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ICM lectures > ICM-Staph > Flashcards

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?

A

MRSA

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
Q

metastatic complications of septicemia: distant foci of staph

A

setting of bacteremia is more common in community acquired MRSA than with nosocomial acquizition

26
Q

metastatic complications

A

more commonly when theres no identifiable source of staph infection present

27
Q

prolonged bacteremia

A

increases likelihood of distant foci of infection

28
Q

symptoms of metastatic infection

A
  • 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
Q

on physical exam, what is important to check for?

A

heart murmurs or evidence of heart failure, stigmata of endocarditis, neurological exam

30
Q

diagnostic evaluation to be done

A

blood cultures
echocardiography (TTE+/-TEE)
other images based off symptoms

31
Q

how to treat staph A. bacteremia in adults

A
  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
Q

MSSA treatment

A

PCN, nafcillin/oxacillin, cefazolin

33
Q

how many blood cultures should be taken?

A

2 sets (peripheral)

34
Q

what are some steps to prevent central line associated bloodstream infections?

A
  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
Q

definition of sepsis:

A

clinical syndrome complications severe infection, signs occur in tissues remote from site of infection

36
Q

SIRS

A

systemic inflammatory response syndrome

-clinical syndrome complicating a noninfectious insult (pancreatitis, pulmonary contusion)

37
Q

Diagnostic criteria for SIRS

A 
fever
HR > 90
RR > 20 breaths/min
PaCO2 < 32
WBC >12k or < 90mmHg
38
Q

septic shock

A

sepsis induced hypotension persisting despite adequate fluid resuscitation (vasodilatory shock)

39
Q

risk factors for sepsis

A 
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
Q

top 3 pathogens to cause sepsis

A
  1. G+ bacteria
  2. G- bacteria
  3. fungal pathogens
41
Q

what are some clinical evaluations to do for septic patients?

A

determine source of infection
asses respiratory status
asses perfusion
asses end-organ effects

42
Q

early management of sepsis

A

control airway
establish venous access
maintain perfusion

43
Q

control of septic focus

A

early antibiotics

possible debridement/surgical intervention

44
Q

sepsis consists of

A

2 SIRS + confirmed or suspected infection

45
Q

severe sepsis consist of

A

sepsis + signs of end organ damage + hypotension + lactate

46
Q

septic shock consist of

A

severe sepsis with persistence + hypotension + signs of end organ damage + lactate

47
Q

MRSA

A

methicillin resistance medicated by PBP-2a

-mecA gene located on mobile genetic element

48
Q

HA-MRSA

A

healthcare associated MRSA

  • occurring 48 hours after hospitalization, or within 12 months of exposure to healthcare
  • severe, invasive disease
49
Q

leading cause of surgical site infections

A

HA-MRSA

50
Q

CA-MRSA

A

community associated MRSA-> infection absence of healthcare exposure
-skin and soft tissue infection in healthy young adults, community outbreaks

51
Q

some risk factors for MRSA

A 
recent hospitalization
residence in long term care facility
HIV infection
antibiotic therapy
hemodialysis
military service

ICM lectures (9 decks)

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