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ABSITE Review > Infection > Flashcards

Infection Flashcards

1
Q

What is the most common immune deficiency that leads to infection?

A

Malnutrition

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2
Q

What type of microflora inhabit the stomach?

A

It’s virtually sterile with some GPC and some yeast

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3
Q

What type of microflora inhabit the proximal small bowel?

A

10^5 bacterial, mostly GPCs

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4
Q

What type of microflora inhabit the distal small bowel?

A

10^7 bacteria, GPCs, GPRs, GNRs

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5
Q

What type of microflora inhabit the colon?

A

10^11 bacterial, almost all anaerobes with some GNRs, GPCs

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6
Q

What is the most common organism in the GI tract?

A

Anaerobes

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7
Q

Why do anaerobes need a low-oxygen environment?

A

Lack superoxide dismutase and catalase, making them vulnerable to oxygen radicals

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8
Q

What is the most common anaerobe in the colon?

A

Bacteriodes fragilis

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9
Q

What is the most common aerobic bacteria in the colon?

A

E. Coli

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10
Q

What is the most common fever source within 48 hours post op?

A

Atelectasis

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11
Q

What is the most common fever source 48 hours - 5 days post-op?

A

UTI

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12
Q

What is the most common fever source >5 days post op?

A

Wound infection

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13
Q

What it’s he most common bacterial to cause gram negative sepsis?

A

E. Coli

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14
Q

What do gram negative bacteria contain that leads to sepsis?

A

Endotoxin (lipid A) which triggers release of TNF-a (triggers inflammation), activates complement, and activates coagulation cascade

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15
Q

What is the optimal glucose level in septic patients?

A

80-120 mg/dL

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16
Q

When does hyperglycemia usually occur in septic patients?

A

Just before the patient becomes clinically septic

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17
Q

What are the insulin and glucose levels usually in early gram-negative sepsis?

A

Decreased insulin, increased glucose (impaired utilization)

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18
Q

What are the insulin and glucose levels usually in late gram-negative sepsis?

A

Increased insulin, increased glucose secondary to insulin resistance

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19
Q

What are the symptoms of Clostridium difficult colitis (pseudomembranous colitis)?

A

Foul-smelling diarrhea, usually seen in nursing home or ICU patients

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20
Q

How to diagnose C. Diff?

A

ELISA for toxin A

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21
Q

What lab value is often extremely elevated in patients with C. Diff?

A

Elevated WBCs often in the 30-40s

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22
Q

What is the treatment for C. Diff?

A

Oral vancomycin, oral flagyl, or IV flagyl
IVF and stop other antibiotics
Lactobacillus can also help

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23
Q

How to treat C. Diff in pregnant person?

A

Oral vancomycin because no systemic absorption

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24
Q

What is the treatment of fulminant (severe sepsis, perforation) pseudomembranous colitis?

A

Total colectomy with ileostomy

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25
Q

How are abscesses treated?

A

Drainage

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26
Q

After how long post-op do abscesses form?

A

7-10 days

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27
Q

In what type of patients are antibiotics used for an abscess?

A

Diabetes, cellulitis, clinical signs of sepsis, fever, or who have bioprosthetic hardware (mechanical valves, hip replacements)

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28
Q

Bacterial component of abdominal abscesses?

A

90% have anaerobes

80% have anaerobes and aerobes

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29
Q

What surgical wound is considered clean?

A

Hernia

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30
Q

What are some examples of clean contaminated wounds?

A

Elective colon resection with prepped bowel

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31
Q

What is a gross contaminated wound?

A

An abscess

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32
Q

Why are prophylactic antibiotics given pre op?

A

To prevent surgical site infections

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33
Q

When should prophylactic antibiotics be given pre-op?

A

Within 1 hour of incision

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34
Q

When should prophylactic antibiotics be stopped post op?

A

Stop within 24 hours of end operation time

Except cardiac, which is stopped within 48 hours

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35
Q

What is the most common organism overall in surgical site infections?

A

Staph aureus — coagulase-positive

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36
Q

What is the most common GNR in surgical wound infections?

A

E. Coli

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37
Q

What is the most common anaerobe in surgical wound infections?

A

B. Fragilis

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38
Q

What does a surgical wound infection with B fragilis indicate?

A

Translocation from the gut

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39
Q

How much bacteria is necessary for a wound infection?

A

10^5

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40
Q

When is less bacteria needed to create a wound infection?

A

When there is a foreign body present

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41
Q

What are the risk factors for wound infection?

A

Long operations, hematoma or sermon formation, advanced ago, chronic disease (COPD, renal failure, liver failure, DM), malnutrition, immunosuppressive drugs

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42
Q

What would cause surgical infections within 48 hours of procedure?

