noscomial infections (general)

Question 1

Q: What are nosocomial infections?

Answer 1

A: Nosocomial infections, or healthcare-associated infections (HAIs), are infections acquired by patients while receiving medical care for another condition.

Question 2

Q: What are common causes of nosocomial infections?

Answer 2

A: Nosocomial infections are commonly caused by multidrug-resistant bacteria such as MRSA, VRE, and CRE. Less commonly, they are caused by viruses and fungi.

Question 3

Q: What are the most common types of nosocomial infections?

Answer 3

A: The most common nosocomial infections include CAUTI, CLABSI, SSI, HAP, VAP, and CDI.

Question 4

Q: What initial assessment should be performed for a patient with signs of a nosocomial infection?

Answer 4

A: Perform an ABCDE assessment to determine if the patient is unstable or stable.

Question 5

Q: What is the first step in managing an unstable patient with suspected nosocomial infection?

Answer 5

A: Stabilize the airway, breathing, and circulation, and start broad-spectrum antibiotics.

Question 6

Q: What should be included in the history and physical examination of a stable patient with suspected nosocomial infection?

Answer 6

A: Obtain a focused history, including current or recent treatment at a healthcare facility, and perform a physical exam looking for systemic symptoms of infection and altered mental status.

Question 7

Q: What laboratory tests should be ordered for a stable patient with suspected nosocomial infection?

Answer 7

A: Order a complete blood count (CBC) with differential and assess for leukocytosis.

Question 8

Q: What should you consider if a patient with a urinary catheter presents with suprapubic discomfort and dysuria?

Answer 8

A: Consider catheter-associated urinary tract infection (CAUTI).

Question 9

Q: What tests confirm a diagnosis of CAUTI?

Answer 9

A: Urinalysis showing pyuria and bacteriuria, and a positive urine culture.

Question 10

Q: What should be suspected in a patient with a central line who shows systemic signs of infection and erythema at the insertion site?

Answer 10

A: Suspect central line-associated bloodstream infection (CLABSI).

Question 11

Q: How is CLABSI diagnosed?

Answer 11

A: Diagnosis is confirmed by two or more positive blood cultures taken from different sites.

Question 12

Q: What are the typical symptoms of a surgical site infection (SSI)?

Answer 12

A: Pain at the surgical site, peri-incisional swelling, warmth, erythema, purulent drainage, and wound dehiscence.

Question 13

Q: How is hospital-acquired pneumonia (HAP) suspected and diagnosed?

Answer 13

A: Suspect HAP in a patient who develops respiratory symptoms 48 hours or more after hospital admission. Diagnosis is confirmed by a chest X-ray showing a new lung infiltrate, consolidation, or effusion.

Question 14

Q: What should be considered in a patient on mechanical ventilation with signs of infection more than 48 hours after intubation?

Answer 14

A: Consider ventilator-associated pneumonia (VAP).

Question 15

Q: What is the preferred imaging modality for diagnosing VAP?

Answer 15

A: Point of care ultrasound (POCUS) is preferred for diagnosing VAP.

Question 16

Q: What are the symptoms and diagnostic steps for Clostridioides Difficile infection (CDI)?

Answer 16

A: Symptoms include large volumes of watery diarrhea and abdominal pain. Diagnosis involves a stool sample for CDI testing, including a glutamate dehydrogenase antigen test and C. difficile toxins A and B.

Question 17

Q: CAUTI: Definition, Symptoms/Clinical Features, Time of Onset, Diagnosis, Management, Treatment

Answer 17

A:

Definition: Catheter-associated urinary tract infection, an infection in patients with urinary catheters.
Symptoms/Clinical Features: Suprapubic discomfort, dysuria, urinary frequency, urgency, suprapubic or costovertebral angle tenderness.
Time of Onset: Typically within a few days of catheter placement or removal.
Diagnosis: Urinalysis showing pyuria and bacteriuria, positive urine culture.
Management: Change the urinary catheter, obtain a clean sample for testing.
Treatment: Antibiotics based on culture sensitivity, removal or replacement of catheter if needed.

Question 18

Q: CLABSI: Definition, Symptoms/Clinical Features, Time of Onset, Diagnosis, Management, Treatment

Answer 18

A:

Definition: Central line-associated bloodstream infection, an infection occurring in patients with a central line.
Symptoms/Clinical Features: Systemic signs of infection, erythema, tenderness, and purulence at the central line site.
Time of Onset: Symptoms typically develop after 2 days of central line placement or on the day of removal or the next day.
Diagnosis: Positive blood cultures from two or more sites.
Management: Obtain blood cultures, remove or replace central line.
Treatment: Broad-spectrum antibiotics, tailored based on culture results, removal or replacement of the central line.

Question 19

Q: SSI: Definition, Symptoms/Clinical Features, Time of Onset, Diagnosis, Management, Treatment

Answer 19

A:

Definition: Surgical site infection, an infection occurring at the site of a surgical incision.
Symptoms/Clinical Features: Pain at the surgical site, peri-incisional swelling, warmth, erythema, purulent drainage, wound dehiscence, induration, fluctuance.
Time of Onset: Typically within 30 days post-surgery, or up to a year if implants are placed.
Diagnosis: Clinical examination, signs of infection at the surgical site.
Management: Clean and dress the wound, consider wound culture.
Treatment: Antibiotics based on culture results, possible surgical debridement.

Question 20

Q: HAP: Definition, Symptoms/Clinical Features, Time of Onset, Diagnosis, Management, Treatment

Answer 20

A:

Definition: Hospital-acquired pneumonia, a lung infection developing 48 hours or more after hospital admission.
Symptoms/Clinical Features: Productive cough, pleuritic chest pain, shortness of breath, rales, decreased breath sounds, decreased oxygen saturation.
Time of Onset: 48 hours or more after hospital admission.
Diagnosis: Chest X-ray showing new lung infiltrate, consolidation, or effusion.
Management: Obtain a chest X-ray, supportive care.
Treatment: Broad-spectrum antibiotics, tailored based on culture results.

Question 21

Q: VAP: Definition, Symptoms/Clinical Features, Time of Onset, Diagnosis, Management, Treatment

Answer 21

A:

Definition: Ventilator-associated pneumonia, a lung infection developing after more than 48 hours of mechanical ventilation.
Symptoms/Clinical Features: Purulent secretions in the endotracheal tube, tachycardia, rales, decreased breath sounds.
Time of Onset: More than 48 hours after intubation.
Diagnosis: POCUS showing subpleural consolidation, liver-like echogenicity, dynamic air bronchograms.
Management: Obtain imaging, supportive care.
Treatment: Broad-spectrum antibiotics, tailored based on culture results.

Question 22

Q: CDI: Definition, Symptoms/Clinical Features, Time of Onset, Diagnosis, Management, Treatment

Answer 22

A:

Definition: Clostridioides Difficile infection, a bacterial infection causing diarrhea and colitis.
Symptoms/Clinical Features: Large volumes of watery diarrhea, lower or diffuse abdominal pain, abdominal distension, tenderness, decreased bowel sounds.
Time of Onset: Typically within a few days to weeks after antibiotic use or hospitalization.
Diagnosis: Glutamate dehydrogenase antigen test and C. difficile toxins A and B; if inconclusive, NAAT.
Management: Obtain a stool sample, supportive care.
Treatment: Metronidazole or vancomycin, isolation precautions to prevent spread.