Infection Flashcards
1
Q
What are the risk factors for HAI?
A
- Critical Care Unit Says
- Patient’s immune status
- Infection Control Practices
- Prevalence of certain pathogens in the community
- Older age
- Longer hospital stays
- Multiple chronic illnesses
- Mechanical ventilatory support
2
Q
How are HAI transmitted?
A
- Direct contact w/ healthcare workers
- Droplet transmission
- Contaminated environments
- Extraluminal migration
3
Q
What types of droplet transmission exist?
A
Large and small droplets
4
Q
True or false, Gloves prevent contamination?
A
F:Gloves alone don’t prevent contamination
5
Q
What types of microbes transfer via extraluminal migration?
A
- Staph. Aureus
* Coagulase neg staphylococci (skin flora)
6
Q
What symptoms suggestive of PRE-existing
infection? (10)
A
- Subjective fever
- Chills
- Night sweats
- Altered mental status
- Productive cough
- Shortness of breath
- Rebound tenderness
- Suprapubic pain
- Dysuria
- Abdominal tenderness
7
Q
What indications during your history and physical tell you that the patient might have an infection?
A
Vital signs
• Hypotension, tachypnea, low saturations, tachycardia
8
Q
What are some things you want to ask when questioning the patient during the history and physical?
A
Where is the infection, when did it occur, and what was placed?
9
Q
What laboratory values can be seen with evidence of organ dysfuntion?
A
- Lactic acid – Normal range: 0.5 – 2.2 mmol/L
- Prothrombin time
- BUN/Creatinine
- Elevated WBC
- Hypo/hyperglycemia
- Cultures
10
Q
What are some common S&S associated with CLABSI Infections? (3)
A
Fever and rigors – bacteremia
• Purulence or erythema at
insertion site
• Catheter dysfunction
11
Q
What are some complications that can exist as a result of CLABSI?
A
- Endocarditis
- Thrombophlebitis
- Septic Arthritis
- Osteomyelitis
- Abscess
12
Q
What are some S&S seen with CAUTI infection?
A
Signs & Symptoms u Fever u Suprapubic or costovertebral angle tenderness u Acute hematuria u Catheter obstruction u Dysuria or urgency.
13
Q
Where do CAUTI Infections Occur?
A
Occurs anywhere along the urinary tract u Urethra u Ureter u Bladder u Kidney
14
Q
What S&S can you observe from C.Diff?
A
S & S… • Diarrhea • Abdominal pain • Distention • Cramping • Dehydration
15
Q
What is special about S&S of SSI?
A
• Can demonstrate different S & S
based on the location of the
infections
16
Q
When do SSI occur?
A
Usually occurs 30 days post- surgery.
17
Q
What are some S&S for skin infections?
A
S & S for skin infections
• Warmth, pus, erythema, wound
dehiscence
18
Q
Which infection happens beneath the
incision area in muscle and tissues
surrounding muscles?
A
• Deep incisional
19
Q
Which infection happens in any area other
than skin and muscle…includes
organs or space between organs
A
Organ or space -
20
Q
Which infeciton happens - just in the
area of the incision
A
Superficial incisional
21
Q
The Most common perpetrator bacteria are (3)
A
- Staphylococcus – gram positive
- Streptococcus – gram positive
- Pseudomonas – gram negative
22
Q
The really bad bacteria include (4)
A
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Vancomycin-resistant Staphylococcus aureus (VRSE)
- Enterobacteriaceae with Cephalosporin resistance (ESBL)
- Vancomycin-resistant Enterococcus (VRE)
23
Q
Describe the difference between Clean, CLean-contaminated, contaminated, and dirty.
A
- Clean: not inflamed or contaminated; doesn’t involve internal organ
- Clean-contaminated: no evidence of infection; does involve internal organ
- Contaminated: involve internal organ with spillage of contents from the organ
- Dirty: known infection at time of surgery
24
Q
Surgeries lasting longer than what increase the risk for SSI?
A
Surgery lasting > 2 hours
25
What comorbidities increase the risk for SSI?
• Overweight, cancer, smoking, immunocompromised, diabetes
26
What can CRNAs do to prevent infection? (4)
* Wash your hands: Alcohol gel #1, soap a close 2nd!
