Infection Flashcards
Enterotoxigenic bacteroides fragilis, think of what other disease?
Colon cancer
e. faecalis too
Mechanism of action of vancomycin?
How does resistance develop?
Inhibits cell wall synthesis in gram (+) bacteria. Cross-linking is interrupted
Resistance as a result of structural changes to the cell wall that prevents vancomycin action
How does resistance to fluoroquinolones?
DNA gyrase conformational changes prevent quinolones from working.
Also decreased cell wall penetration.
But if you give it a while the enzyme changes go back to being susceptible
Role of vasopressin in non-septic pts?
No role for non-septic pts.
Most effective method of preventing surgical site infection?
Prevent hypothermia
Antibiotics needs to be given in what timeframe before the incision?
60 minutes before the incision
GI prophylaxis with proton pump inhibitor has what effect to nosocomial pneumonia rate? Why?
Increases rate of pneumonia. Because the pH is increased so much that the bugs survive now
PPI is not superior to sucralfate for barrier protection
What is the worry with using clarithromycin in renally impaired pts?
Increased risk of qt prolongation. You have to adjust the dose
Most common organism for emphysematous GB?
Clostridium species
What is the most common side effect of zosyn?
Diarrhea
Tetanus immune globulin vs toxoid. When to give?
Immune globulin: tetanus prone wound, >6 hrs, >5 yrs or unknown immunization
Toxoid: >5 yrs or unknown immunization
Pts taking amphotericin B are at a risk for what electrolyes abnormality?
What does it do to sodium? Potassium? Magnesium?
Hypokalemia
Hypomagnesemia
No effect on sodium
What is the rate of transmission after exposure to hep C?
What is the postexposure prophylaxis?
0.1 - 1.8%
Postexposure prophylaxis generally not recommended due to low chance of exposure. Treatment only if an infection is proven
What is the mechanism of how bacteria develop resistance to bactrim?
Trimethoprim-sulfamethoxazone.. develop resistance by ability to use preformed folic acid
How does bacteria develop resistance to gentamicin?
Genetic mutation for production of modifying enzymes
What’s in the surviving sepsis guideline’s 1hr bundle?
Blood culture then start abx
30cc/kg crystalloid
Apply pressors to keep MAP > 65
Measure lactate and repeat if >2
What is the scoring system in SOFA score?
Sequential organ failure assessment
Respiratory rate > 22
GCS < 15
SBP < 100
What’s included in the surgical site infection bundle?
1) abx 1hr prior to incision
2) clipping of hair (not shaving)
3) perioperative glucose control <200
4) perioperative normothermia
What is the most common organism in CAUTI? 2nd most common?
What is the #2 most common organism isolated from UTI in general?
1: e. Coli
2: enterococcus
Klebsiella
What is BI/NAP 1/027?
Especially virulent c. Diff strain. Produces both toxin A and toxin B
Evidence based intraoperative interventions to decrease SSI
Perioperative glucose control with goal < 200
Normothermia
Alcohol based prep unless otherwise contraindicated
Post-op abx not needed for 24hr post-op
Antibiotic wound irrigation and abx powders do not improve SSI
What are the 3 types of nec fasc?
Only type II benefits from what therapy?
Type I: polymicrobial
Type II: Group A strep/MRSA (IVDU)
Type III: Clostridium species/vibrio (marine exposure)
Type IV: fungal (immunocompromised)
Only type II group A strep benefits from IVIG. Actually has mortality benefit. Type I and III do not
Most common organism causing severe soft tissue infection? (SSTI)
Mrsa
Side effect of linezolid to be concerned for in someone with depression?
Serotonin syndrome
Pts after splenectomy are more susceptible to encapsulated organism infection because spleen is the primary location of storage for what?
For macrophages
Most up to date guideline for perioperative antibiotics
- when to give it
- when do you need to redose?
- post-op abx?
- IV and 1 hr prior to incision
- Redose when the operation time is twice the half life of the drug or if there is a lot of blood loss and transfusion
- no need for post-op abx 24 hrs beyond first dose
What are the triad of symptoms from fungal infection that pose an ominous prognosis?
Muscle pain, rash, fever
Most common organisms causing cholangitis (4)
E coli
Klebsiella pneumoniae
Enterococcus
B fragilis
Most common organism for central venous Catheter infection?
Most common organism for suppurativa thrombophlebitis?
Most common organism in lactating breast abscess?
CVC: staph epi
Suppurative thrombo: staph aureus
Lactating breast abscess: staph aureus
Which of the following has the highest transmission rate from blood transfusions?
- hep B
- hep C
- HIV
- EBV
Hep B: 1 in 200,000
Hep C and HIV: 1 in 2,000,000
Emphysematous cholecystitis. Aerobe or anaerobe? Gram positive or negative? Rods or cocci?
Anaerobic gram positive rods.
perforated appy. does irrigation reduce abscesses? increase abscesses? solution to pollution is dilution?
irrigation vs. no irrigation -> there is no difference
Lap ccy. You spill stones and purulent bile. Wound class?
What is the wound class for gangrenous cholecystitis?
Purulent bile and stone: contaminated
Gangrenous ccy: dirty
