Infection Flashcards
What is the most common immune deficiency that leads to infection?
Malnutrition
What type of microflora inhabit the stomach?
It’s virtually sterile with some GPC and some yeast
What type of microflora inhabit the proximal small bowel?
10^5 bacterial, mostly GPCs
What type of microflora inhabit the distal small bowel?
10^7 bacteria, GPCs, GPRs, GNRs
What type of microflora inhabit the colon?
10^11 bacterial, almost all anaerobes with some GNRs, GPCs
What is the most common organism in the GI tract?
Anaerobes
Why do anaerobes need a low-oxygen environment?
Lack superoxide dismutase and catalase, making them vulnerable to oxygen radicals
What is the most common anaerobe in the colon?
Bacteriodes fragilis
What is the most common aerobic bacteria in the colon?
E. Coli
What is the most common fever source within 48 hours post op?
Atelectasis
What is the most common fever source 48 hours - 5 days post-op?
UTI
What is the most common fever source >5 days post op?
Wound infection
What it’s he most common bacterial to cause gram negative sepsis?
E. Coli
What do gram negative bacteria contain that leads to sepsis?
Endotoxin (lipid A) which triggers release of TNF-a (triggers inflammation), activates complement, and activates coagulation cascade
What is the optimal glucose level in septic patients?
80-120 mg/dL
When does hyperglycemia usually occur in septic patients?
Just before the patient becomes clinically septic
What are the insulin and glucose levels usually in early gram-negative sepsis?
Decreased insulin, increased glucose (impaired utilization)
What are the insulin and glucose levels usually in late gram-negative sepsis?
Increased insulin, increased glucose secondary to insulin resistance
What are the symptoms of Clostridium difficult colitis (pseudomembranous colitis)?
Foul-smelling diarrhea, usually seen in nursing home or ICU patients
How to diagnose C. Diff?
ELISA for toxin A
What lab value is often extremely elevated in patients with C. Diff?
Elevated WBCs often in the 30-40s
What is the treatment for C. Diff?
Oral vancomycin, oral flagyl, or IV flagyl
IVF and stop other antibiotics
Lactobacillus can also help
How to treat C. Diff in pregnant person?
Oral vancomycin because no systemic absorption
What is the treatment of fulminant (severe sepsis, perforation) pseudomembranous colitis?
Total colectomy with ileostomy
How are abscesses treated?
Drainage
After how long post-op do abscesses form?
7-10 days
In what type of patients are antibiotics used for an abscess?
Diabetes, cellulitis, clinical signs of sepsis, fever, or who have bioprosthetic hardware (mechanical valves, hip replacements)
Bacterial component of abdominal abscesses?
90% have anaerobes
80% have anaerobes and aerobes
What surgical wound is considered clean?
Hernia
What are some examples of clean contaminated wounds?
Elective colon resection with prepped bowel
What is a gross contaminated wound?
An abscess
Why are prophylactic antibiotics given pre op?
To prevent surgical site infections
When should prophylactic antibiotics be given pre-op?
Within 1 hour of incision
When should prophylactic antibiotics be stopped post op?
Stop within 24 hours of end operation time
Except cardiac, which is stopped within 48 hours
What is the most common organism overall in surgical site infections?
Staph aureus — coagulase-positive
What is the most common GNR in surgical wound infections?
E. Coli
What is the most common anaerobe in surgical wound infections?
B. Fragilis
What does a surgical wound infection with B fragilis indicate?
Translocation from the gut
How much bacteria is necessary for a wound infection?
10^5
When is less bacteria needed to create a wound infection?
When there is a foreign body present
What are the risk factors for wound infection?
Long operations, hematoma or sermon formation, advanced ago, chronic disease (COPD, renal failure, liver failure, DM), malnutrition, immunosuppressive drugs
What would cause surgical infections within 48 hours of procedure?
Injury to bowel with leak
Invasive soft tissue infection — Clostridium perfringens and beta-hemolytic strep (produce exotoxins)
What is the most common infection in surgery patients?
UTI
What is the biggest risk factor for UTI in surgery patients?
Urinary catheters
What is the MCC of UTI in surgical patients?
E. Coli
What is the leading cause of infectious death after surgery?
Nosocomial pneumonia
What are the most common organisms in ICU pneumonia?
1) S. Aureus 2) pseudomonas 3) E. Coli
What class fo organisms is most common in ICU pneumonia?
GNRs
What increases risk of nosocomial pneumonia in surgical patients?
Length of ventilation
Aspiration from duodenum thought to have a role
What are the three most common bacteria in line infections?
- S. Epidermidis
- S. Aureus
- Yeast
What location for central lines has the highest risk of infection? Lowest risk?
Highest risk is femoral line
Lowest risk is subclavian line
What is the salvage rate for lines during infection, when giving antibiotics?
50%
What decreases the line salvage rate when infected?
If the bug is yeast
What are the most common organisms to cause necrotizing soft tissue infections?
Beta-hemolytic Steptococcus, C. Perfringes, or mixed organisms
In what types of patients do necrotizing soft tissue infections usually occur?
Immunocompromised and patients with poor blood supply
How long after injury or post op does it take for necrotizing soft tissue to occur?
Quickly, within hours
What are the signs and symptoms of necrotizing soft tissue infections?
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
What organism usually causes necrotizing fasciitis?
Beta-hemolytic group A strep or MRSA. Have exotoxin
Why can the overlying skin look normal in the early stages of nec fasc?
Because it spreads deep along fascial planes
Overlying skin progresses from pale red to purple with blister or bullae development
What does thin, foul-smelling gray drainage from would indicate?
A necrotizing fasciitis
What is the treatment for nec fasciitis?
Early debridement, high dose penicillin (broad spectrum if thought to be poly-organisms
What are the common presentations of C. Perfringens infections?
Myonecrosis and gas gangrene
Why is necrotic tissue a perfect environment for C. Perfringens?
Necrotic tissue decreases oxidation-redux potential
What toxin does C. Perfringens have?
Alpha toxin
What does gram stain show in wound with C. Perfringens?
GPRs without WBCs
What is seen on physical exam in a patient with C. Perfringens infection?
Pain out of proportion to exam
What is the treatment for C. Perfringens infected wounds?
Early debridement, high-dose penicillin