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PHM 604 > ID and CDiff > Flashcards

ID and CDiff Flashcards

1
Q

What is the main cause of death due to infectious Diseases?

A

Dehydration

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2
Q

Who are those at risk for infectious diseases?

A

Ages <5 and >74
Immunocompromises
Travelers/Military
Chronic Care Institutions

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3
Q

What is the leading global cause of Infectious Diseases? Viral or Bacterial?

A

Viral

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4
Q

Viral ID Pathogens

A

Rotavirus/Adenovirus (6 mos-2 yrs)
Noravirus (all ages)

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5
Q

Bacterial ID Pathogens

A

Shigella
Salmonella
E. Coli
S. aureus
C. diff

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6
Q

Parasitic ID Pathogens

A

Entamoeba
Giarda
Crypto
Round/Tapeworm

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7
Q

Traveller’s Diarrhea Onset

A

5 - 15 days

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8
Q

Traveller’s Diarrhea Therapy

A

Loperamide 2 mg PRN X 2 days

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9
Q

Would you give ABx in Traveller’s Diarrhea?

A

Only in High risk

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10
Q

What ABx’s to give in high risk Traveller’s Diarrhea?

A

TMP/SMX
Ciprofloxacin
Norfloxacin

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11
Q

Which one is more important water loss of ABx? (ie most effect)

A

Water loss

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12
Q

Symptoms of Mild Water Loss

A

<5% BW lost
Increased thirst
Slightly dry mucous membrane
Slightly decreased urine output

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13
Q

Symptoms of Moderate Water Loss

A

6 - 9% BW lost
Lethargic
Low BP; High HR
Dark urine
Dry mucous membrane

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14
Q

Symptoms of Severe Water Loss

A

> 10% BW lost
Loss of Consciousness
Cyanotic
Bradycardic

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15
Q

Treatment for Water Loss

A

Supportive Care: Rehydration and Elytes
Mild-Mod: ORT
Sever: IV Fluids

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16
Q

What is the most common microbial that causes healthcare associated infections?

A

CDiff

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17
Q

Pathogenesis of CDiff Infection

A

Fecal-oral route spores - large intestine - mature - toxin production

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18
Q

Biggest factor in CDiff Infection?

A

Antibiotic exposure

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19
Q

Patient Specific Risk factors

A

Immunocompromised
Age >65
Tube feeding
GI surgery

20
Q

Facility Related Risk Factors

A

Length of stay
ICU admission
Exposure

21
Q

Medication Related Risk factor

A

Acid-Suppressing Agents
Chemo
Antibiotics

22
Q

Antibiotics that are a risk factor in CDiff

A

Clindamycin
Fluoroquinolones
Cephalosporins (3rd/4th gen)
Carbapenems

Erythromycin
Ampicillin
Tetracycline

Aminoglycosides
Vancomycin
Metronidazole

23
Q

Non-Severe CDiff Presentation

A

Leukocytosis WBC <15K and SCr <1.5

24
Q

Severe CDiff Presentation

A

Lekocytosis WBC >15K or SCe >1.5

25
Fulminant CDiff Presentation
Hypotension ileus Megacolon
26
Manifestation of CDI
ABx associated diarrhea without colitis ABx associated colitis without Pseudomonas Pseudomonas colitis
27
ABx associated diarrhea without colitis
~6 loose stools/day
28
AB associated colitis without pseudomembranes
10+ loose stools a day
29
Pseudomonas colitis
>10 loose stools a day; elyte imbalance
30
What is pseudomembranous colitits?
irregular yellow plaques of necrosis indicative/caused by CDiff Infection
31
How to diagnose CDiff?
>3 unformed stools in 24 hours + CDiff +ve stool test OR >3 unformed stools in 24 hours + pseudomembranous colitis
32
Gold standard test for CDiff toxin strain?
EIA detection of GDH + cell cytotoxicity assay
33
True or False. You shoud test formed stool.
False
34
What medications should you not use with a CDiff infection?
Loperamide Narcotics
35
General management of CDiff
No anti-peristaltics Supportive care: water and elyte balance Stop any AB use
36
IDSA Treatment Guidelines for Non-Severe Infection
Vancomycin 125 mg PO QID x10days Fidaxomicin 200 mg PO BID x10 days Metronidazole 500 mg PO tID x10 days
37
IDSA Treatment Guidelines for Severe Infection
Vancomycin 125 mg QID x10 days Fidaxomicin 200 mg BID x10 days
38
IDSA Treatment Guidelines for Severe, Complicated Infection
Vancomycin 500 mg PO/NG QID + Metronidaole 500 mg IV Q8H (if ileus present)
39
True or False. Vancomycin and Fidaxomicin have similar efficacy
True
40
How do you approach CDiff infection that keeps recurring?
A tapered approach and a pulsed approach
41
What medications have shown high efficacy in recurrent infections?
Actoxumab Bezlotoxumab
42
When does a fecal transplant become feasible?
Severe recurrent CDI multiple recurrences who failed ABx regimen
43
Who can be a donor for a fecal transplant?
Intimate partner Housemate Family member
44
How is the fecal transplant done?
It is done within 24 hours of donation in the distal lower GI tract
45
How to prevent CDiff Infection?
Soap and hot water (Not sanitizer)

PHM 604 (11 decks)

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