $3.5-8 billion c) $10-12 billion d) $15-20 billion

b) $3.5-8 billion ## Footnote slide 11

Which type of surgical site infection is isolated to just the area of the incision? a) Deep incisional b) Organ/space c) Superficial incisional d) Subcutaneous tissue infection

c) Superficial incisional ## Footnote Slide 12

Which type of infection involves being in the muscles and tissues surrounding the incision? a) Organ/space infection b) Deep incisional infection c) Superficial incisional infection d) Muscle abscess

b) Deep incisional infection M - *This is when we start to see like pus and elevated white blood cell counts and things that are more indicative of a more serious infection* ## Footnote Slide 12

An infection that involves any area other than skin and muscle and spaces between organs is referred to as __________. a) Superficial incisional b) Deep incisional c) Organ/space d) Muscle-related

c) Organ/space ## Footnote Slide 12

Signs of Surgical Site Infection (SSI) include redness, pain, ______, and ______. A) Fever, drainage of pus B) Warmth, itching C) Fever, numbness D) Coolness, bruising

A) Fever, drainage of pus ## Footnote Slide 13

Delayed healing in a surgical wound, along with ______ and ______, may be signs of Surgical Site Infection (SSI). A) Swelling, warmth B) Redness, bruising C) Coldness, itching D) Discoloration, tingling

A) Swelling, warmth ## Footnote Slide 13

Which of the following is a potential sign of a Surgical Site Infection (SSI)? A) Increased blood flow B) Delayed healing C) Bruising D) Numbness

B) Delayed healing ## Footnote Slide 13

## Footnote Slide 14

Which of the following bacteria are most commonly associated with Surgical Site Infections (SSI)? Select 3 A) Escherichia coli, B) Staphylococcus C) Clostridium D) Pseudomonas E) Listeria F) Bacillus G) Streptococcus

B) Staphylococcus D) Pseudomonas G) Streptococcus ## Footnote Slide 14

Which type of wound is not inflamed or contaminated; does not involve internal organs and least likely to result in a Surgical Site Infection (SSI)? A) Dirty wound B) Contaminated wound C) Clean wound D) Clean-contaminated wound

C) Clean wound ## Footnote Slide 15

A ______ wound involves an internal organ without evidence of infection, while a ______ wound involves an internal organ and has spillage of contents from the organ. A) Clean-contaminated, dirty B) Clean-contaminated, contaminated C) Dirty, clean D) Clean, clean-contaminated

B) Clean-contaminated, contaminated ## Footnote Slide 15

What type of wound is described as having a known infection at the time of surgery? A) Clean-contaminated B) Contaminated C) Dirty D) Clean

C) Dirty ## Footnote Slide 15

Surgeries lasting longer than ______ hours are more likely to result in infection. A) 1 B) 4 C) 2 D) 3

C) 2 ## Footnote slide 15

Patients with comorbidities such as ______ and ______ are at higher risk of developing a Surgical Site Infection (SSI). A) Smoking, diabetes B) Overweight, youth C) Elderly, exercise D) Clean wound, obesity

A) Smoking, diabetes ## Footnote Slide 15

Which of the following comorbidities increase the risk of Surgical Site Infection (SSI)? (Select 2) A) Immunocompromised B) Cancer C) Smoking D) Asthma E) Overweight

A) Immunocompromised B) Cancer ## Footnote Slide 15

Which of the following factors are associated with an increased risk of Surgical Site Infection (SSI)? (Select 2) A) 30 min procedure B) Emergency surgery C) Elderly patient D) Plastic Surgery

B) Emergency surgery C) Elderly patient ## Footnote Slide 15

What percentage of Surgical Site Infections (SSIs) may be preventable? A) 10% B) 25% C) 50% D) 75%

C) 50% ## Footnote Slide 16

The GRADE approach used in the 2017 guidelines for SSI prevention evaluated the following aspects: (Select 3) A) Recommendations B) Development C) Literature review D) Diagnostic tests E) Hypothesis F) Evaluation

A) Recommendations B) Development F) Evaluation *170 studies appraised and synthesized* *Systematic Review of the literature from 1998-2014* ## Footnote Slide 17

What does a "1A" grading in the SSI prevention guidelines represent? A) Strong recommendation with low-quality evidence B) Weak recommendation C) Strong recommendation with moderate to high-quality evidence D) Recommendation required by state/federal regulation

C) Strong recommendation with moderate to high-quality evidence M - *most highly recommended anti-infection measures that we can take...something like giving IV antibiotics is a level 1A highly recommended intervention* ## Footnote Slide 18