* Change gloves often.
* Use magnificent aseptic technique (Leave your Pride at the door).
* Clean your work-station
27
What EBP recommendations exist to prevent infection?
Parenteral antibiotics
• 1. Administer only when indicated (1B)
• 2. Timed so that agent is established in tissue upon incision
28
What recommendations exist for non-parentral abx? (3)
• No recommendations for antibiotic irrigation
• No recommendation for soaking prosthetic devices in antibiotic
solution
• Should not apply antibiotic ointments to incisions (1B)
29
What are 4 glycemic control recommendations in the OR?
```
Glycemic control
• Perioperative control (1A)
• Glucose targets < 200 mg/dL (1A)
• No recommendation for tighter control
• No recommendation for A1C target
```
30
What recommendations about patient's temperature exist?
Normothermia
• Maintain perioperative normothermia (1A)
• No recommendation for strategies to maintain normothermia
31
Please state 2 recommendations regarding oxygenation for prevention of infections.
```
Oxygenation
• No recommendation for increased FiO2
• Neuraxial anesthesia
• Postoperatively by mask or nasal cannula
• No duration defined
• Only intraoperatively with GETA
• Patients with normal pulmonary function, GETA intraoperative
and immediately after extubation (1A)
```
32
Regarding antispetic prophylaxis; Intraoperative skin preparation should be done with what?
with alcohol-based antiseptic
33
What should the patient do the night before surgery?
Shower or bathe with soap or antiseptic pm before
34
What has the research demonstrated for intraop iodine irrigation in deep tissues?
Consider intraoperative iodine irrigation in deep tissues (II)
• No benefit intra-peritoneally
• No benefit with iodine imbedded adhesive drapes
• No benefit soaking prosthetic devices
35
Are blood transfusions the common cause of infection?
No
Do not withhold necessary transfusion from surgical
patient as a means to prevent SSI (IB)
• Very rare – Hepatitis, HIV, or other viruses.
36
What is the most common indication for
| revision TKA?
Infection
37
What are the goals of preoperative prophylaxis?
```
Goal:
•Adequate bactericidal
concentration in serum
and tissues when incision
is made…
•MIC: Minimum inhibitory
concentration
• Based on evidence
•Given by anesthesia
```
38
What are 6 general principles to consider when administering abx?
* 1. Should be active against common surgical wound pathogens
* 2. Proven efficacy in clinical trials
* 3. Must achieve MIC
* 4. Shortest possible course effective… ideally 1 dose
* 5. Newer antibiotics reserved for resistant infections
* 6. If everything equal: oldest, cheapest…
39
Antibiotics should be initiated when?
* Initiated 1 hr prior of incision (30 minutes even better)
| * Unless vancomycin or fluoroquinolone: initiated within 2 hrs
40
If you are using a tourniquet, what should you ensure of?
Completely infused antibiotic prior to tourniquet use
41
Should you hold abx for cultures?
Yes. May hold antibiotics for cultures…Pay attention
42
When should you redose an antibiotic? (3)
* Usually redose , 2 half-lives or with excessive blood loss
* May be re-dosed following cardiopulmonary bypass
* Required for prolonged procedures
* Drug dependent; usually 2-4 hours while in OR
43
What are 5 common surgical abx?
* Beta lactams
* Penicillin
* Cephalosporins
* Carbapenems
* Vancomycin
* Aminoglycosides (gentamycin)
* Fluoroquinolones (cipro)
* Metronidazole (flagyl)
44
Which common surgical antibiotics are known to attack beta lactams?
* Beta lactams
* Penicillin
* Cephalosporins
* Carbapenems
45
How does penicillin work?
* Inhibit bacterial cell wall synthesis
* Resistance d/t Beta-lactamase enzyme
* Reside on outer surface of cytoplasmic membrane
* DOC for streptococci, meningococci, pneumococci
46
What are 4 examples of common penicillin derivatives?
* Penicillin G
* Methicillin
* Nafcillin
* Amoxicillin
47
Cephalosporins-Beta lactams are more or less stable against Beta lactamases than penicillin?
