Infections Lecture

Question 1

Temp > 100.9 F or < 96.8 F
HR> 90
RR > 20
AMS
Significant edema or + fluid balance
Hyperglycemia (plasma glucose > 140)

Answer 1

general variables for SIRS

Question 2

Leukocytosis or leukopenia
Normal WBC with >10% immature
Plasma C-Reactive protein >2 SDs above normal

Answer 2

inflammatory variables of SIRS

Question 3

SIRS + infection =?

Answer 3

Sepsis

Question 4

If you make a SIRS dx, what must you do next?

Answer 4

Look for infection (SEPSIS)

Question 5

UTI
Pneumonia
Cellulitis

Answer 5

Common bacterial causes of sepsis

Question 6

Flu
Viral meningitis
Severe shingles

Answer 6

common viral causes of sepsis

Question 7

Can parasites and fungus causes sepsis?

Answer 7

YES

Question 8

2+ SIRS criteria + infection

AND:

• *end organ damage as defined by 1 of the following:**
• Hypotension (MAP <65 or SBP <90 at any check)
• Renal failure (Cr >2.0 or oliguria)
• Shock liver (bili >2)
• Coagulopathy (PLT< 100, INR > 1.5, PTT > 60 seconds)
• Resp failure (any invasive or noninvasive mechanical vent)
• *-Elevated lactic acid <2**

Answer 8

Severe sepsis

Question 9

MAP <65 or SBP <90
Creatinine > 2.0 or oliguria
Bili > 2.0
Platelets < 100
INR > 1.5
PTT > 60 sec
Mechanical ventilation
elevated lactic acid <2

in addition to 2+ SIRS criteria and an infection

Answer 9

Severe sepsis

Question 10

Diagnosed severe sepsis and then…

Severe hypoperfusion within 1st hour after aggressive fluid resuscitation

• *-severe hypotension (SBP<90 x2 or MAP <65 x2)
• worsening baseline pressures >40 mmHg SBP as compared to previous readings**
• *********lactate levels >4**

Answer 10

Septic shock

Question 11

SIRS has a 7% mortality rate
Sepsis has a 16% mortality rate
Severe sepsis has a 20% mortality rate
Septic shock has a __% mortality rate

Answer 11

46%

Question 12

How many sites do you need to collect from for blood cultures?

Answer 12

at least 2 different ones

Question 13

start broad spectrum abx

-Monotherapy:
Carbapenems
Cephalosporins
Fluoroquinolones
Extended spectrum PCN

-Combo therapy: cipro+ vanco!

Answer 13

Severe sepsis tx

Question 14

What is the combo therapy for severe sepsis?

Answer 14

Cipro + Vanco

(vanco covers MRSA)

Question 15

+ blood cultures x2 with common pathogens:

Persistent pos blood cultures after or during tx

TTE evidence of vegetation or good auscultation of NEW valvular regurg

Other imaging suggesting intracardiac abnormality

(strep veridans, s. aureus, enterococcus)

Answer 15

MAJOR Duke Criteria for Endocarditis

Question 16

Presence of valvular heart disease NOS

IV drug use

Fever

Unexplained vascular phenomenon (conjunctival hemorrhage, cuteanous petechiae)

Answer 16

MINOR Duke Criteria

Question 17

Will a TEE show vegetation in endocarditis?

Answer 17

YES

Question 18

Can endocarditis cause respiratory failure?

Answer 18

YES..bc of valve damage

Question 19

true or false…

get blood cultures before starting abx and follow them until finalized

Answer 19

true

Question 20

Bacteremia leads to seeding of bacteria within bone

monomicrobial

blood and bone cultures should match

Answer 20

Hematogenous osteomyelitis

Question 21

Bacteria seeds the bone from adjacent tissue

Polymicrobial

Blood cultures may or may not be positive

Answer 21

Contiguous (diabetic) osteomyelitis

Question 22

Slow, insidious onset
frequently presenting as skin disruptions that are very slow healing, non healing or recurrent

Subacute= days to week
chronic= months to years

Answer 22

DM associated contiguous osteomyelitis

Question 23

Preferred image for osteomyelitis?

Answer 23

MRI!

Question 24

True or False…

WBC
ESR
CRP

may be elevated in osteo

Answer 24

True

Question 25

Tx=
surgery
broad spectrum parenteral abx. metronidazole + cefepime (or fluoroquinolones) + vanco

length of tx= 6 weeks!

Answer 25

Osteo tx

(also want to get weekly CBC, CMP and CRP)