A

Injury to bowel with leak

Invasive soft tissue infection — Clostridium perfringens and beta-hemolytic strep (produce exotoxins)

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43
Q

What is the most common infection in surgery patients?

A

UTI

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44
Q

What is the biggest risk factor for UTI in surgery patients?

A

Urinary catheters

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45
Q

What is the MCC of UTI in surgical patients?

A

E. Coli

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46
Q

What is the leading cause of infectious death after surgery?

A

Nosocomial pneumonia

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47
Q

What are the most common organisms in ICU pneumonia?

A

1) S. Aureus 2) pseudomonas 3) E. Coli

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48
Q

What class fo organisms is most common in ICU pneumonia?

A

GNRs

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49
Q

What increases risk of nosocomial pneumonia in surgical patients?

A

Length of ventilation

Aspiration from duodenum thought to have a role

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50
Q

What are the three most common bacteria in line infections?

A
  1. S. Epidermidis
  2. S. Aureus
  3. Yeast
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51
Q

What location for central lines has the highest risk of infection? Lowest risk?

A

Highest risk is femoral line

Lowest risk is subclavian line

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52
Q

What is the salvage rate for lines during infection, when giving antibiotics?

A

50%

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53
Q

What decreases the line salvage rate when infected?

A

If the bug is yeast

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54
Q

What are the most common organisms to cause necrotizing soft tissue infections?

A

Beta-hemolytic Steptococcus, C. Perfringes, or mixed organisms

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55
Q

In what types of patients do necrotizing soft tissue infections usually occur?

A

Immunocompromised and patients with poor blood supply

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56
Q

How long after injury or post op does it take for necrotizing soft tissue to occur?

A

Quickly, within hours

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57
Q

What are the signs and symptoms of necrotizing soft tissue infections?

A

Pain out of proportion to skin findings (infections tarts deep to the skin), mental status change, WBCs>20, thin gray drainage that is foul-smelling, can have skin blistering/necrosis, induration and edema, crepitus or soft tissue gas on x-ray, can be septic

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58
Q

What organism usually causes necrotizing fasciitis?

A

Beta-hemolytic group A strep or MRSA. Have exotoxin

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59
Q

Why can the overlying skin look normal in the early stages of nec fasc?

A

Because it spreads deep along fascial planes

Overlying skin progresses from pale red to purple with blister or bullae development

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60
Q

What does thin, foul-smelling gray drainage from would indicate?

A

A necrotizing fasciitis

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61
Q

What is the treatment for nec fasciitis?

A

Early debridement, high dose penicillin (broad spectrum if thought to be poly-organisms

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62
Q

What are the common presentations of C. Perfringens infections?

A

Myonecrosis and gas gangrene

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63
Q

Why is necrotic tissue a perfect environment for C. Perfringens?

A

Necrotic tissue decreases oxidation-redux potential

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64
Q

What toxin does C. Perfringens have?

A

Alpha toxin

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65
Q

What does gram stain show in wound with C. Perfringens?

A

GPRs without WBCs

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66
Q

What is seen on physical exam in a patient with C. Perfringens infection?

A

Pain out of proportion to exam

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67
Q

What is the treatment for C. Perfringens infected wounds?

A

Early debridement, high-dose penicillin

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68
Q

What is Fournier’s gangrene?

A

Severe infection in perineal and scrotal region

69
Q

What are the risk factors for developing Fournier’s gangrene?

A

Diabetes and immunocompromised state

70
Q

What causes Fournier’s gangrene?

A

Mixed organisms

71
Q

What is the treatment of Fournier’s gangrene?

A

Early debridement and try to preserve testicles if possible

Antibiotics

72
Q

When is fungal coverage warranted?

A

Positive blood cultures, 2 sites other than blood, 1 site with severe symptoms, endophthalmitis, or patients on prolonged bacterial antibiotics with failure to improve

73
Q

What symptoms are most common with actinomyces (not a true fungus)?

A

Pulmonary symptoms

74
Q

What does Actinomyces usually cause?

A

Pulmonary symptoms and tortuous abscesses in cervical, thoracic, and abdominal areas

75
Q

Histologic characteristic of Actinomyces?

A

Yellow sulfur granules on Gram stain

76
Q

What is the treatment for Actinomyces?

A

Drainage and penicillin G

77
Q

What are the most common symptoms of Nocardia (not a true fungus)?

A

Pulmonary and CNS symptoms

78
Q

What is the treatment for Nocardia?

A

Drainage and sulfonamides (Bactrim)

79
Q

What organism is the MCC of fungemia?

80
Q

Candida is a common inhabitant of what part of the body?

A

Respiratory tract

81
Q

What is the treatment of Candida?

A

Fluconazole or anidulafungin for severe infections

82
Q

What is the treatment for Candiduria?

