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Infection Flashcards

1
Q

MC organism in GI tract

A

Anaerobes

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2
Q

MC anaerobe in colon/SSI

A

Bacteroides Fragilis

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3
Q

MC aerobic organism in colon

A

E. coli

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4
Q

MC cause of post op FEVER in:

1) 48 hours
2) 3 days
3) 5 days
4) 5-7 days
5) >= 7 days

A

1) Atelectasis
2) UTI
3) DVT
4) Wound infection
5) Wonder drugs

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5
Q

MC organism in GN sepsis

A

E. coli

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6
Q

What is Lipid A

A

Endotoxin release by GNRs

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7
Q

What does Lipid A cause the release of

A

TNF-a -> stimulates inflammation/macrophages/complement/coag cascade

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8
Q

Insulin/Glucose response to sepsis:

1) Early response
2) Late response

A

1) DEC insulin, INC glucose

2) INC insulin, INC glucose

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9
Q

Optimal Glucose control in septic patient

A

80-120 mg/DL

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10
Q

Optimal preventative measures for surgical site infection

A 
Use clippers over razor
Glucose control 80-120
Inc Pre-induction PO2 by giving 100% O2
Keep patient warm (bair hugger)
Chlorhexidine prep
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11
Q

What does Chlorhexidine prep cover that Betadyne does not?

A

FUNGUS
Chlorhexidine: Fungus, GNR, GPR, GPC
Betadyne: GNR, GPR, GPC

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12
Q

C diff dx

A

ELISA for Toxin A

WBCs often 30s-40s

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13
Q

C diff Tx:

A

Mild (WBC < 15, Cr < 1.5): PO Vanc or PO fidoxamicin
Severe (WBC > 15, Cr >= 1.5): PO Vanc or PO fidoxamicin
Fulminant (HypoTN, Shock, ileus, megacolon): Enteric Vanc + IV Metronidazole; total colectomy + ileostomy

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14
Q

Is PO vanc okay in pregnancy?

A

Yes it doesn’t get absorbed systemically

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15
Q

Abscess

A

90% of abd abscesses have anaerobes

80% of abd abscesses have anaerobes/aerobes

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16
Q

Abscess Tx

A

Drainage!!!!

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17
Q

When to give abx for an abscess

A

1) DM
2) Cellulitis
3) Signs of sepsis
4) Fever
5) Prosthetic hardware
Often give a max of 4 additional days of abx status post drain placement or control after perforated viscous

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18
Q

Single glove leak rate for 2 hr case?

A

50%

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19
Q

Double glove leak rate for 2 hr case?

A

10%

20
Q

SSI risk for wound classification:

1) Clean
2) Clean contaminated
3) Contaminated
4) Grossly contaminated

A

1) 2% (hernia)
2) 3-5% (elective SBR, colon resection)
3) 5-10% (Gunshot wound to colon)
4) 30% (abscess or feculent peritonitis)

21
Q

CDC risk factors for SSI

A

1) ASA 3-5
2) Length of case > 75% of expected time of case
3) Grossly contaminated

22
Q

SSI ppx:

1) How long before surgery do we give abx?
2) When do we stop abx after surgery?

A

1) 1 hour

2) Within 24 hours if gangrenous viscous; 48 hours of cardiac case; otherwise stop immediately.

23
Q

What abx to give pre-op?

A

Clean contaminated cases -> cephalosporin

GI: Cefoxitin (Mefoxin), cefotetan (Cefotan), ampicillin/sulbactam (Unasyn), or cefazolin plus metronidazole

24
Q

Definition of SSI?

A

Infection in the area of surgery or incision within 30 days of surgery or 1 year if there is a prosthesis

25
Q

MC organism in SSI

A

S. auerus

26
Q

MC anerobe in SSI

A

B. fragilis

27
Q

MC GNR in SSI

A

E. coli

28
Q

What is Exoslime?

A

Substance released by staph that is an exopolysaccharide matrix -> helps form biofilmsq

29
Q

Amount of bacterial isolates required for infection?

A

10^5; fewer for foreign bodies or immunocompromised

30
Q

Other risk factors for SSI

A 
Increased length of operartion
Hematoma/Seroma
Increased age
Chronic disease (COPD, CRF, Liver Failure, DM)
Malnutrition
Immunosuppression
31
Q

MC infection in surgical patient

A

UTI -> TAKE OUT CATHETERS!!!

MC organism -> E. coli

32
Q

MC infectious cause of death in SSI

A

Nosocomial pneumonia
Directly related to length of ventilation
MC organism: S. aureus, Pseudomonas, E. coli
MC ICU pneumonia: GNR

33
Q

1 thing to decrease line infections

A

Stopping procedure if sterile technique is broken

34
Q

MC organisms in line infections

A

1) S. epidermidis
2) S. aureus
3) Yeast

35
Q

Tx of line infection

A

Removal of line -> then 0-3 days of antibiotics

36
Q

Tx of line infection in septic, DM, immunocompromised

A

10-14 days after removal of line

37
Q

If cannot remove line what is the salvage rae with 2 wks of abx?

A

50%

38
Q

MC organism necrotizing soft tissue infections

A

Group A (B-hemolytic) Strep
Clostridium perfringens
Multiorganism

39
Q

RFs for necrotizing infection

A

Obesity
DM (immunocompromised)
Poor blood supply patients

40
Q

S/S of necrotizing infection

A

Fast onset presentation
Pain out of proportion to exam (May not show superficial signs because spreads along deep tissues)
WBC > 20
Thin gray discharge, foul smelling
AMS
Skin blistering, necrosis, induration, edema
Gas on scan

41
Q

LRINEC score

A

CR,azy W,H,ite N,oob Cr,apped Glucose

1) CRP (<15 or > 15)
2) WBC (<15, 15-25, >25)
3) Hgb (>13.5, 11-13.5, < 11)
4) Na (>= 135, < 135)
5) Cr (<1.6, >= 1.6)
6) Glucose (<180, >= 180

42
Q

Tx of necrotizing infection

A

Early debridement, high dose penicillin vs broad spectrum abx for Nec Fasc (Group A strep, MRSA)
Early debridement, high dose penicillin (Clostridium)
Early debridement, try to save the TESTICLES, abx (Fournier’s)

43
Q

Fungus: Actinomyces

A

Pulmonary sxs, yellow sulfur granules on gram stain

Tx: Drainage/Penicillin G

44
Q

Fungus: Nocardia

A

Pulmonary/CNS sxs

Tx: Drainage/Sulfonamides = Bactrim

45
Q

Fungus: Aspergillosis

A

Tx: VORICONAZOLE

46
Q

Fungus: Histoplasmosis

A

Pulmonary sxs; Mississippi/Ohio river valleys

Tx: Liposomal amphotericin

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