Which of the following best describes the 1B grading category? A) Strongly recommended based on low-quality evidence B) Required by state or federal regulation C) Strong recommendation with moderate to high-quality evidence D) Weak recommendation based on very low evidence

A) Strongly recommended based on low-quality evidence M - *the level of evidence is a little lower, not as great, may have some bias, but still oftentimes used because it doesn't seem to be harmful, just not as highly associated with eliminating infections* ## Footnote Slide 18

Which of the following represents a "1C" grading? A) Strong recommendation required by state/federal regulation B) Weak recommendation C) Strong recommendation with moderate to high-quality evidence D) Strong recommendation with low-quality evidence

A) Strong recommendation required by state/federal regulation ## Footnote Slide 18

A "II" grade recommendation for SSI prevention is characterized by: A) Strongly recommended by federal regulations B) Weak recommendation with limited evidence C) Strong recommendation based on low-quality evidence D) Required by federal law regardless of evidence

B) Weak recommendation with limited evidence M - *there's no strong evidence, but we still see type II interventions occurring in practice just because surgeons will sometimes do everything in their power to prevent infection, even if the interventions aren't necessarily known to be all that helpful.* ## Footnote Slide 18

Which of the following studies were **excluded** from the SSI prevention guidelines? (Select 3) A) Studies involving only orthopedic procedures B) Studies involving only dental procedures C) Studies involving dirty procedures D) Studies involving primary closure procedures E) Studies where SSIs were not reported as outcomes

B) Studies involving only dental procedures C) Studies involving dirty procedures F) Studies where SSIs were not reported as outcomes M - *they excluded studies that didn't have surgical site infections as a reported outcome. And they did not include patients that had dirty procedures...if the patients were dirty to begin with, came in with pre -infected wounds, then those were eliminated from their studies* *Dental or oral health procedures are not considered sterile, and so they would skew the results. * ## Footnote Slide 19

Which of the following exclusion criteria were applied in the development of the SSI prevention guidelines? (Select 2) A) Use of wound protectors post-incision B) Procedures with no primary closure C) Clean procedures with primary closure D) Studies reporting SSI outcomes

A) Use of wound protectors post-incision B) Procedures with **no** primary closure M - *So if the wound was left open, it's obviously going to be more likely to be infected, a more vulnerable situation...and with wound vacs* ## Footnote Slide 19

When should parenteral antibiotics be administered before surgery? A) Only when indicated B) Always, regardless of the procedure C) After the incision has been made D) Only in emergency cases

A) Only when indicated ***(SCIP Protocol)*** ## Footnote Slide 20

What grade of recommendation is given to the practice of administering parenteral antibiotics before surgery? A) 1A B) 2C C) 1B D) II

C) 1B *Strongly recommended based on low-quality evidence* ## Footnote Slide 20

The timing of administering parenteral antibiotics should ensure the agent is established in the tissue: A) Immediately after surgery B) Before anesthesia C) Upon incision D) During post-op recovery

C) Upon incision M - *generally within 30 minutes of incision.* ## Footnote Slide 20

Which of the following is NOT recommended for use in surgical incisions? A) Saline irrigation with antibiotics B) Antibiotic ointments C) Dry dressings D) Sterile closure techniques

B) Antibiotic ointments (1B) ***Dry incisions are better.*** ## Footnote Slide 21

# True or False There are strict recommendations and guidlines for antibiotic irrigation and soaking prosthetic devices in antibiotic solution to help prevent infection.

FALSE M - *there's no recommendations for soaking prosthetic devices in antibiotic solution. No known benefit based on the research, but also probably not harmful. We do still see that.* ## Footnote Slide 21

What is the grade of evidence for perioperative glycemic control? A) 1A B) 2B C) 1B D) 2A

A) 1A *strongly recommended; moderate-to high quality of evidence* M - *it's becoming common practice to check everybody's blood sugar within 30 minutes after putting them to sleep and making sure that they're in that target range...and if not, then you do your interventions and you continue to check it every 30 minutes* ## Footnote Slide 22

What is the recommended perioperative glucose target for blood sugar control? A) Less than 100 mg/dL B) Less than 150 mg/dL C) Less than 200 mg/dL D) Less than 250 mg/dL

C) Less than 200 mg/dL (1A) ## Footnote Slide 22

Which of the following is true regarding tighter glycemic control during surgery? A) Recommended for all diabetic patients B) Targeting glucose levels below 70 mg/dL is necessary C) Tighter control leads to better surgical outcomes D) No recommendation for tighter control exists

D) No recommendation for tighter control exists M - *research shows it helps prevent a surgical site infection. * ## Footnote Slide 22