A

Remove urinary catheter only, no anti-fungal is necessary

83
Q

What is the treatment for Aspergillosis?

A

Voriconazole for severe infections

84
Q

What are the most common symptoms of Histoplasmosis?

85
Q

Where is Histoplasmosis usually found?

A

Mississippi and Ohio River Valleys

86
Q

What is the treatment of histoplasmosis?

A

Liposomal amphotericin for severe infections

87
Q

What symptoms are most common with Cryptococcus?

A

CNS symptoms

88
Q

In what patients is Cryptococcus usually found?

A

AIDS patients

89
Q

What is the treatment of Cryptococcus?

A

Liposomal amphotericin

90
Q

What type of symptoms are often seen with Coccidioidomycosis?

A

Pulmonary symptoms

91
Q

What region is Coccidioidomycosis usually found?

92
Q

What is the treatment of Coccidioidomycosis?

A

Liposomal amphotericin

93
Q

What are the symptoms of spontaneous bacterial peritonitis (SBP)?

A

Mental status changes, fever, abdominal pain in cirrhotic patient

94
Q

What is a risk factor for developing SBP?

A

Low protein (<1g/dL) in peritoneal fluid

95
Q

What are the 3 most common causes of SBP?

A

50% E. coli
20% Streptococcus
10% Klebsiella

96
Q

What causes SBP?

A

Secondary to decreased host defenses (intrahepatic shunting, impaired bactericides activity in ascites), NOT transmucosal migration

97
Q

How do you diagnosis SBP?

A

Peritoneal tap that shows PMNs >250 or positive cultures

Fluid cultures are often negative

98
Q

What is the treatment of SBP?

A

Ceftriaxone or other 3rd-generation cephalosporin

99
Q

When should you worry about other intra-abdominal causes when treating someone with suspected SBP?

A

If not getting better on antibiotics or if cultures are polymicrobial

100
Q

What antibiotic is used for prophylaxis for SBP?

A

Weekly fluoroquinolones (norfloxacin)

101
Q

When is SBP prophylaxis indicated?

A

After an episode of SBP

102
Q

Can a liver transplant be performed with active SBP?

103
Q

What is secondary bacterial peritonitis?

A

Comes from abdominal source

104
Q

What does secondary bacterial peritonitis imply?

A

That there is a perforated viscous

105
Q

What are the common bacterial causes of secondary bacterial peritonitis?

A

Polymicrobial— B. Fragilis, E. Coli, Enterococcus

106
Q

What is the treatment for secondary bacterial peritonitis?

A

Usually laparotomy to find source

107
Q

What type of virus is HIV?

A

RNA virus with reverse transcriptase

108
Q

What are the exposure risks for developing HIV?

A

HIV blood transfusion — 70%
Infant from positive mother — 30%
Needle stick from positive patient — 0.3%
Mucous membrane exposure — 0.1%

109
Q

How long does it usually take for seroconversion of HIV Abs?

A

6-12 weeks

110
Q

What drugs are used to help decrease seroconversion of HIV after exposure?

A

AZT (zidovudine, reverse transcriptase inhibitor) and ritonavir (protease inhibitor)

111
Q

What is the most common indication for laparotomy in HIV patients?

A

Opportunistic infections

112
Q

What is the MC infection in HIV patients?

113
Q

What is the second MC reason for laparotomy in HIV patients?

A

Neoplastic disease

114
Q

What it’s he most common neoplastic disease that requires laparotomy in HIV patients?

115
Q

What is the MC intestinal manifestation of AIDS?

A

CMV colitis— can present with pain, bleeding, or perforation

116
Q

What is the MC neoplasm in AIDS patients?

A

Kaposi’s sarcoma —rarely needs surgery

117
Q

What is the MC and second MC site of lymphoma in HIV patients?

A
  1. Stomach

2. Rectum

118
Q

What type of lymphoma is MC seen in HIV patients?

A

Non-Hodgkin’s (B cell)

119
Q

What is the treatment of lymphoma in HIV patients?

A

Chemotherapy. May need surgery with significant bleeding or perforation

120
Q

What type of GI bleed is more common in HIV patients? Lower or upper

121
Q

What is the MCC of upper GI bleeds in HIV patients?

A

Kaposi’s sarcoma and lymphoma

122
Q

What are the MCC of lower GI bleeds in HIV patients?

A

CMV, bacterial, HSV

123
Q

What is the normal CD4 count?

124
Q

At what CD4 count wil; HIV be symptomatic?

125
Q

At what CD4 count will opportunistic infections occur?

126
Q

What is the possibility of transmitting hepatitis C through blood transfusion?

A

0.0001%/unit

127
Q

What percentage of the population is infected by hepatitis C?

128
Q

In what % of patients with hepatitis C does chronic infection occur?

