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Infection Flashcards

1
Q

what are the different types of infection in surgical patients

A

3 types

1) superficial - an infection in the skin area only
2) deep - infection goes deeper than skin
3) organ - infection deep and involves organ

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2
Q

what are the patient risk factors in infection in the surgical patient

A 
extremes of age 
poor nutritional state 
DM 
Renal failure 
smoking 
co-existing infection at other sites 
immunosuppression 
long post-operative stay
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3
Q

what are the operative risk factors in infection in the surgical patient

A 
pre-op shaving 
length of operation 
foreign material in surgical site 
insertion of a surgical drain 
inadequate instrument sterilization 
poor closure of the wound 
post-op hypothermia 
post-op hematoma or lymphatic leak 
site of procedure
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4
Q

clinical features of infection in surgical pts

A

typically appear 3-7 days post-procedure - can take up to 3 weeks for prosthetic

surgical erythema

localised pain

pus/discharge from wound

wound dehiscence

unexplained persistent pyrexia

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5
Q

investigation for infection in a surgical patient?

A

wound swabs

bloods - FBC, U&E, CRP

blood cultures

if severe - BUFALO

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6
Q

what is the management of infection in a surgical patient?

A

ABX - using local guidelines to cover the most likely causative agent

removal of surgical sutures/clips

discharge of drainage of an pus

monitor closely

return to theatre if required for wash out

supportive care - analgesia and antipyrexial

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7
Q

what are some of the actions which can be carried out to prevent infection

A

hand decontamination

clean environment

sterile equipment

pre-op showering

hair removal

mechanical bowel prep

good diabetic control, smoking cessation, weight loss will all help to reduce infection risk

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8
Q

what is another name for glandular fever

A

infective mononucleosis or kissing disease

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9
Q

what is the main causative agent for infective mononucleosis

A

Epstein - Barr Virus - 90% of the time and it is most commonly spread through saliva ie kissing, sharing cups, toothbrushes, and other equipment that transmits saliva

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10
Q

which age group is most suspectable to infective mononucleosis

A

15-24 –> uni student esp freshers

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11
Q

clinical features of infective mononucleosis

A

the classic triad of fever, pharyngitis, and lymphadenopathy (general or cervical)

other symptoms incl –> fatigue, hepatitis, jaundice, myalgia, splenomegaly

macular rash in 10-20% of pts esp if treatment has started (ampicillin, amoxicillin etc)

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12
Q

investigation of infective monocuelosis

A

1) monospot test –> test for heterphil antibodies –> 60% +ve in 1st week, if -ve, repeat test in 7 days
2) FBC with blood film –> present of atypical lymphocytes
3) EBV specific antibodies if urgent test required

LFT
PCR
USS/CT abdo - splenomegaly/spleen rupture

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13
Q

differentials of infective mononucleosis

A 
acute HIV infection 
Group A streptococcal pharyngitis 
Hep A 
Adenovirus 
Human herpes virus 6 
CMV 
Herpes simplex virus -1
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14
Q

management of infective monoculceosis

A

acute - supportive

if upper airway obstruction due to pharyngitis / haemolytic anaemia - Prednisolone + admission

if Thrombocytopaenia -Prednisolone + IV Immunoglobulin

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15
Q

what is the definition of hospital-acquired pneumonia

A

pneumonia 48 hours after admission to hospital

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16
Q

what is the definition of ventilator-acquired pneumonia

A

pneumonia 48-72 hours after endotracheal intubation

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17
Q

what is the definition of hospital-acquired MRSA

A

MRSA 48 hours after admission to hospital

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18
Q

what is the definition of hospital-acquired C.Diff

A

occurs more than 3 days after admission to the hospital

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19
Q

what are some of the causative agents for HAP

A

usually aerobic gram -ve bacilli

Pseudomonas aerginsoa 
E.coli 
Klebsiella pneumonia 
Acinetobacter
MSSA/MRSA
Legionella- water supply
Aspergillus- airvent.
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20
Q

what are some of the causative agents for VAP

A 
Pseudomonas aerginosa
E.coli
Klebsiella
Acinetobacter
Staph A
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21
Q