There is no recommendation for targeting which of the following in perioperative glycemic control? A) Blood pressure B) Insulin sensitivity C) A1C levels D) Electrolyte balance

C) A1C levels ## Footnote Slide 22

What is the grade of recommendation for maintaining perioperative normothermia? A) 1B B) 2C C) 1A D) 2A

C) 1A *maintaining perioperative normothermia helps reduce and cut down on our surgical site infections* ## Footnote Slide 23

Which of the following statements is true regarding strategies for maintaining perioperative normothermia? A) Specific strategies are required B) There is no recommendation for specific strategies C) Only warming blankets are recommended D) Fluid warming is mandatory

B) There is no recommendation for specific strategies ## Footnote Slide 23

For which patient population was the increase in FiO2 found to have potential benefits in reducing surgical site infections? Select 2 A) Patients with neuroaxial anesthesia B) Patients with normal pulmonary function C) Patients receiving sedation only D) GETA intraoperative and immediately after extubation E) Patients with postoperative oxygen therapy

B) Patients with normal pulmonary function D) GETA intraoperative and immediately after extubation M - *there were some studies that looked at patients with normal pulmonary function who received general anesthesia and then with an increased FiO2 at 80%, it did show some benefit and some reduction in surgical site infections.* ## Footnote Slide 24

What percentage of FiO2 was studied for its potential to reduce surgical site infections? A) 40% B) 60% C) 80% D) 100%

C) 80% ## Footnote Slide 24

What other types of anesthesia have no clear recommendation due to a lack of supporting evidence or trials when increasing FiO2 and decreasing surgical site infections? (Select 3) A) Neuraxial anesthesia B) Patients with normal lung function C) Sedation only D) Only intraoperatively with GETA E) GETA intraoperative and immediately after extubation F) Postoperatively by mask or nasal cannula

A) Neuraxial anesthesia D) Only intraoperatively with GETA F) Postoperatively by mask or nasal cannula M - *there was no recommendations ultimately based on the type of delivery of oxygen and no trials, no studies looked at the percentage of oxygen, the duration of oxygen or the delivery method of oxygen.* ## Footnote Slide 24

What is the recommendation level for showering or bathing with soap or antiseptic the night before surgery? A) 1A B) 2B C) 1B D) 3C

C) 1B ## Footnote Slide 25

Which type of antiseptic solution is recommended for intraoperative skin preparation? A) Alcohol-based antiseptic B) Povidone-iodine solution C) Chlorine-based antiseptic D) Water and soap only

A) Alcohol-based antiseptic M - *this is **level 1A,** so you will always see a circulator prep their patient before surgery, and so that kind of sterilizes the area before the incision is made. * ## Footnote Slide 25

Evidence suggests that iodine irrigation in deep tissues has a recommendation level of______. A) 1A B) 1B C) 1C D) II

D) II ## Footnote Slide 25

Which of the following practices have been shown to have **NO** benefit related to intraoperative iodine irrigation according to current evidence? (Select 4) A) Bathing with soap the night before B) Intraoperative skin preparation C) Intra-peritoneal irrigation with iodine D) Preoperative bathing with antiseptic E) Using iodine-embedded adhesive drapes F) Soaking prosthetic devices in iodine

C) Intra-peritoneal irrigation with iodine E) Using iodine-embedded adhesive drapes F) Soaking prosthetic devices in iodine M - *I still see surgeons do this, but the evidence doesn't show that's really all that necessary...the cons are that it can be wasteful, you also have the potential for allergy to these betadine solutions and stuff on prosthetic devices* ## Footnote Slide 25

In the context of preventing SSIs, it is recommended that necessary blood transfusions should ______ be withheld from surgical patients. A) Always B) Not C) Sometimes D) Only

B) Not ***1B** - Do not withhold necessary blood transfusions as a means to prevent SSI.* ## Footnote Slide 26

What is the primary concern with using systemic corticosteroids in joint arthroplasty surgeries? A) Decreased risk of surgical site infection B) Increased risk of surgical site infection C) Reduced joint mobility D) Prolonged recovery time

B) Increased risk of surgical site infection (SSI) M - *systemic immunosuppressive therapy - it's anti -inflammatory, cuts down on sore throat, helps with PONV.* ## Footnote Slide 27

Infection is the **most common reason** for ______ in total knee arthroplasty (TKA). A) Early mobilization B) Revision surgery C) Postoperative pain D) Delayed recovery

B) Revision surgery ## Footnote Slide 27

The use of **intra-articular corticosteroids** before planned joint arthroplasty has ______ evidence for reducing infection risk. A) Strong B) Unclear C) No D) Definitive