129
Q

In what % of patients with hepatitis C dose cirrhosis occur?

130
Q

In what % of patients with hepatitis C does hepatocellular carcinoma occur?

131
Q

What is the most common indication for liver transplant?

A

Hepatitis C

132
Q

What drugs are used to cure hepatitis C?

A

Sovaldi (sofosbuvir) with ribavirin

133
Q

Is fulminant hepatic failure common in patients with hepatitis C?

134
Q

How is CMV transmitted?

A

Via leukocytes

135
Q

What is the most common infection in transplant patients?

136
Q

What is the MC manifestation of CMV?

A

Febrile mononucleosis (sore throat, adenopathy)

137
Q

What is the most deadly form of CMV?

A

CMV pneumonitis

138
Q

How do you diagnose CMV infection?

A

Biopsy and CMV serology

139
Q

What would you see on the biopsy in someone infected with CMV?

A

Characteristic cellular inclusion bodies

140
Q

What is the treatment for CMV?

A

Ganciclovir, CMV immune globulin (Cytogram)

141
Q

In what cases is CMV immune globulin (Cytogram) given?

A

For severe infections or a CMV-negative patient receiving a CMV-positive organ

142
Q

Where in the lungs is aspiration pneumonia MC seen?

A

Superior segment of the right lower lobe

143
Q

What is the MC organism causing aspiration pneumonia? What other class of organism must you also treat against?

A

Strep pneumonia. Must also cover anaerobes

144
Q

What is the highest sensitivity test for osteomyelitis?

A

MRI (avoid bone biopsy)

145
Q

What is the treatment for Brown recluse spider bites?

A

Oral Dawson initially, avoid early surgery, but may need resection of area and skin graft for large ulcers later

146
Q

What are the most common causes of diabetic foot infections?

A

Usually polymicrobial. Staph, strep, GNRs, and anaerobes

147
Q

What is the treatment for diabetic foot infections?

A

Broad-spectrum antibiotics (Unasyn, Zosyn)

148
Q

What are the MC causes of acute septic arthritis?

A

Gonococcus, staph, H. Influenzae, strep

149
Q

What is the treatment for acute septic arthritis?

A

Drainage, 3rd generation cephalosporin and vancomycin until results of cultures

150
Q

What organism is only found in human bites and cause permanent joint injury?

151
Q

What organism is found in cat and dog bites?

A

Pasteurella multocida

152
Q

What is the antibiotic of choice for cat/dog/human bites?

153
Q

What is the MC infection resulting from cat/dog/human bites?

A

Strep pyogenes

154
Q

What are the 2 MC organisms to causes impetigo, erysipelas, cellulitis, and folliculitis?

A

Staph (MC) and strep

155
Q

What is a furuncle and what organisms usually cause it?

A

A boil. S. Epidermidis or S. Aureus

156
Q

What is the treatment of a furuncle?

A

Drainage +/- antibiotics

157
Q

What is a carbuncle?

A

A multiloculated furuncle

158
Q

What are the symptoms of a peritoneal dialysis catheter infection?

A

Cloudy fluid, abdominal pain, fever, usually mono bacterial

159
Q

What are the MC organisms to cause peritoneal dialysis catheter infections?

A

S. Epidermidis (MC), S. Aureus, and pseudomonas

160
Q

What is the treatment for peritoneal dialysis catheter infections?

A

Intraperitoneal vancomycin and gentamicin (IV not as effective) and increased dwell time and intraperitoneal heparin

161
Q

When should you remove the catheter in a patient with a peritoneal dialysis catheter infection?

A

For peritonitis that lasts 4-5 days

162
Q

Peritoneal dialysis catheter should be removed if infected with what organisms?

A

Fungal, tuberculosis, and pseudomonas infections

163
Q

What are the risk factors for developing sinusitis?

A

Nasoenteric tubes, intubation, patients with severe facial fractures

164
Q

What organisms usually cause sinusitis?

A

Polymicrobial

165
Q

What would the CT head of a patient with sinusitis show?

A

Air-fluid levels in the sinus

166
Q

What is the treatment of sinusitis?

A

Broad-spectrum antibiotics

It is rare to have to tap sinus percutaneously for systemic illness

167
Q

What is the best prevention strategy to prevent nosocomial infections?

A

Hand washing

168
Q

What patients have the highest risk of developing a nosocomial infection?

A

Burn patients

169
Q

What are the prevention strategies used to prevent surgical site infections?

A
  • Use clippers preoperativey instead of razors
  • Keep glucose 80-120
  • Keep PO2 elevated (give 100% oxygen)
  • Keep patient warm (keep OR 70F, and use Bair Hugger (warm air conduction)
  • Chlorhexidine prep with iodine-impregnated drapes

ABSITE Review (7 decks)

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