Infectious Disease

Question 1

What does antibiotic misuse mean?

Answer 1

Prescribed without indication (colnoization, fever, bacteriuria)
Too broad/too narrow
Wrong dose
Wrong duration

Question 2

What does abx misuse contribute to? (2)

Answer 2

Resistance 
adverse events (c difficile)

Question 3

What is the most common exposure in patients with CDI ?

Answer 3

abx

c difficile infection

Question 4

What is the antimicrobial stewardship program (ASP)? 4

Answer 4

• improve abx prescribing practises
• limit emergence of abx rsistance
• enable more cost effective usage
• decrease CDI

Question 5

What procedures require abx prophylaxis? to prevent catastrophic

Answer 5

• prosthesis (vascular surgery, orthopaedic)
• intra abdominal surgery + most urologic procedures
• spinal surgery
• invasive ophthalmic sx

Question 6

When should you decide what abx you order?

Answer 6

“As soon as possible” before OR

Question 7

How do you kno what abx to order, what specific issue to identify?

Answer 7

Allergies,

especially to G+ve (penicillins)

Question 8

Whose responsibility is it to prescribe abx prophylaxis?

Answer 8

The surgeon’s

Question 9

How do you dose ancef abx?

Answer 9

1g IV less than 60kg

2g IV more than 60kg

Question 10

Which abx cannot be giving within 1 hour of incision?

Answer 10

Vanco (needs drip, and cannot be bolused)

Cipro

Question 11

For a patient already on abx, do you give the prophylactic dose anyway?

Answer 11

Yes, it can be considered *** as 1 dose pre-op is not problematic

Question 12

When do you redose cefazoline?

Answer 12

• 3-4 hours after first dose given, or last dose given

- When there is excessive blood loss (>1/3rd blood volume)

Question 13

When do you discontinue prophy abx?

Answer 13

Within 24 hours

Question 14

What is the cross reactivity between penicillins and cefazolin?

Answer 14

No more than 10%

Question 15

What allergies to penicillin preclude its use?

Answer 15

• Anaphylaxis, resp disterss,
• urticaria (hives, not just rash)
• Steven Johnson’s syndrome
• Abx renal or liver dysfunction

Question 16

What percent of clindaymycin resistance exists, from staph auerus, at TOH?

Answer 16

25 %

Question 17

What cefazolin timing decreases SSI rate the most ?

Answer 17

Within 15 minutes of surgical incision

Question 18

What % abx are inappropriately prescribed at TOH?

Answer 18

10 to 60% of the time

Question 19

Klebsiella pneumonia skin and urine

Answer 19

-

Question 20

What is hospital acquired pneumonia?

Answer 20

> 72 hr = HAP, not CAP

-resp flora, more likely to be colonized by s aureus, g-ves

Question 21

Management of HAP (early)?

Answer 21

• Early (less than 5days) and no abx in prior 90 days

- - ceftriaxone or levofloxacine

Question 22

Management of HAP (late)?

Answer 22

Late (> 5 days), abx in prior 90 days, im-suppresive disease or tx
-anti-pseudomonal coverage (ceftazidime, or piptazo +/or vanco)

Question 23

Bacteruria?

Answer 23

• unless symptomatic rarely important
• do NOT tx urine without evidence of infection
• do NOT culture urine based on appearance or odour alone

Question 24

When is a U/A sensitive for ruling out a UTI?

Answer 24

BOTH WBC and nitries negative

Question 25

What are the only bacteria that creates nitrites?

Answer 25

"PUNCH-K" | proteus, ureoplasma, nocardia, cryptococcus, Hpylori, klebsiella

Question 26

Pleural effusion grows CoNS, susceptible to vanco only, do you add vanco?

Answer 26

- No. CoNS (coag negative staph) is not typically a resp pathogen, therefore not tx indicated - common contaminant

Question 27

DDx for abnormal looking wound, ex post op THR ? (3)

Answer 27

- dehiscence without infection - cellulitis (superficial infection) - abscess (superficial or deep)

Question 28

How do you assess possible abscess?

Answer 28

Ultrasound

Question 29

SSI account for what pecent of HAI ?

Answer 29

second most common

Question 30

Pathogenesis of SSI?

Answer 30

1-outside in (introduce organisms via skin at time of sgx) or 2- from inside out (intra-abdo sx)

Question 31

Therapy of SSI?

Answer 31

Cover skin organism - cefazolin (staph or strep) or cloxacillin (staph) - clinda if allergies - NB rates of clinda (25% MSSA) - Vanco if MRSA

Question 32

Cdiff tx?

Answer 32

- PO flagyl 500 q8h - PO vanco 125mg q6h (not IV !) - if ileus, consider PR vanco and or IV flagyl - reassess all PPI use

Question 33

what are the encapsulated organisms?

Answer 33

Strep pneumoniae H Influenza N Meningitidis -need humoral immunity (B cels)

Question 34

Degree of immunosuppression in an HIV pt depends on what?Degree of infectivity?

Answer 34

Immunosuppression - CD4 count | Infectivity - viral load

Question 35

True or False, early (non-transplant related) post op infections same as in non-SOT (solid organ transplant) patients?

Answer 35

True

Question 36

Asplenia can be anatomic or functional, which organisms do you worry about?

Answer 36

Encapsulated organisms, and parasites (malaria, babesiosis)

Question 37

What is is OPSI?

Answer 37

Overwhelming post-splenectomy infection --> sepsis/death

Question 38

Elective splenectomy, when do you vaccinate?

Answer 38

ideally 10 wks, but minimum 2 weeks before OR

Question 39

EMERGENT splenectomy, when do you vaccinate?

Answer 39

2 weeks POST OR, or at discharge

Question 40

TOH SPelenectomy guidelines suggest Rx of what else?

Answer 40

-amox-clav 875 mg PO BID x 7 days or, -moxifloxacin 400mg PO Daily x7D (if pen allergy) -Take if fever, unwell etc. -medicalert bracelet

Question 41

Which surgical resident level is most at risk of a needle stick injury?

Answer 41

PGY1 | But your risk accumulates by the end of your training

Question 42

Infection risk with Hep B from needlestick (in a patient WITH the disease)?

Answer 42

0% if vx responder

Question 43

Infection risk with Hep C from needlestick (in a patient WITH the disease)?

Answer 43

- Risk is 1.8% from needlestick or cut | - unknown (but low) from splash to eye, nose or mouth

Question 44

Infection risk with HIV from needlestick (in a patient WITH the disease)?

Answer 44

0. 3% from needlestick or cut | 0. 1% from splash to eye, nose, mouth, non-intact skin

Question 45

Post-exposure follow-up, if patient is positive?

Answer 45

- PEP x 4 weeks - Followup x 6 months - Discontinue if negative, no follow-up