B) Unclear ## Footnote Slide 27

What are goals of proper preoperative prophylaxis measures? Select 2 A) Achieve bactericidal concentration in the tissues at the time of incision B) Give the antibiotic more than an hour before the incision C) Achieve bactericidal concentration in the serum at the time of incision D) Use antibiotic ointments on surgical wounds postoperatively

A) Achieve bactericidal concentration in the **tissues** at the time of incision C) Achieve bactericidal concentration in the **serum** at the time of incision ## Footnote Slide 29

The goal of preoperative antibiotics is to reach a ________________ concentration in serum and tissues. A) Maximum B) Minimum inhibitory C) Moderate D) Target

B) Minimum inhibitory *Based on evidence and Given by anesthesia* ## Footnote Slide 29

# True or False Hospitals will be penalized if the SCIP antibiotics are not given within the expected window...even if you gave them and didn't document it

True Document.. reciepts

Which of the following are general principles of antibiotic prophylaxis for surgery? Select 4 A. Must be active against common surgical wound pathogens B. Shortest possible course is effective, ideally one dose C. Newer antibiotics should be preferred over older ones D. Proven efficacy in clinical trials E. Antibiotics should be avoided unless infection is present F. Must achieve minimum inhibitory concentration (MIC)

A. Must be active against common surgical wound pathogens B. Shortest possible course is effective, ideally one dose D. Proven efficacy in clinical trials F. Must achieve minimum inhibitory concentration (MIC) ## Footnote slide 30

Which statements are true regarding general principles of antibiotic prophylaxis for surgery? Select 2 A. Should only be administered if infection is present B. Newer antibiotics reserved for resistant infections C. Proven inefficacy in clinical trials D. Administered only after incision has been made E. Always administer even without infection risk F. Rely on basic, older and cheaper antibiotics

B. Newer antibiotics reserved for resistant infections C. Should be timed so the agent is established in tissue upon incision (1B recommendation) F. Rely on basic, older and cheaper antibiotics M - *unless the patient has MRSA, VRE.. one of those big superbugs, we're going to try to rely on the more basic, older, cheaper antibiotics * ## Footnote Slide 30

According to guidelines, when should antibiotics be administered prior to surgery? A) Within 30 minutes to 1 hour before the incision. B) 2 hours before incision for all antibiotics. C) After the surgery is completed. D) Administered only after tourniquet release.

A) Within 30 minutes to 1 hour before the incision. ## Footnote Slide 31

Which of the following statements are true regarding antibiotic timing and administration? Select 2 A) May hold antibiotics for cultures B) Vancomycin and fluoroquinolones can be initiated within 2 hours before incision. C) Antibiotics should always be administered after tourniquet use. D) Antibiotics should be completely infused after tourniquet use

A) May hold antibiotics for cultures B) Vancomycin and fluoroquinolones can be initiated within 2 hours before incision. ## Footnote Slide 31

# True or False Antibiotics should be completely infused prior to tourniquet use

True! ## Footnote Slide 31

Antibiotics may need to be redosed after procedures such as __________ due to a decrease in tissue concentrations of the drug. A) Appendectomy B) Cardiopulmonary bypass C) Cholecystectomy D) Laparoscopic hysterectomy

B) Cardiopulmonary bypass ## Footnote Slide 32

Redosing of antibiotics is usually required after __________ or with excessive blood loss during surgery. A) 1 half-life B) 3 half-lives C) 2 half-lives D) 4 half-lives

C) 2 half-lives ## Footnote slide 32

# True or False Antibiotic redosing is drug dependent, usually every 2-4 hours and required for prolonged procedures and when transferred to the PACU

FALSE Antibiotic redosing is drug dependent, usually every 2-4 hours and required for prolonged procedures and **NOT** redosed in the PACU M - *The PACU is not responsible for keeping that four hours going. That's only an intraoperative thing. So sometimes you'll end your surgery and you might just go ahead and give that extra dose, but it's not required to give the dose after they're out of the operating room.* ## Footnote Slide 32

# KRISTA START :D Which of the following drugs are β-lactam based? (Select all that apply) A) Penicillins B) Cephalosporins C) Carbapenems D) Macrolides

A) Penicillins B) Cephalosporins C) Carbapenems ## Footnote Slide 33

Which of the following are major common surgical antibiotics? (Select all that apply) A) β-Lactams B) Vancomycin C) Aminoglycosides (Gentamycin) D) Fluoroquinolones (Cipro) E) Macrolides F) Metronidazole (Flagyl)

A) β-Lactams B) Vancomycin C) Aminoglycosides (Gentamycin) D) Fluoroquinolones (Cipro) F) Metronidazole (Flagyl) ## Footnote Slide 33

How do Penicillin β-lactam antibiotics work? A) Inhibition of bacterial protein synthesis B) Disruption of bacterial DNA replication C) Inhibition of bacterial cell wall synthesis D) Enhancement of bacterial cell wall synthesis

C) Inhibition of bacterial cell wall synthesis ## Footnote Slide 34

The β-lactamase enzyme is located on the outer surface of the bacterial cytoplasmic membrane and contributes to resistance against Penicillin β-lactam.

