Infections Lecture Flashcards
Temp > 100.9 F or < 96.8 F
HR> 90
RR > 20
AMS
Significant edema or + fluid balance
Hyperglycemia (plasma glucose > 140)
general variables for SIRS
Leukocytosis or leukopenia
Normal WBC with >10% immature
Plasma C-Reactive protein >2 SDs above normal
inflammatory variables of SIRS
SIRS + infection =?
Sepsis
If you make a SIRS dx, what must you do next?
Look for infection (SEPSIS)
UTI
Pneumonia
Cellulitis
Common bacterial causes of sepsis
Flu
Viral meningitis
Severe shingles
common viral causes of sepsis
Can parasites and fungus causes sepsis?
YES
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**
Severe sepsis
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
Severe sepsis
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**
Septic shock
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
46%
How many sites do you need to collect from for blood cultures?
at least 2 different ones
start broad spectrum abx
-Monotherapy:
Carbapenems
Cephalosporins
Fluoroquinolones
Extended spectrum PCN
-Combo therapy: cipro+ vanco!
Severe sepsis tx
What is the combo therapy for severe sepsis?
Cipro + Vanco
(vanco covers MRSA)
+ 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)
MAJOR Duke Criteria for Endocarditis
Presence of valvular heart disease NOS
IV drug use
Fever
Unexplained vascular phenomenon (conjunctival hemorrhage, cuteanous petechiae)
MINOR Duke Criteria
Will a TEE show vegetation in endocarditis?
YES
Can endocarditis cause respiratory failure?
YES..bc of valve damage
true or false…
get blood cultures before starting abx and follow them until finalized
true
Bacteremia leads to seeding of bacteria within bone
monomicrobial
blood and bone cultures should match
Hematogenous osteomyelitis
Bacteria seeds the bone from adjacent tissue
Polymicrobial
Blood cultures may or may not be positive
Contiguous (diabetic) osteomyelitis
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
DM associated contiguous osteomyelitis
Preferred image for osteomyelitis?
MRI!
True or False…
WBC
ESR
CRP
may be elevated in osteo
True
Tx=
surgery
broad spectrum parenteral abx. metronidazole + cefepime (or fluoroquinolones) + vanco
length of tx= 6 weeks!
Osteo tx
(also want to get weekly CBC, CMP and CRP)