what are some of the causative agents for catheter acquired UTI

A

E.coli
proteus mirabilis
Klebsiella

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22
Q

what is the causative pathogens for MRSA

A

methicillin-resistant staphylococcus aureus

Staphylococcus aureus

23
Q

what are some risk factors for acquiring MRSA

A

chronic illness requiring healthcare visits

living in crowded condition/semi-closed communised

prior abx use

prex Hx MRSA

exposure to MRSA +ve people

24
Q

what are the 4Cs for C.diff infection

A

Clindamycin
Co-amoxiclav
cephalosporin eg ceftriaxone, cefuroxime
ciprofloxacin

25
what is the causative pathogens for IV line infection
coagulase -ve staphylococci | staphylococci aureus
26
what are some of the clinical features of HAP/VAP
colonized by MDR bacteria ``` fever > 38 SOB productive cough chest pain fatigues ``` ``` crackles maybe present hypoxia inc RR asymmetric chest expansion diminished resonance ```
27
what are some of the clinical features of catheter-associated UTI?
``` fever + rigors dysuria/polyuria/frequency N+V loin to groin pain fatigue ``` cloudy urine foul smelling urine haematuria
28
what are some of the clinical features of MRSA infection?
boils abscess cellulitis impetigo if bloodstream spread - secondary infection - pneumonia, UTI, septic arthritis, osteomyelitis
29
what are some of the clinical features of C.diff infection
``` Diarrhoea abdo pain fever N+V symptoms of shock if dehydrated/sepsis - hypotension and tachycardia ```
30
what are some of the clinical features of IV line infection
site of IV line - red, inflammed, tender to touch, hot, purulent, pain fever * blood infection = sepsis and so those with IV line infection should be treated seriously
31
what is the diagnostic criteria for HAP/VAP
2/3 of the following findings 1) fever > 38 degree 2) leucocytosis or leukopenia 3) purulent secretions
32
investigation for HAP/VAP?
bloods - FBC, U&E, CRP CXR culture of LRTI --> HAP (a protected brush specimen via bronchoscopy) VAP culture --> endotracheal asipiration ABG
33
investigation for catheter-associated UTI
urine dip initially/MSU culture | bloods - FBC, CRP
34
investigation for MRSA associated hospital infection
``` FBC blood culture urine culture tissue culture sputum culture Echo - indicated if new murmur and signs of endocarditis CXR - indicated if suspected pneumonia arthrocentesis fluid culture - indicated if evidence of joint effusion, pain or warmth ```
35
investigation for C-diff associated infection
FBC Faecal occult blood - often positive stool PCR stool immunoassay for glutamate dehydrogenase (detect C.diff in bowel but no infection) stool toxin A & B (+ve) AXR - indicated if significant distension
36
investigation for IV line associated infection
FBC CRP blood culture 2x swab from access site
37
what are some differentials to C.diff colitis?
ABx associated diarrhea ischaemic colitis gastroenteritis IBD
38
What are some risk factors to consider when managing HAP/VAO
1) ABx in th pre-ceding 90 days 2) septic shock at the time of VAP 3) ARDS preceding the VAP 4) current admission to hospital of > 5 days 5) acute renal replacement therapy prior to VAP onset
39
what are the managing plan after considering the risk factors of HAP/VAP?
Before culture results without RF: empirical abx Before culture results with RF : empirical combination abx After culture results: guided monoptherpay
40
what is the CPIS scoring system?
clinical pulmonary infection score - used for VAP only used in day of diagnosis and day 3 for consideration of continuing Abx
41
management for catheter associated UTI?
change catheter if > 7 days obtain urine sample empirial abx
42
management for MRSA associated infection?
Skin and soft tissue: debridement including abscess incision and drainage and IV abx Bacteremia, pneumonia, endocarditis: IV abx UTI: oral abx (uncomplicated, IV (complicated) Recurrent (bactericidal cleansing + nasal instillation of mupirocin)
43
management for C.diff associated infection?
Initial episode fulminant (sudden and severe) - Vancomycin plus metronidazole or trugecycline or IVIG - Discontinue causative agent - Supportive care + infection control measures Less severe 1st episode: - oral vancomycin or fidaxomicin or metronidazole - discontinuecauasative agent - supportve care + infection control measures First recurrence: repeat abx Second recurrence repeat abx + faecal transplant.
44
management of IV line associated infection
remove device empirial abx sepsis - bufalo
45
what are the complications of C.diff
Ileus peroration and peritonitis toxic megacolon
46
what is the definition of pyrexia of unknown origin?
temp of > 38.3 lasting more than 3 weeks with no obvious source despite an investigation (3 days in the hospital or 3 episode of outpatients visit
47
infective causes of pyrexia of unknown origin
TB intra-abdominal abscess pelvic abscess HIV in immunosuppressed pts
48
malignancy causes of pyrexia of unknown origin
leukemia lymphoma renal cell carcinoma ant mets
49
autoimmune causes of pyrexia of unknown origin
``` IBD polyarthritis rheumatics temproal arteritis SLE Still's disease - rare autoimmune inflammatory disease ```
50
miscellaneous causes of pyrexia of unknown origin
``` drug induced fever hepatitis cirrhosis DVT sarcoidosis thyroid disease CNS disorder factious fever ```
51
emergency causes of pyrexia of unknown origin
immunocompromised or neutropenic sepsis | suspected GCA
52
red flags of pyrexia of unknown origin
``` fever + pattern of fever recent travel abroad to the TB affected area recent contact with animals/ets night sweats weight loss ``` system review required (Hx + Exam) - CVS - chest pain, palpitations - RVS - SOB, haemopytsis - GI - abdo pain, N+V, diarrhoea - Neuro - headaches, visual defects, sensory or motor deficit
53
investigation of pyrexia of unknown origin
temperature basic obs - pulse, RR, BP, oxygen saturations system review - CVS - new murmur? - RVS - RR - GI - abdo tenderness, hepatoseplenomeglay - Neuro - mainly hx - lymphadenopathy - infection/malignancy - rash or skin lesiosn - SLE, sarcoidosis, HIV, EBV blood test - CRP, FBC, U&Es, LFT, TFT, blood cultures, skin TB test, CXR, rahs or palpable lymph node biopsy, MRI imaging - CT abdo pelvis, serological testing
54
management of pyrexia of unknown origin
watchful wait approach = acceptable in a clinically stable pt for whom no diagnosis can be made after extensive investigation and prognosis is likely to be good empirical abx for individuals who are clinically unstable or neutropenic

Year 5 Conditions (19 decks)

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