True ## Footnote Slide 34

Penicillin β-lactams are the drug of choice for which of the following pathogens? (Select all that apply) A) Streptococci B) Staphylococci C) Meningococci D) Pneumococci E) Mycobacteria

A) Streptococci C) Meningococci D) Pneumococci Gram + Bacterium (Cocci) ## Footnote Slide 34

β-Lactams are effective for treating healthcare-associated infections such as ___, ___, and ___. A) Skin B) Fungal C) Catheter-related D) Tuberculosis E) Upper respiratory

A) Skin C) Catheter-related E) Upper respiratory ## Footnote Slide 34

Which of the following are examples of penicillin-based antibiotics? (Select all that apply) A) Penicillin G B) Methicillin C) Nafcillin D) Amoxicillin E) Ciprofloxacin

A) Penicillin G B) Methicillin C) Nafcillin D) Amoxicillin ## Footnote Slide 34

Which of the following are common adverse reactions to penicillin β-lactams? (Select all that apply) A) Hypersensitivity B) GI upset C) Hyperglycemia D) Vaginal Candidiasis E) Hepatitis

A) Hypersensitivity *History of reaction unreliable* *Skin rashes to anaphylaxis* B) GI upset D) Vaginal Candidiasis ## Footnote Slide 35

__ β-lactams are more stable against β-lactamase. A) Penicillins B) Cephalosporins C) Carbapenems D) Monobactams

B) Cephalosporins *Broader spectrum. Beta-lactam rings bind to Penicillin-binding protein and inhibit the normal activity of the protein. Resistance occurs by protein altering its structure* ## Footnote Slide 36

Cephalosporin β-lactam antibiotics are the drug of choice for what? (Select all that apply) A) Surgical prophylaxis B) Treatment of viral infections C) Patients allergic to penicillin D) Fungal infection treatment

A) Surgical prophylaxis C) Patients allergic to penicillin (except true anaphylaxis) ## Footnote Slide 36

Match each cephalosporin to its appropriate generation:

1. Cefazolin – A. First Generation 2. Ceftriaxone – C. Third Generation 3. Cefepime – D. Fourth Generation 4. Cefuroxime – B. Second Generation 5. Cefotaxime – C. Third Generation 6. Cefoxitin – B. Second Generation 7. Ceftazidime – C. Third Generation 8. Cefotetan – B. Second Generation ## Footnote Slide 37

# Waiting for verificaiton from Mordecai Which of the following cephalosporins do NOT penetrate the blood-brain barrier? (Select all that apply) A) Cefazolin (Ancef) B) Cefuroxime (Ceftin) C) Cefoxitin (Mefoxin) D) Cefotetan (Cefotan) E) Ceftriaxone

A) Cefazolin (Ancef) B) Cefuroxime (Ceftin) C) Cefoxitin (Mefoxin) D) Cefotetan (Cefotan) ## Footnote Slide 37

# Waiting for verificaiton from Mordecai Cefazolin is primarily used to treat which of the following conditions? (Select all that apply) A) Cellulitis B) Abscesses C) Upper respiratory infections D) Urinary tract infections E) Meningitis

A) Cellulitis B) Abscesses C) Upper respiratory infections D) Urinary tract infections | Most gram + (staph and streptococci) ## Footnote Slide 37

# Waiting for verificaiton from Mordecai Cefuroxime is effective in treating which of the following conditions? (Select all that apply) A) H. influenzae pneumonia B) Urinary tract infections C) Meningitis D) Otitis media

A) H. influenzae pneumonia B) Urinary tract infections D) Otitis media | Better gram – coverage ## Footnote Slide 37

# Waiting for verificaiton from Mordecai Which of the following cephalosporins can cross the blood-brain barrier to some extent? (Select all that apply) A) Ceftriaxone B) Cefotaxime C) Cefuroxime D) Ceftazidime

A) Ceftriaxone B) Cefotaxime D) Ceftazidime ## Footnote Slide 37

# Waiting for verificaiton from Mordecai Cefotaxime is most commonly used to treat which of the following conditions? A) Gonorrhea B) Urinary tract infections C) Meningitis D) Otitis media

