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ICM-Staph Flashcards

1
Q

staph

A

G+ cocci
catalase +
beta hemolytic

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2
Q

most virulent staph?

A

staph. aureus

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3
Q

most common cause of contaminated blood cultures

A

coagulase negative staph

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4
Q

who has a higher risk of colonization of staph?

A

insulin-dependent diabetic
HIV
hemodialysis
individuals with skin damage

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5
Q

site of human colonization

A 
tip of nose
skin
vagina
axilla
perineum
oropharynx
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6
Q

risk factors for increased infection from S.A

A

diabetics (injectable insulin, possible impaired leukocyte fxn)
congenital or acquired qualitative or quantitative defects of PMN’s: neutropenia, chronic granulomatous, job’s or Chediak-higashi syndrome
skin abnormalities
prosthetic devices

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7
Q

staph A. pathogenesis

A

abscesses at primary or distant sites

inflammatory response-> initial intense infiltrate of PMN’s-> macrophage and fibroblast infiltration

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8
Q

3 toxins with staph A

A

cytotoxins
pyrogenic toxin super antigen mediate-> food poisoning
S TSS
exfoliative toxins

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9
Q

criteria for staph TSS

A

fever
hypotension
rash: macular erythroma
desquamation: 1-2 week after onset of illness, primarily of palms and soles
multisystem involvement: GI, renal, mucosal membrane, hepatic

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10
Q

clinical manifestations from staph

A
  • skin and soft tissue: impetigo, folliculitis, furuncles, cellulitis, pyomyositis (infection of skeletal muscle)
  • bacteremia
  • cardiovascular infection
  • spleen
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11
Q

most common clinical manifestations from staph

A

skin and soft tissue infections, including wounds
bacteremia
septic arthritis and osteomyelitis
prosthetic joint and device infections

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12
Q

less common clinical manifestations from staph

A

respiratory

urinary, mostly related to indwelling catheter

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13
Q

rare clinical manifestations from staph

A

CNS

GI

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14
Q

impetigo

A

superficial dermal infection of staph

-mostly in children ages 2-5 years old

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15
Q

folliculitis

A

superficial infection of hair follicles

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16
Q

carbuncles

A

infections orginiating from hair follicles and extending into epidermis

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17
Q

furbuncles

A

coalescence of multiple carbuncles and are more likely to lead to septic systems

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18
Q

skin abscesses

A

collection of pus in the dermis and deeper tissue

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19
Q

treatment for simple lesions

A

requires only drainage

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20
Q

treatment of more extensive lesions

A

may have better outcomes if antibiotics are administered

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21
Q

what can people mistake for spider bites?

22
Q

decolonization techniques

A

environmental cleaning of high touch surfaces
nasal decolonization with mupirocin twice daily for 5-10days
diluted bleach
bleach baths twice weekly 3-4 months
antibiotic administered is not routinely recommended, can use if all other efforts fail: rifampin

23
Q

what is staph the leading cause of?

A

community acquired and healthcare acquired (nosocomial) bacteremia

24
Q

risk factors for bacteremia

A

intravascular catheters
MRSA colonizations
implanted prosthetic devices
injection drug use

25
metastatic complications of septicemia: distant foci of staph
setting of bacteremia is more common in community acquired MRSA than with nosocomial acquizition
26
metastatic complications
more commonly when theres no identifiable source of staph infection present
27
prolonged bacteremia
increases likelihood of distant foci of infection
28
symptoms of metastatic infection
- bone or joint pain: vertebral osteomyelitis, discitis, epidural abscess - protracted fever or sweats (endocarditis) - abdominal pain: LUQ-> splenic infarction/abscess - CVA tenderness: renal infarction, psoas abscess - headache: septic emboli
29
on physical exam, what is important to check for?
heart murmurs or evidence of heart failure, stigmata of endocarditis, neurological exam
30
diagnostic evaluation to be done
blood cultures echocardiography (TTE+/-TEE) other images based off symptoms
31
how to treat staph A. bacteremia in adults
1. control source of infection 2. empiric antibiotics 3. tailored therapy 4. follow up blood culture: 48-72 hours after initiating therapy 5. duration of therapy: uncomplicated infection, absence of cardiac abnormalities-> 14 days IV therapy
32
MSSA treatment
PCN, nafcillin/oxacillin, cefazolin
33
how many blood cultures should be taken?
2 sets (peripheral)
34
what are some steps to prevent central line associated bloodstream infections?
1. hand hygiene and aseptic techniques during line insertion 2. peripheral catheters and tunneled catheters 3. subclavian placement of central lines: safer than internal jugular and femoral lines 4. daily chlorhexidine bathing in ICU 5. occlusive dressing, changed frequently
35
definition of sepsis:
clinical syndrome complications severe infection, signs occur in tissues remote from site of infection
36
SIRS
systemic inflammatory response syndrome | -clinical syndrome complicating a noninfectious insult (pancreatitis, pulmonary contusion)
37
Diagnostic criteria for SIRS
``` fever HR > 90 RR > 20 breaths/min PaCO2 < 32 WBC >12k or < 90mmHg ```
38
septic shock
sepsis induced hypotension persisting despite adequate fluid resuscitation (vasodilatory shock)
39
risk factors for sepsis
``` ICU patient with nosocomial infection bacteremia age >65 yrs old IC's diabetic cancer community acquired pneumonia genetic factors contributing to susceptibility to infection ```
40
top 3 pathogens to cause sepsis
1. G+ bacteria 2. G- bacteria 3. fungal pathogens
41
what are some clinical evaluations to do for septic patients?
determine source of infection asses respiratory status asses perfusion asses end-organ effects
42
early management of sepsis
control airway establish venous access maintain perfusion
43
control of septic focus
early antibiotics | possible debridement/surgical intervention
44
sepsis consists of
2 SIRS + confirmed or suspected infection
45
severe sepsis consist of
sepsis + signs of end organ damage + hypotension + lactate
46
septic shock consist of
severe sepsis with persistence + hypotension + signs of end organ damage + lactate
47
MRSA
methicillin resistance medicated by PBP-2a | -mecA gene located on mobile genetic element
48
HA-MRSA
healthcare associated MRSA - occurring 48 hours after hospitalization, or within 12 months of exposure to healthcare - severe, invasive disease
49
leading cause of surgical site infections
HA-MRSA
50
CA-MRSA
community associated MRSA-> infection absence of healthcare exposure -skin and soft tissue infection in healthy young adults, community outbreaks
51
some risk factors for MRSA
``` recent hospitalization residence in long term care facility HIV infection antibiotic therapy hemodialysis military service ```

ICM lectures (9 decks)

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