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Infectious Diseases > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

What antibiotic therapy is recommended for sepsis of unknown location

A

IV Amox, Met, Gent

If penicillin allergic use vancomycin instead of amox

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2
Q

Why would you switch a patient from gentamicin to azetreonam

A

If they have been on gent for 72 hours but still require therapy
If they have renal impairment

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3
Q

Metronidazole covers which type of bacteria

A

Anaerobes

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4
Q

What are some of the complications of using peripheral venous catheters

A

Insertion site phlebitis and catheter related blood stream infection

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5
Q

Explain the formation of biofilms on peripheral vascular catheters

A

A sheath of biological material can form on the PVC
Microorganisms can adhere to this biofilm and some such as S.aureus contribute
This biofilm can protect microorganisms from the effect of antibiotics
If left in long enough, parts of the biofilm can break off and spread through the blood leading to infection

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6
Q

What should be done to prevent contamination of the blood culture bottle itself

A

Remove the cap and decontaminate the rubber stopper with an alcohol wipe
Ensure the fluid in the bottle is not orange/red as this indicates prior contamination - get a new bottle

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7
Q

What is the optimum blood volume taken for a blood culture

A

8-10ml per botthle

No more than 1% of blood volumes for infants and children

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8
Q

What is the risk of overfilling a blood culture bottle

A

Can lead to false positives

CO2 generated by the excess WBC can trigger the detectors indicating a false positive

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9
Q

Which sites should be avoided for blood culture samples

A

Femoral vein - hard to adequately clean area
Existing peripheral cannulae - may be colonised
Central venous access devices - unless it is the device that is infected
Arteriovenous shunt - do not cannulate the affected arm/hand

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10
Q

Which blood culture bottle should be filled first

A

The aerobic one

Reduces chance of air contamination in the anaerobic one

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11
Q

What is the main causative organism of UTIs

A

E.coli

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12
Q

List risk factors for catheter associated UTI

A 
Female 
Elderly 
Impaired immune system 
History of catheter use 
The length of time it is in situ 
Length of hospital stay prior to insertion 
Previous UTI/CAUTI
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13
Q

What is an Arteriovenous fistula

A

A subcutaneous anastamosis of an artery and adjacent vein - usually wrist radiocephalic or elbow brachiocephalic
It is used for long lasting, permanent vascular access
E.g. in dialysis patients

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14
Q

What is the purpose of an AVF

A

It causes more blood to flow into the vein (as now connected directly to the artery)
This makes it larger and stronger and so improves the site for repeated needle insertions

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15
Q

What is an arteriovenous graft

A

A synthetic tube graft is used to connect an artery and vein - this becomes the site of needle placement
Used if the patient doesn’t have a suitable vein for fistula creation

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16
Q

Which patient factors increase the risk of severe infection

A 
Severe underlying disease 
Severe malnourishment 
Immunosuppression or immunodeficiency 
Loss of skin integrity - i.e. trauma 
Pre-existing infection near or at insertion site
17
Q

How does a AVF/AVG infection present

A

Local signs - redness, swelling, pain, general inflammation

Systemic infection signs

18
Q

How long does it take an AV fistula to mature before it can be used

A

4-8 weeks

19
Q

C.diff will always cause symptoms if present - true or false

A

False
Present in the bowel of up to 3% of the healthy population and can live in the bowel without causing harm (asymptomatic colonisation)

20
Q

C.diff produces spores - true or false

A

True

21
Q

Which antibiotics are most frequently associated with a C.diff infection

A

Clindamycin
Cephalosporins
Ciprofloxacin (fluoroquinolones)
Co-amoxiclav (broad spectrum penicillins)

22
Q

What is the main risk factor for C.diff infection

A

Previous exposure to antibiotics

23
Q

How does C.diff infection present

A

It is a GI infection
Symptoms range from mild diarrhoea to life threatening colitis
Also abdominal cramps, fever, raised WCC
Can be fatal - peritonitis, toxic megacolon etc.

24
Q

How do patients aquire C.diff infection

A

Receive antibiotic or enteral therapy
This alters the micro flora in the gut
Patients are exposed to C.diff and become colonised
C.diff mulitplies and releases toxins leading to infection

25
Q

What are the risk factors for a C.diff infection

A 
Current or recent (last 3 months) used of antibiotics 
Increased age (>65)
Prolonged inpatient stay 
Serious underlying disease 
Surgical procedures 
Immunosuppression 
Use of PPIs 
Previous C.diff infection
26
Q

How long after antibiotic treatment is started does C.diff infection typically present

A

Symptoms usually present between day 4-9 of treatment

However, they can occur up to 8 weeks after discontinuation of treatment

27
Q

What is the definition of diarrhoea

A

The passage of 3 or more loose or liquid stools per day

Or more frequently if 3 is normal for the patient

28
Q

How does C.diff spread

A

It is spread via spores which C.diff releases
Can be ingested from environment, contaminated surfaces, hands of staff or visitors
Symptomatic patients shed these spores in their stool at a high rate - main source of contamination in hospital

29
Q

What is the main route of transmission of C.diff

A

Faecal oral route

Contact with an infected person or contaminated surface and then touching your mouth

30
Q

How do you treat C.diff infection

A

Oral metronidazole - mild
Oral Vancomycin - severe

Start treatment as soon as suspected - don’t wait for the lab

31
Q

C.diff infections can recur - true or false

A

True

Either via reinfection from a contaminated environment or relapse from ggerminatingspores in the gut

32
Q

C.diff patients should be isolated - true or false

A

True
If symptomatic they need to be isolated and contact precautions put in place
Give an ensuite or commode to prevent toilet contamination and spread
Isolated until 48 hours symptom free

33
Q

Alcohol hand gel is sufficient when contacting a C.diff patient - true or false

A

FALSE
Must use warm water and soap
Gel does not kill or get rid of the spores

34
Q

When is a patient considered to be clear of a C.diff infection

A

When they have been asymptomatic (e.g. no diarrhea) for 48 hours
You do not need to send samples to the lab to confirm clearance

35
Q

What are the requirements for IV antibiotics to oral switch (IVOST)

A

Haemodynamically stable - BP/HR normalising and apyrexial for >24 hours
Oral route available - eating/drinking and no malabsorption
Infection markers improving - WCC moving towards normal
Excluded deep seated infection source.

Infectious Diseases (1 decks)

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