C) Meningitis ## Footnote Slide 37

# Waiting for verificaiton from Mordecai What drug was noted for treatment of gonorrhea? A) Cefazolin B) Cefepime C) Ceftriaxone D) Cefoxitin

C) Ceftriaxone ## Footnote Slide 37

# Waiting for verificaiton from Mordecai What generation of cephalosporins penetrate the blood brain barrier well? A) Cefazolin B) Cefepime C) Ceftriaxone D) Cefoxitin

B) Cefepime *Most resistant to hydrolysis by β-lactamase*. *Reserved for multi-resistant organisms*. ## Footnote Slide 37

What drugs should be used if true anaphylaxis to Penicillin exists when giving Cephalosporin? A) Ceftriaxone or cefazolin B) Vancomycin or clindamycin C) Erythromycin or ampicillin D) Tetracycline or doxycycline

B) Vancomycin or clindamycin | Cross reaction approx. 1% ## Footnote Slide 38

What are the adverse effects are associated with Cephalosporins? A) Rashes B) Fever C) Nephritis D) Anaphylaxis E) Vitamin K production deficit

All of the above ## Footnote Slide 38

What drugs are a common cause of colitis? A) First-generation cephalosporins B) Second-generation cephalosporins C) Third-generation cephalosporins D) Fourth-generation cephalosporins

C) Third-generation cephalosporins ## Footnote Slide 38

# ** Carbapenem β-lactams have good activity against? A) Gram-negative rods B) Gram-positive cocci C) Fungi D) Enterobacter

A) Gram-negative rods (Pseudomonas Aeruginosa) D) Enterobacter ## Footnote Slide 39

What β-lactam drug class has the broadest spectrum of activity and can inhibit the β-lactamase enzyme? A) Penicillins B) Cephalosporins C) Carbapenems D) Monobactams

C) Carbapenems ## Footnote Slide 39

Carbapenems are considered last-line agents used for treating which of the following infections? A) Skin infections and ear infections B) Intra-abdominal infections, resistant UTIs, and pneumonia C) Viral infections and fungal infections D) Sinusitis and otitis media

B) Intra-abdominal infections, resistant UTIs, and pneumonia ## Footnote Slide 39

Which of the following are examples of carbapenem antibiotics? (Select all that apply) A) Ertapenem (Invanz) B) Meropenem (Merrem) C) Imipenem (Primaxin) D) Cefepime (Maxipime)

A) Ertapenem (Invanz) B) Meropenem (Merrem) C) Imipenem (Primaxin) | Most penetrate BBB to treat Meningitis ## Footnote Slide 39

Which of the following are common adverse reactions to Carbapenems? A) Nausea, vomiting, diarrhea, and rashes B) Hypertension, dry mouth, and constipation C) Hair loss, anemia, and joint pain D) Weight gain, insomnia, and blurred vision

A) Nausea, vomiting, diarrhea, and rashes ## Footnote Slide 40

IM formulations of Carbapenems contain _______. A) Epinephrine B) Lidocaine C) Saline D) Propofol

B) Lidocaine *Consider LA allergies prior to IM administration*. ## Footnote Slide 40

Carbapenems can decrease what medication by up to 90%? A) Phenytoin B) Valproic acid C) Warfarin D) Digoxin

B) Valproic acid *can precipitate seizures* ## Footnote Slide 40

How does vancomycin work to combat bacterial infections? A) Inhibiting protein synthesis B) Inhibiting DNA replication C) Inhibition of cell wall synthesis D) Disrupting bacterial metabolism

C) Inhibition of cell wall synthesis ## Footnote Slide 41

Vancomycin is active against ___ bacteria but is too large to penetrate __ bacteria. A) Gram-negative, Gram-positive B) Gram-positive, Gram-negative C) Aerobic, Anaerobic D) Anaerobic, Aerobic

B) Gram-positive, Gram-negative Vancomycin is active against **gram +** but is too large for **gram -** bacteria | Only works if bacterial is actively dividing; Is very slow ## Footnote Slide 41

Vancomycin is most useful against what infections? A) MRSA bloodstream infections B) MRSA endocarditis C) Viral pneumonia D) E. coli urinary tract infections

A) MRSA bloodstream infections B) MRSA endocarditis ## Footnote Slide 41

What are the most common adverse reactions to vancomycin? (Select all that apply) A) Phlebitis at the injection site B) Chills and fever C) Nephrotoxicity D) "Red man" syndrome

