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Infectious Disease > Nosocomial Infections > Flashcards

Nosocomial Infections Flashcards

1
Q

Types of nosocomial infections

A
  • pneumonia
  • urinary catheter associated infection
  • venous access associated bacteremia
  • soft tissue infection: sx site or pressure ulcers
  • C diff
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2
Q

Non infective causes of nosocomial fever

A
  • bleeding
  • thrombosis
  • drug fever
  • cancer
  • central fever
  • atelectasis
  • tissue damage
  • polyarticular gout
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3
Q

Nosocomial pneumonia

  • RF
  • Diagnosis
A

RF: cannot protect airways - stroke, dementia, post sx, mechanical ventilation

Diag: clinical

  • fever
  • leukocytosis
  • purulent sputum
  • desaturation
  • new or progressive infiltrates
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4
Q

Nosocomial pneumonia

  • bugs
  • tx
A

Bugs

  • pseudomonas
  • MRSA
  • less common: klebsiella, acinetobacter baumannii

Empiric abx

  • anti pseudomonas: ceftazidime, cefepime, tazocin, meropenem, imipenem, amikacin, gentamicin, ciprofloxacin, levofloxacin, aztreonam, polymyxin B
  • anti MRSA: vancomycin, linezolid

culture directed abx if culture +ve for 7days

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5
Q

Cause of non response to initial abx

A
  • wrong organism
  • complication
  • wrong diagnosis
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6
Q

What to tx for ventilator associated pneumonia

A

MRSA, pseudomonas aeruginosa

- pip-taco and vancomycin

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7
Q

risk factors for CAUTI

A

prolonged catheterisation > 6 days

Female gender

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8
Q

Acceptable indications for indwelling urinary catheter use

A
  1. clinically significant urinary retention
  2. urinary incontinence: e.g. comfort in terminally ill patient
  3. accurate urine output monitoring required: e.g. in critically ill patients
  4. patient unable or unwilling to collect urine: operation/ procedures
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9
Q

How to diagnose CAUTI

A

gold standard is urine culture

- dipstick and other non culture tests not reliable

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10
Q

What are the complications of pyelonephritis

A
  • renal or perinephric abscess
  • emphysematous pyelonephritis
  • renal papillary necrosis
  • recurrent infection: xanthogranulomatous pyelonephritis
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11
Q

What are RF for complicated pyelonephritis

A
  • urolithiasis
  • structural abnormality
  • ureter catheter/ stents
  • urinary tract instrumentation
  • long term catheterisation
  • immunocompromised host
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12
Q

How to diagnose pyelonephritis

A 
Clinical
- fever >38 with chills, flank pain, n&v
- costovertebral angle tenderness
Laboratory
- urine culture/ UFEME: WBC>10^5
- blood cultures
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13
Q

When to image pyelonephritis

A
  • severely ill
  • persistently febrile despite 48-72 hours of appropriate antibiotics
  • suspicion for urinary tract obstruction (worsening renal function or decreasing urine output) or other complications (e.g. abscess)
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14
Q

What is the criteria for admitting someone with pyelonephritis

A
  • male
  • underlying DM
  • persistent n&v
  • fever > 38
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15
Q

empiric tx for pyelonephritis

A
  • IV cefazolin

- IV gentamicin stat

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16
Q

empiric tx for nosocomial urinary infection

A

IV cefepime, IV amikacin stat

17
Q

empiric tx for cystitis

A

PO co-trimoxazole
else
PO augmentin

18
Q

what is fulminant CDI

- tx

A
  • hypotension
  • shock
  • ileus
  • megacolon

tx:
- po vancomycin
- rectal vancomycin
- IV metronidazole
sx:
- subtotal colectomy with preservation of rectum
- diverting loop ileostomy with colonic lavage with antegrade vancomycin flushes

19
Q

what to do for recurrent C diff recurrence

A
  • PO vancomycin in pulsed and tapered regimen
  • PO vancomycin 125mg Q6h x10d then rifaximin 400mg TDS 20 d
  • Fidaxomicin 200mg BD 10day
  • Fecal microbiota transplant
20
Q

Definition of HCAP vs HAP

A

pneumonia acquired in healthcare facilities (nursing home, hemodialysis centers, outpatient clinics, hospitalisation) within last 3 months

HAP: pneumonia acquired after 72 hours of hospitalisation

21
Q

how to prevent VAP

A
  • use non invasive positive pressure ventilation in selected populations
  • manage patients without sedation wherever possible
  • interrupt sedation daily
  • assess readiness to extubate daily
  • perform spontaneous breathing trials with sedatives turned off
  • facilitate early mobility
  • utilise endotracheal tubes with subglottic secretion drainage ports for patients expected to require greater than 48-72 hours of mechanical ventilation
  • change ventilator circuit only if visibly soiled/ malfunctioning
  • elevate head of bed to 30-45deg
  • hand hygiene
  • glove and gown compliance
  • oral care with chlorhexidine
  • maintain ETT cuff pressure > 20mmhg
  • orogastric rather than nasogastric feeding tubes
  • avoiding gastric overdistension
  • eliminating non essential tracheal suctioning
22
Q

Common VAP bugs

A

can be polymicrobial
gram neg bacilli: e coli, klebsiella, stenotrophomonas, pseudomonas, acinetobacter
gram pos: S aureus (MRSA). streptococcus

virus and fungi uncommon in immunocompetent hosts

23
Q

What are the drugs useful against pseudomonas

A 
BETA LACTAMS
- cephalosporin: ceftazidime, cefepime
- carbapenems: imipenem, meropenem
- monobactam: aztreonam
NON BETA LACTAMS
- fluroquinolones: ciprofloxacin, levofloxacin
- aminoglycosides: amikacin, gentamicin
- polymyxin B
24
Q

how do I prevent nosocomial pneumonia

A

General: hand hygiene, contact precaution

Mech ventilation:

  • non invasive ventilation, avoid intubation
  • continuous suction of subglottic secretions
  • endotracheal tube
  • contaminated condensate emptied and prevented from entering ETT

Prevent aspiration

  • 30-40deg
  • enteral nutrition

colonisation
- daily interruption of sedation and avoid paralytic agents

stress bleeding prophylaxis: H2 antagonist/ sucralfate

25
Q

How to prevent CAUTI

A

– Strict indications: urinary retention, critically ill, peri- operative period
– Handhygiene
– Aseptic insertion
– Maintain closed drainage system
– Urine bag below hip level
– Do not cause blockage of urinary catheter e.g. kinking

26
Q

Empiric antibiotic for venous access associated bacteremia

A

stable: IV vancomycin (MRSA)
unstable: IV vancomycin + amikacin (ecoli, k. pneumoniae, Pseudomonas)

27
Q

what is complicated venous access bacteremia

A

suppurative thrombophlebitis, endocarditis or osteomyelitis

persistent bacteremia despite >72h of microbial therapy

28
Q

principles of pre-operative antibiotic prophylaxis

- indications

A
  • evidence of efficacy or effect of SSI catastrophic
  • antibiotics: safe, inexpensive, bactericidal, active against probable contaminants
  • time the infusion so bactericidal drug level in tissue and serum at skin incision
  • maintain therapeutic lvl until few hours after incision closed
  • antibiotic given no more than 30 min before skin incision (vancomycin need 1 hour infusion)

Indications

  • all op entering hollow viscus
  • clean ops with insertion of prosthetic materia
  • Effect of SSI catastrophic

Infectious Disease (6 decks)

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