Infection Flashcards
MC organism in GI tract
Anaerobes
MC anaerobe in colon/SSI
Bacteroides Fragilis
MC aerobic organism in colon
E. coli
MC cause of post op FEVER in:
1) 48 hours
2) 3 days
3) 5 days
4) 5-7 days
5) >= 7 days
1) Atelectasis
2) UTI
3) DVT
4) Wound infection
5) Wonder drugs
MC organism in GN sepsis
E. coli
What is Lipid A
Endotoxin release by GNRs
What does Lipid A cause the release of
TNF-a -> stimulates inflammation/macrophages/complement/coag cascade
Insulin/Glucose response to sepsis:
1) Early response
2) Late response
1) DEC insulin, INC glucose
2) INC insulin, INC glucose
Optimal Glucose control in septic patient
80-120 mg/DL
Optimal preventative measures for surgical site infection
Use clippers over razor Glucose control 80-120 Inc Pre-induction PO2 by giving 100% O2 Keep patient warm (bair hugger) Chlorhexidine prep
What does Chlorhexidine prep cover that Betadyne does not?
FUNGUS
Chlorhexidine: Fungus, GNR, GPR, GPC
Betadyne: GNR, GPR, GPC
C diff dx
ELISA for Toxin A
WBCs often 30s-40s
C diff Tx:
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
Is PO vanc okay in pregnancy?
Yes it doesn’t get absorbed systemically
Abscess
90% of abd abscesses have anaerobes
80% of abd abscesses have anaerobes/aerobes
Abscess Tx
Drainage!!!!
When to give abx for an abscess
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
Single glove leak rate for 2 hr case?
50%
Double glove leak rate for 2 hr case?
10%
SSI risk for wound classification:
1) Clean
2) Clean contaminated
3) Contaminated
4) Grossly contaminated
1) 2% (hernia)
2) 3-5% (elective SBR, colon resection)
3) 5-10% (Gunshot wound to colon)
4) 30% (abscess or feculent peritonitis)
CDC risk factors for SSI
1) ASA 3-5
2) Length of case > 75% of expected time of case
3) Grossly contaminated
SSI ppx:
1) How long before surgery do we give abx?
2) When do we stop abx after surgery?
1) 1 hour
2) Within 24 hours if gangrenous viscous; 48 hours of cardiac case; otherwise stop immediately.
What abx to give pre-op?
Clean contaminated cases -> cephalosporin
GI: Cefoxitin (Mefoxin), cefotetan (Cefotan), ampicillin/sulbactam (Unasyn), or cefazolin plus metronidazole
Definition of SSI?
Infection in the area of surgery or incision within 30 days of surgery or 1 year if there is a prosthesis
MC organism in SSI
S. auerus
MC anerobe in SSI
B. fragilis
MC GNR in SSI
E. coli
What is Exoslime?
Substance released by staph that is an exopolysaccharide matrix -> helps form biofilmsq
Amount of bacterial isolates required for infection?
10^5; fewer for foreign bodies or immunocompromised
Other risk factors for SSI
Increased length of operartion Hematoma/Seroma Increased age Chronic disease (COPD, CRF, Liver Failure, DM) Malnutrition Immunosuppression
MC infection in surgical patient
UTI -> TAKE OUT CATHETERS!!!
MC organism -> E. coli
MC infectious cause of death in SSI
Nosocomial pneumonia
Directly related to length of ventilation
MC organism: S. aureus, Pseudomonas, E. coli
MC ICU pneumonia: GNR
1 thing to decrease line infections
Stopping procedure if sterile technique is broken
MC organisms in line infections
1) S. epidermidis
2) S. aureus
3) Yeast
Tx of line infection
Removal of line -> then 0-3 days of antibiotics
Tx of line infection in septic, DM, immunocompromised
10-14 days after removal of line
If cannot remove line what is the salvage rae with 2 wks of abx?
50%
MC organism necrotizing soft tissue infections
Group A (B-hemolytic) Strep
Clostridium perfringens
Multiorganism
RFs for necrotizing infection
Obesity
DM (immunocompromised)
Poor blood supply patients
S/S of necrotizing infection
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
LRINEC score
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
Tx of necrotizing infection
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)
Fungus: Actinomyces
Pulmonary sxs, yellow sulfur granules on gram stain
Tx: Drainage/Penicillin G
Fungus: Nocardia
Pulmonary/CNS sxs
Tx: Drainage/Sulfonamides = Bactrim
Fungus: Aspergillosis
Tx: VORICONAZOLE
Fungus: Histoplasmosis
Pulmonary sxs; Mississippi/Ohio river valleys
Tx: Liposomal amphotericin
