Infectious disorders Flashcards
Antibiotic resistance is
bacteria that have become resistant to the antibiotics designed to kill them
* it does not mean that the body is becoming resistant to antibiotics
________ are responsible for an increasing number of hospital acquired infections
multi-drug resistant organisms
The antibiotic class that causes the most allergic reactions is
the Beta lactams (includes penicillin)
The types of penicillin include
penicillin G (must be given IV) destroyed by stomach acid Penicillin V (given by mouth) semi-synthetic
There is a crossover allergy between
penicillin & cephalosporins
cephalosporins contain benzylpenicillin causing the side chain reaction
Patients with penicillin allergies should
avoid 1st generation cephalosporines (cefazolin & cephalexin)
Surgical site infection statistics:
2 to 5% for extra-abdominal surgeries
20% for intraabdominal surgeries
15% of all nosocomial (hospital acquired) infections
Occur within 30 days of surgery or within 1 year of a prosthetic implant or organ
Prevention of SSI includes:
preoperative antibiotics- timed so that concentration is established in the serum and tissues when incision is made
glycemic control <200 mg/dL
maintain normothermia
optimize oxygenation
shower/bath prior to surgery with antimicrobial soap
intraoperative skin prep with an alcohol-based antiseptic agent
Blood stream infections are most likely due to
central venous catheters
Catheter associated BSI is defined as
bacteremia or fungemia in a patient with an intravascular catheter and at least one positive blood culture obtained from a peripheral vein
Central line insertion bundles include
clean skin with CHG avoid femoral site if possible wash hands full barrier precautions sterility when access ports remove as soon as no longer needed avoid parental dextrose/nutrition when no longer needed
Clostridium difficile is a
spore-forming bacterium
C diff produces
antibiotic associated diarrhea and pseudomembranous colitis due to production of toxins A & B
C diff may lead to the need for
subtotal colectomy and ileostomy
Treatment of C diff is
removal of causative antibiotic and oral antibiotics (metronidazole or vancomycin)
Intraoperative considerations for the C diff patient include
hemodynamic instability is likely
contact and isolation precautions are essential
must use handwashing to remove spores
must use bleach germicidal wipes on equipment/room
The mortality of necrotizing soft tissue infections is
75%
Necrotizing soft tissue infections include
gas gangrene, toxic shock syndrome, severe cellulitis, flesh-eating infection, Fournier’s gangrene- genital/perineal area
The presentation of necrotizing soft tissue infections is
general infection, AMS, pain
infection begins in deep tissue planes
Anesthetic management of the patient with necrotizing soft tissue infections includes
do not delay surgical tx.
resuscitation often necessary d/t septic & fluid shifts
hemodynamic instability- release of cytokines, good IV access, a-line, +/- CVC, blood product availability
at risk for multiorgan failure–> ICU
Tetanus is caused by
the neurotoxin tetanospasmin which is produced by Clostridium tetani organisms
leads to the clinical manifestations of tetanus
Tetanus suppresses the
inhibitory neurons in the spinal cord–> generalized skeletal muscle contractions
Early signs of tetanus are
Trismus and neck rigidity
The treatment of tetanus is to
control skeletal muscle spams (benzodiazepines, muscle relaxants)
- neutralize exotoxin- human anti-tetanus immunoglobulin
- penicillin
Tetanus affects
disadvantaged areas and communities and the disease is transmitted when children are born in unhygienic conditions
non-sterile materials are used to cut the umbilical cord
The main challenges to eliminate tetanus are
a lack of access to communities because of insecurity, cultural barriers, competing priorities, and inadequate funding
Types of pneumonia include
community acquired, aspiration, postoperative, and ventilator- associated
Communicated acquired pneumonia is most often due to
streptococcus pneumoniae
other organisms can be viral (RSV, SARS, influenza) or fungal (pneumocystis, cyptococcus)
Aspiration pneumonia clinical manifestations
depend on the nature and volume of aspirated material and can include fulminating arterial hypoxemia, airway obstruction, atelectasis, and pneumonia
The presentation of pneumonia includes
fever, chest pain, dyspnea, fatigue, rigors, cough, & sputum production
chest radiograph, + cultures, increased WBCs
patient history (travel, cave exploration, diving, contact with birds/sheep, immunocompromise)
Prevention of pneumonia includes
PPSV23 for adults >65 and for adults 19-64 who smoke or have certain health conditions
For patients with pneumonia who must undergo anesthesia
delay surgery if possible, during acute pneumonia
avoid fluid overload
suctioning
maintain abx/antiviral/antifungal schedule
LPV, often PEEP dependent- consider same ventilator settings as ICU, lowest inspired Oxygen possible
S/S of SARS include
nonspecific (fever, headache, diarrhea, respiratory distress, hemoptysis)
SARS is highly
virulent with high mortality
7 coronavirus strains that can infect people, also includes “bird flu” H5N1
For viral transmission, an increase in
viral load with peak is when you are infectious
Viral infections treatment includes
prevention of spread
vaccines when available
neuraminidase inhibitors decrease severity when given in first 48 hours of symptoms
mostly supportive care
Anesthesia management of SARS include
LPV and symptom management
barrier precautions- full body disposable over suits, double glove, goggles, air purifying respirators, filters, N95
