immunocompromised, nosocomial FUO

Question 1

what viruses are frequent pathogens of HIV assoc FUO (2)

Answer 1

CMV, HSV

Question 2

what bacterial infections are common in HIV assoc FUO (2)

Answer 2

mycobacterial (MAI), pic line inf

Question 3

in what time frame are nosocomial infections likely to occur

Answer 3

48-72 hrs after admission

Question 4

how frequent are nosocomial inf among hospitalized pts

Answer 4

5-10% of those admitted will acquire nosocomial inf

Question 5

“a frequent cause of FUO”

Answer 5

Clostridium difficile colitis (esp if diarrhea minimal or absent)

Question 6

other non-infectious causes of FUO (3)

Answer 6

drug reaction, tissue injury or infarct, thromboembolic

Question 7

“a frequent cause of nosocomial FUO”

Answer 7

C diff - especially when diarrhea is minimal or absent

Question 8

3 noninfectious causes of nosocomial FUO

Answer 8

tissue injury/infarction, drug rxn, thromboembolic dz

Question 9

what may happen to the breathing rate and BP of the infected hospital pt

Answer 9

tachypnea /resp alkalosis, hypotension

Question 10

what may happen to the frequency of urination and WBC in the infected hospital pt

Answer 10

oliguria (scant urine), leukocytosis (increase)

Question 11

what is theclassic pathology of a nosocomial pneumonia

Answer 11

microaspiration of pharyngeal org’s (75% of seriously ill colonized by atypicals)

Question 12

MCC of Noso pneumo

Answer 12

S aureus

Question 13

4 organisms typical of Noso Pneumonia

Answer 13

PA, Enterobacter, K pneumoniae, E coli

Question 14

Under what conditions is an indwelling catheter likely to cause infections (2)

Answer 14

greater than 72 hours, open drainage/interruption of closed drainage

Question 15

MCC of nosocomial UTI

Answer 15

coagulase-neg Staph or S aureus (Candida in immunocompromised)

Question 16

What is found to be ineffective in the case of nosocomial UTI’s

Answer 16

prophylaxis by antibiotics, irrigation acidification

Question 17

first line tx of Candida UTI

Answer 17

discontinue catheter and broad-spec abx

Question 18

second line tx of Candida UTI (which hasn’t proven overly effective)

Answer 18

oral fluconazole (Diflucan) or single dose IV amphotericin B

Question 19

first line tx of nosocomial UTI

Answer 19

vancomycin 15 mg/kg IV BID

Question 20

newer causative org’s of noso UTI

Answer 20

ENTEROCOCCUS FAECIUM (resistant to vanc), [Citrobacter, Acinitobacter, Stentotrophomonas]

Question 21

empiric tx of the seriously ill pt

Answer 21

vanco and carbapenem with or without Amikacin/Gentamicin