All of the above ## Footnote Slide 42

How do Aminoglycosides work? A) Inhibition of cell wall synthesis B) Inhibition of ribosomal proteins and causing mRNA misreading C) Inhibition of DNA replication D) Disruption of bacterial membrane integrity

B) Inhibition of ribosomal proteins and causing mRNA misreading ## Footnote Slide 43

# True or False Aminoglycosides have a short post-antibiotic effect

FALSE Aminoglycosides have a **significant **post-antibiotic effect ## Footnote Slide 43

Aminoglycosides are __ w/ β lactams or vancomycin. A) Antagonistic B) Synergistic C) Inhibitory D) Neutral

B) Synergistic *Especially useful for enterococcal endocarditis*. ## Footnote Slide 43

Which of the following is an example of an aminoglycoside antibiotic? A) Amoxicillin B) Ceftriaxone C) Gentamicin D) Erythromycin

C) Gentamicin ## Footnote Slide 43

What drug(s) increases the likelihood of nephrotoxicity when paired with aminoglycosides? A) Beta-blockers B) Loop diuretics C) Antihistamines D) NSAIDs

B) Loop diuretics ## Footnote Slide 44

What are the adverse reactions associated with Aminoglycosides?(Select all that apply) A) Ototoxicity B) Nephrotoxicity C) Curare-like effect D) Hepatotoxicity

A) Ototoxicity B) Nephrotoxicity C) Curare-like effect ## Footnote Slide 43

The curare-like effect of Gentamicin (an aminoglycoside) involves which of the following? A) Potentiation of acetylcholine release B) Interference with acetylcholine receptors C) Stimulation of muscle contraction D) Reduction in heart rate and blood pressure

B) Interference with acetylcholine receptors *leading to muscle paralysis* | treatment is Ca++ ## Footnote Slide 44

How do fluoroquinolones exert their antibacterial effect? A) Inhibition of cell wall synthesis B) Inhibition of bacterial DNA synthesis C) Inhibition of protein synthesis D) Disruption of bacterial membrane integrity

B) Inhibition of bacterial DNA synthesis ## Footnote Slide 45

Fluoroquinolones are most effective against which type of bacteria? A) Gram-positive organisms B) Gram-negative organisms C) Fungal infections D) Viral infections

B) Gram-negative organisms - UTI - Bacterial diarrhea - Bone/joint infections ## Footnote Slide 45

What examples are there of fluoroquinolones? (Select all that apply) A) Ciprofloxacin B) Levofloxacin C) Amoxicillin D) Azithromycin

A) Ciprofloxacin (Cipro) B) Levofloxacin (Levaquin) ## Footnote Slide 45

What are the adverse reactions for fluoroquinolones?Select all that apply) A) Nausea, vomiting, and diarrhea (N/V/D) B) QT interval prolongation C) Cartilage damage and tendon rupture D) Hepatotoxicity

A) Nausea, vomiting, and diarrhea (N/V/D) B) QT interval prolongation C) Cartilage damage and tendon rupture ## Footnote Slide 46

What three factors will exacerbate cartilage damage and tendon rupture associated with fluoroquinolones? (Select all that apply) A) Advanced age B) Renal insufficiency C) Concurrent steroid use D) Diabetes

A) Advanced age B) Renal insufficiency C) Concurrent steroid use ## Footnote Slide 46

What type of antibiotic is Metronidazole? A) Antifungal B) Antiprotozoal / Anaerobic antibacterial C) Broad-spectrum antibacterial D) Antiviral

B) Antiprotozoal / Anaerobic antibacterial ## Footnote Slide 47

# True or False Metronidazole inhibits bacterial protein synthesis as its primary mechanism of action.

False Metronidazole forms toxic byproducts that cause unstable DNA molecules ## Footnote Slide 47

What is Metronidazole (Flagyl) indicated for?(Select all that apply) A) Intra-abdominal infections B) Vaginitis C) C-diff infections D) Fungal infections

A) Intra-abdominal infections B) Vaginitis C) C-diff infections ## Footnote Slide 47

What are the adverse reactions associated with metronidazole? A) Nausea, peripheral neuropathy, and disulfiram-like effect B) Hypertension, dizziness, and visual disturbances C) Increased heart rate and hyperkalemia D) Dry mouth, dizziness, and photosensitivity

A) Nausea, Peripheral neuropathy (In prolonged use), and Disulfiram-like effect- ## Footnote Slide 48

Which substance should be avoided while taking Metronidazole (Flagyl)? A) Dairy products B) Caffeine C) Alcohol D) NSAIDs

C) Alcohol (EtOH) Disulfiram effect induces hangover-like s/s ## Footnote Slide 48