filters placed on both limbs of breathing circuit- protect patient and ventilator
clean the room with alcohol
if possible, wait 48 hours until another case
Personal protective equipment for the SARS patient includes
negative pressure rooms
& provider precautions
Provider precautions for SARS include
goggles, face shields, gowns, gloves, masks, and shoe covers
Operating rooms are considered to be
positive pressure rooms
Ultraviolet germicidal irradiation is used
against multiple organisms (Ebola, coronavirus, bacteria)
Ultraviolet germicidal irradiation uses
different types of wavelengths- hospitals use UV-C (vs. UV-A, UV-B)- germicidal UV
Ultraviolet germicidal irradiation can be
installed in HVAC systems
needs direct line of sight to the surface
Blind spots: underside of a table won’t be exposed
Ultraviolet germicidal irradiation can cause
burns
HEPA filters are
high-efficiency particular air filters that can theoretically mechanically remove dust, pollen, mold, bacteria, and any airborne particles with a size of 0.3 microns
HEPA filters are used in
HVAC systems for isolation rooms
available for AGM breathing circuits-expiratory and inspiratory limbs
portable- filters the air in a room when it is not an isolation room- useful in ORs which are positive pressure rooms
HMEF are
heat & moisture exchange medium together with an electrostatic filter medium
*add dead space & resistance
Tuberculosis is the result of
mycobacterium tuberculosis- an obligate aerobe responsible for TB which survives most successfully in tissues with high oxygen concentrations
-pulmonary and extrapulmonary
Most cases of TB come from
Asia & Africa-TB more likely in HIV infected than HIV negative individual
Signs and symptoms of TBB include
cough, anorexia, weight loss, night sweats, chest pain
chest radiographs show apical or subapical infiltrates or bilateral upper lobe infiltration with the presence of cavitation
TB vertebral osteomyelitis (Pott’s disease) is a common manifestation of extrapulmonary TB
The most common test for TB is
tuberculin skin (Mantoux’s) test
TB treatment includes
Can be resistant to second-line therapeutic agents (fluoroquinolones and at least one of three injectable (amikacin, kanamycin, or capreomycin)
chemotherapy with isoniazid
Anesthetic considerations for TB include
delay case until treatment if possible, negative pressure rooms, patients and staff should wear N95 face masks, HEPA filter, caution to avoid spine injury during airway manipulation
Acquired immunodeficiency syndrome is an
acute seroconversion illness occurs with a high viral load soon after infection
_______ does not usually occur until the CD4 count is less than 200 cells/mL
Pneumocystis pneumonia
Gradual involution of lymph nodes occurs with
a decrease in T help lymphocytes (CD4 T cells) and an increase in viral load as onset of AIDs occurs
The diagnosis of AIDs in HIV positive patients is established
When one of the AIDs defining diagnoses is present
The most specific and sensitive test for HIV is
nucleic acid testing of HIV RNA
Anesthesia considerations for the for the AIDs patient includes
patients are subject to long-term metabolic complications including lipid abnormalities and glucose intolerance which may result in the development of DM, CAD, and CVD
Anesthesia that should be avoided with AIDs patients includes
focal neurologic lesions may increase intracerebral pressure, precluding neuraxial anesthesia
neurologic involvement may make the use of succinylcholine hazardous
Appropriate labs to draw for patients with AIDs include
CBC, metabolic panel, renal function studies, liver function tests, coagulation studies
Chest XR, ECG
Antiretroviral treatment includes
six major classes of antiretroviral agents in which at least 3 are used
When an accidental exposure occurs,
students must call the Duke employee occupational health and wellness safety hotline
Prions are
proteinaceous infective particles that are infectious proteins without known nucleic acid genomes
Prions preferentially target
neurologic tissue, cause spongiform encephalopathies
Types of prions include
Creutzfeldt Jakob disease, Mad cow disease
these neurodegenerative diseases are universally lethal
Prions (contagious)
are not contagious unless you have direct inoculation of the brain or nervous system with infective tissue
-standard precautions are used
Standard precautions apply to
the care of all patients, regardless of suspected or confirmed infection or colonization status
hand hygiene, safe injection practices, respiratory hygiene and cough etiquette, environmental cleaning and disinfection, and reprocessing of reusable medical equipment
Contact precautions are used for
known or suspected infections that represent an increased risk for contact transmission
intended to prevent transmission of infectious agents, like MDROs
use of gown & gloves, dedicated equipment, private room when possible
e.g. norovirus, C. diff. MRSA
Enhanced barrier precautions are used to
expand the use of PPE beyond situations in which exposure to blood and body fluids is anticipated
care activities requiring gown and glove- toilet, airway care, wound care
Droplet precautions are used for
pathogens transmitted by respiratory droplets that are generated by a patient who is coughing, sneezing, or talking
E.g. meningitis, TB, rash petechial with fever, RSV, adenovirus, flu, SARS, avian flu
Airborne precautions are used for
known or suspected to bbe infected with pathogens transmitted by the airborne route (e.g. TB, measles, chickenpox, herpes zoster, herpes simplex, smallpox, rubeola
