ICU Infections Flashcards
Should women be screened for UTI post foley removal?
Yes, check urinalysis 48 hrs post removal and if positive, treat for 7d or 5d levo or 3d if mild
How to prevent Foley cath infxn ?
Closed drainage system Keep urine bag below level of bladder Preconnected Anti microbial coated if available (no data) Avoid in dwelling foley Remove cath when possible
do NOT replace regularly and do NOT irrigate bladder with abx
Pyuria + asymptomatic bacteriuria,
No treatment
When to treat asymptomatic bacteriuria?
Prior to TURP or any urology procedure with mucosal bleeding
Or in pregnant female
Malignant hyperthermia
Somnolent Lead pipe rigidity High fever Mixed met/resp acidosis Classic trigger: halothane type anesthesia
Tx: benzos, dantrolene
Neuroleptic malignant syndrome
Autonomic instability Hyperthermia Agitated, rigid Mental status changes Classic triggers: haldol, dose changes, withdrawal of antiparkinsonian drugs or citalopram
Tx: benzos, dantrolene, dopamine agonists (bromocroptine)
Serotonin syndrome
Agitated and hyper reflexive
Nausea, vomiting, diarrhea
Classic triggers: ssri, antiemetics, linezolid, TCAs (amitryptilline)
Tx: benzos , cyproheptadine
Rapid resolution after withdrawal of offending drug
Most common HCA infxn worldwide?
Foley catheter infections
Central line associated blood stream infection (CLABSI)
Only cx line tips if infxn suspected
Catheter is the source if >15 cfu from 5cm segment of tip
Or >100 cfu from broth culture
Cath associated UTI
> 10 *3 cfu
CoNS CLABSI?
Can either salvage line with IV abx and abx lock x 10-14 d
Remove line and tx with IV abx x 7d
CLABSI tx?
Empiric double gram negative coverage for neutropenia, severe sepsis - de escalate once sensis available
If pt on tpn, prolongued abx, heme malignancy, sot, bmt, include fungal coverage
If fungemia/bacteremia persists >72 hrs after catheter removal then tx: 4-6 wks
How to decrease CLABSI
Bathe in 2% chlorhexidine
Abx locks
Abx impregnated cvc
Try to use subclavian lines
Uncomplicated line infxn when you can salvage the line
No hardware No embolic phenomenon No infective endocarditis No fever CoNS Gram negative bacilli Enterococcus Uncomplicated infxn
When CANT you salvage a line?
If pt is in shock Fungal line infections Sepsis IE Septic thrombophlebitis \+ blood cx >72 hrs post tx (staph aureus, pseudomonas, bacillus, atypical mycobacteria, candida, malassezia furfur, micrococcus, propionibacterium
How long to treat staph aureus bacteremia?
14 d if tee negative, no fever after 72 hrs, no positive blood cx >72-96 hrs post abx
If complicated, 28 d
Ventilator associated pna
2+: fever, decr WBC, incr WBC, ms changes in 70+, incr secretions, purulent secretions
To prevent VAP
Oral care with chlorhexidine Prevent aspiration Dvt ppx Elevate head of bed Assess readiness to extubate
UTI tx
At least 10*2 cfu/ml
1st line: nitrofurantoin x 5-7 d or bactrim x 3 d, or fosfomycin 3G po x1
No longer FQ (assoc with MRSA and FQ resistant GNR)
Organisms that don’t grow in routine blood cx?
Borrelia Campylobacter Legionella Leptospira Tropheryma whipplei
Organisms that grow in blood cx but need more time
Bartonella Brucella Francisella Nocardia Mycobacterium
Recurrent uncomplicated cystitis
Enhanced perineal hygiene
Post coital voiding
If > 3/year, 1/2 SS bactrim daily or 1 DS bactrim/nitrofurantoin post coitus
Fever of unknown origin
Fever > 3 weeks
Temp 38.3 or higher
Workup: cbcd, cmp, ldh, bili, u/a, cxr, ESR, ana, RF, Ace, blood cx x 3, cmv IgG, ppd, abd CT, HIV ab
Uncomplicated tx of pyelo?
Prefer FQ - cipro x 5-7 d
Levofloxacin x 5 d
Bactrim x 7-14 d