What is (essentially) the first line antibiotic for essentially all surgical prophylaxis? A) Ciprofloxacin B) Vancomycin C) Cefazolin D) Metronidazole

C) Cefazolin

What is the most common alternative to cefazolin for surgical prophylaxis? A) Clindamycin B) Gentamicin C) Azithromycin D) Ceftriaxone

A) Clindamycin (or vancomycin) ## Footnote Slide 50

Which of the following Cefazolin doses are correct for the corresponding weight ranges? (Select all that apply) A) 1g for adults weighing < 80 kg B) 2g for adults weighing ≥ 120 kg C) 2g for adults weighing 81-119 kg D) 1g for adults weighing 81-119 kg E) 3g for adults weighing ≥ 120 kg F) 3g for adults weighing 100-119 kg

A) 1g for adults weighing < 80 kg C) 2g for adults weighing 81-119 kg E) 3g for adults weighing ≥ 120 kg ## Footnote Slide 50

What is the recommended administration time for Cefazolin (Ancef) during surgical prophylaxis? A) 60 minutes B) 15-20 minutes C) 3-5 minutes D) 30 minutes

C) 3-5 minutes ## Footnote Slide 50

Which of the following antibiotics are administered over 30 minutes? (Select all that apply) A) Ampicillin B) Aztreonam (Azactam) C) Cefotaxime (Claforan) D) Ciprofloxacin (Cipro) E) Clindamycin (Cleocin) F) Ertapenem (Invanz) G) Gentamicin (Garamycin) H) Levofloxacin (Levaquin) I) Metronidazole (Flagyl) J) Piperacillin with tazobactam (Zosyn)

A) Ampicillin B) Aztreonam (Azactam D) Ciprofloxacin (Cipro) E) Clindamycin (Cleocin) F) Ertapenem (Invanz) G) Gentamicin (Garamycin) H) Levofloxacin (Levaquin) I) Metronidazole (Flagyl) J) Piperacillin with tazobactam (Zosyn) ## Footnote Slide 50

Which of the following antibiotics are administered over 60 minutes? (Select all that apply) A) Ceftriaxone (Rocephin) B) Fluconazole (Diflucan) C) Moxifloxacin (Avelox) D) Trimethoprim-Sulfamethoxazole (Bactrim) E) Vancomycin (Vancocin)

C) Moxifloxacin (Avelox) D) Trimethoprim-Sulfamethoxazole (Bactrim) E) Vancomycin (Vancocin) ## Footnote Slide 50

Fluconazole, when used as an antifungal, should be administered over how many minutes? A) 30 minutes B) 45 minutes C) 60 minutes D) 120 minutes

D) 120 minutes ## Footnote Slide 50

Which of the following antibiotics are redosed every 2 hours in the operating room? (Select all that apply) A) Ampicillin 2g (Principen) B) Cefoxitin 2g (Mefoxin) C) Piperacillin with tazobactam 3.375g (Zosyn) D) Vancomycin 15 mg/kg (Vancocin)

A) Ampicillin 2g (Principen) B) Cefoxitin 2g (Mefoxin) C) Piperacillin with tazobactam 3.375g (Zosyn) ## Footnote Slide 50

Which of the following antibiotics are redosed every 3 hours in the operating room? (Select all that apply) A) Cefotaxime 1g (Claforan) B) Cefotetan 2g (Cefotan) C) Cefoxitin 2g (Mefoxin) D) Vancomycin 15 mg/kg (Vancocin)

A) Cefotaxime 1g (Claforan) ## Footnote Slide 50

Which of the following antibiotics are redosed every 4 hours in the operating room? (Select all that apply) A) Aztreonam 2g (Azactam) B) Cefazolin 1g (Ancef) C) Cefuroxime 1.5g (Zinacef) D) Piperacillin with tazobactam 3.375g (Zosyn)

A) Aztreonam 2g (Azactam) B) Cefazolin 1g (Ancef) C) Cefuroxime 1.5g (Zinacef) ## Footnote Slide 50

Which of the following antibiotics are redosed every 6 hours in the operating room? (Select all that apply) A) Cefotetan 2g (Cefotan) B) Clindamycin 900mg (Cleocin) C) Metronidazole 500mg (Flagyl) D) Vancomycin 15 mg/kg (Vancocin)

A) Cefotetan 2g (Cefotan) B) Clindamycin 900mg (Cleocin) ## Footnote Slide 50

Trimethoprim-Sulfamethoxazole 160 mg/800 mg (Bactrim) is redosed every ________ hours in the OR. A) Every 2 hours B) Every 4 hours C) Every 6 hours D) Every 8 hours

D) Every 8 hours ## Footnote Slide 50