Infection Flashcards by J Pint

Types of infections that lead to sepsis

Bacterial>fungal>parasitic>viral>others

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Non-septic infections include

Cystitis, local cellulitis, osteomyelitis, Upper Resp Infection, early onset fungal or viral

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Diagnosis of sepsis includes

Infection plus greater than or equal to 2 SIRS

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Diagnosis of severe sepsis

Infection plus 2 or more SIRS plus diminished perfusion, correct with fluids

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First line for treatment of sepsis

Fluids

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Diagnosis of septic shock??

Infection plus 2 or more SIRS

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Treatment for septic shock

Give fluid with vasopressors

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What is a Quick SOFA (qSOFA)

A new bed side assessment to providing criteria to identify patients with suspected infection who likely will have poor outcomes

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How many qSOFA criteria are needed to predict prolonged ICU stay and death

2 or more criteria

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What are the qSOFA criteria

Altered mentation
systolic blood pressure less than 100
Respiratory rate greater than 22

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patient with suspected infection and positive qSOFA should be assess further for? Treat? Lab?

Assess using SOFA for sepsis,
Treat sepsis using fluids, vasopressors to keep MAP >65
Serum lactate should be <2mmol/L (normal 0.6 to1.2)

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Management of skin and soft tissue infections

Treatment of mild non-purulent necrotizing infection, cellulitis, or erysipelas

Oral antibiotics:
Penicillin 
Cephalosporins 
Dicloxacillin
Clincamycin

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Management of skin and soft tissue infections

Treatment of moderate non-purulent necrotizing infection, cellulitis, or erysipelas

IV antibiotics:
Penicillin 
Ceftriaxone
Cefazolin
Clindamycin

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Management of skin and soft tissue infections

Treatment of severe non-purulent necrotizing infection, cellulitis, or erysipelas

Emergency surgical inspection and debridment inspecting for any necrotizing process
Start empirically on vancomycin and piperacillin/tazobactam (zosyn)
THEN
Culture and sensitivity
Look for monomicrobial or polymicrobial

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SIRS criteria

increased WBC, fever, increased heart rate, lower bp

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Purulent abcess Mild (no systemic signs of infection) treatment

I and D

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Treatment for Purulent infection in patient with: SIRS, >100.4 F, >24 RR, >90 HR, WBC >12,000 cells/mcL

Treat for moderate infect:

I and D
C and S
Empiric 
Doxcycline or bactrium
Define;
MRSA (BACTRIUM)
MSSA (Dicloxacilin or cephalexin

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Treatment for Purulent infection in patient with: SIRS plus hypotension, WBC <400 cells/mcL, who has went through one round of abx.

Severe treatment:

i and D
C and S
Empiric rx
Vanc or Daptomycin
linezolid
televacin
ceftaroline
Define rx
Mrsa
MSSA

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celluiltis caused by

Beta hemolytic strep

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Patient obese asking for antibiotis for bilateral lower extremity edema and erythema, dark pigmentation. Patient says its been going on for a long time. The lesions are nontender with bound down plaques, you look closely and see some serous drainage. what do you tell patient

Explain to the patient this is due to venous stasis, antibiotics will not help.

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Why is culturing cellulitis not recommeded

staph will grow in culture because of virulent and growth

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Duration of treatemtn for cellulities

5 days

Number one treatment for skin condition

wound care

Recurrent cellulitis risk factors

(edema, obesity, eczema, venous insufficiency,

interdigital toe space abnormalities

Recurrent cellulitis tx

3 to 4 episodes per year despite preventive measures: Antimicrobial prophylaxis: - pcn, cephalosporin or erythromycin bid x 4–52 wks - intramuscular benzathine penicillin every 2–4 weeks

Abscess Signs and Symptoms

``` Redness • Heat • Swelling • Pain • Loss of function • Fluctuant upon palpation ``` treat for staph

Abscess >5cm

needs draining

pantsvalentivne isolated and susceptible to bactrim, | TCN/Doxicillin, arithromycn clithromycin

CA MRSA

Recurrent abscess

culture 5-10 day course of abx topical decolonization family sterilized

clostridial myonecrosis

cellulitis | gangren

Diabetic foot

cellulitis

What is a SOFA and what 6 areas are assessed

``` Sequential (sepsis related) organ failure assessment 6 areas studied circulation (MAP) coagulation (platelet) central nervous system (GCS) Liver function (bilirubin) respiratiory (FiO2/PaO2) Renal (creatinine/urine volume) ```

normal bilirubin levels

0.1 to 1.2 mg/dL

Normal creatinine levels

0.6 to 1.2mg/dL

normal serum lactate level

0.5 to 1 mmol/L

Treatment of Severe Nonpurulent infection with Streptococcus pyogenes

penicillin plus clindamycin

Treatment of Severe Nonpurulent infection with Clostridial sporogenes

penicillin plus clindamycin

Treatment of Severe Nonpurulent infection with Vibrio vulnificus

doxycycline plus ceftazidime

Treatment of Severe Nonpurulent infection with Aeromonas Hydrophila

doxycycline plus ciprofloxacin

Treatment of Severe Nonpurulent infection with polymicrobial infection

vancomycin plus piperacillin/tazobactam

Empiric Treatment of Severe purulent infection with?

``` Vancomycin or ceftaroline or Daptomycin or Linezolid or televancin ```

Treatment of Severe purulent MRSA infection with

``` Vancomycin or Ceftaroline Daptomycin Linezolid televancin ```

Treatment of Severe purulent MSSA infection with

nafcillin cefazolin clindamycin

Patient obese asking for antibiotics for lower left extremity erythema. Patient says its been going on for a few days. The lesions are tender , you look closely and see some indistinct borders with streaking what do you tell patient

explain to the patient they will need antibiotic. | start on penicillin

When should cellulitis be covered for MRSA

``` Patient has; nasal colonization evidence of MRSA elsewhere hx of iv drug use traumatic injury ```

Treatment for cellulitis?

Treat for Beta hemolytic strep penicillin cephalexin and tmp/smx

Treat for cellulitis and MRSA?

``` treating for MRSA and strep Vancomycin or linezolid or clindamycin ```

What can be used for non-antimicrobial treatment of cellulitis? how long?

corticosteroids (in non-DM) for 5 days

Predisposing factors causing reoccurring cellulitis

``` obese venous stasis edema eczema foot wounds (interdigital toe space abnormalities) ```

Treatment for a patient with reoccurring cellulitis 3 to 4 times a year despite preventive measures should be?

antimicrobial therapy: PCN, cephalosporin, erythromycin BID x 4 to 52 weeks or intramuscular benzathine penicillin every 2-4 weeks

CA-MRSA is most likely when patient meets what criteria

1) MRSA was found 48 hours within admission to hospital 2) no history of admission to any facility or dialysis within last year 3) no medical history of MRSA infection or colonization 4) no indwelling catheter being used 5) Susceptible to >2 non-Beta-lactam antimicrobials

Empiric treatment for purulent cellulitis without abscess | with coverage for MRSA

Clindimycin plus Trimethprim-sulfamethoxazole plus doxycycline (minocycline)

Treatment for necrotizing faciitis? what to suspect in culture?

1) surgical debride 2) Culture 3) Emipric treatment Vanc plus Zyson plus ceftriaxzone 4) Confirm with Group A Strep (treat with penicillin plus clindamycin)