More-broader spectrum
48
Describe some characteristics of cephalosporins
* More stable against Beta lactamases
* Broader spectrum
* Very active against gram + cocci: staph and strep
49
Can you use cephalosporins in case of a penicillin allergy?
yes• Can be used with PCN allergy except anaphylaxis
50
Does cephazolin penetrate BBB?
Cefazolin Ancef, Kefzol-Does not penetrate BBB
51
Which ABx provide better gram negative coverage?
Cefuroxime Ceftin, Zinacef Better gram (-) coverage
52
Describe two characteristics of cefepime.
Cefepime Maxipime Most resistant to hydrolysis by lactamases
| Penetrates BBB well
53
What are some possible adverse reactions to beta lactamses?
Adverse reactions
• Hypersensitivity
• Rashes, fever, nephritis, anaphylaxis
• Increased likelihood of reaction IF PCN anaphylaxis
• Cross reaction approx. 1%
• For true anaphylaxis, use vancomycin or clindamycin
54
Good activity against gram (–) rods (P.
| aeruginosa) and enterobactor
Carbapenem-Beta
| lactam
55
Can Carbapenem-Beta
| lactam cross the blood/brain barrier?
yes
56
Name two examples of Carbapenem-Beta
| lactam
* Ertapenem (Invanz)
| * Meropenem (Merrem)
57
Carbapenem-Beta
| lactam offer good coverage for what 2 microbes?
gram (–) rods (P.aeruginosa) and enterobactor
58
Carbapenem-Beta lactam would be typically administered in what surgical cases?
Stomach surgeries, meningitis, sepsis, skin
| infections
59
What adverse reactions can be seen by Carbapenem-Beta lactam?
```
Adverse
reactions
• N/V
• Diarrhea
• Rashes
• Injection site reactions
• Cross sensitivity to PCN < 1%
```
60
How does vancomycin work?
• Inhibits cell wall synthesis
61
Which types of microbes does vanc protect against?
Active against gram (+) bacteria (too
large to penetrate gram (–) wall)
• Only works if bacteria is actively dividing
• Is very slow
62
Vanc is most valuable in what cases?
Most valuable against blood-stream
| infection and endocarditis caused by MRSA
63
What are some adverse reactions of Vanc?
```
Frequent
• Phlebitis at injection site
• Chills, fever
• Nephrotoxicity
• “red man” syndrome
```
64
How do aminoglycosides work?
Inhibit ribosomal proteins and cause mRNA to be misread
| • Used with abdominal and urinary tract procedures, bacteremia, and endocarditis
65
What other antibiotics can aminoglycosides work with?
Synergistic with Beta-lactams or vancomycin
| • Especially useful in enterococcal endocarditis
66
What is an example of aminoglycoside?
Gentamycin
67
What are 3 adverse reactions of aminoglycosides?
* Ototoxicity
* Nephrotoxicity
* Curare-like affect
68
In what instances would nephrotoxicity be more common?
* In elderly
* For more than 5 days
* In renal insufficiency
* With higher doses
* Concurrent with loop diuretics
69
How does Fluoroquinolone work?
Inhibits DNA protein synthesis
70
What do Fluoroquinolones work best on?
Excellent with gram (–) organisms
• UTI, bacterial diarrhea, bone/joint
infections
71
What are examples of Fluoroquinolones?
Examples:
• Ciprofloxacin (Cipro)
• Levofloxacin (Levaquin)
72
What are 3 adverse reactions of Fluoroquinolones?
* N/V/D
* Prolongation of QT interval
* Cartilage damage/tendon rupture
* Renal insufficiency
* Concurrent steroid use
* Advanced age
* 2016 Black box warning
73
Which antibiotic forms toxic byproducts that cause unstable DNA molecules?
Metronidazole
74
What are 3 common indications for Flagyl?
Indicated for:
• Intra-abdominal infections
• Vaginitis
• C-diff
75
Describe the properties of FLagyl.
• Antiprotozoal /Anaerobic antibacterial
76
Describe 3 common adverse reactions to Flagyl.
Nausea
Peripheral neuropathy
Disulfiram-like effect
77
What Disulfiram-like effect would you note in Flagyl?
* With alcohol
* Flushing, dizziness, HA, chest/abd pain, N & V
* Hangover
