Post operative complications: Healthcare associated infections Flashcards
CA-UTI
Illness associated with _____ infection and a _____ catheter.
Presence of bacteria in urine is very common. (3x risk of ____ versus no bacteruria)
____of patients with catheters
Risk factors: ____, _____ of catheterisation*, ___ ____
CA-UTI
Illness associated with bacterial infection and a urinary catheter.
Presence of bacteria in urine is very common. (3x risk of death versus no bacteruria)
10% of patients with catheters
Risk factors: women, duration of catheterisation, poor care
Recognition of CA-UTI
- ___ _____ symptoms: fever, confusion, ____, flank pain is rarer
- Pyuria is ___ _____, absence suggest something else however
- Presence/absence of ____/____urine is not diagnostic
- Cultures usually show 1 bacterial species
- Non specific symptoms: fever, confusion, lethargy, flank pain is rarer
- Pyuria is not diagnotic, absence suggest something else however
- Presence/absence of smelly/cloudy urine is not diagnostic
- Cultures usually show 1 bacterial species. e.g E coli, GNB, pesudomonas aeruginosa
Strategies to reduce CA-UTI
YES: avoid catheters; aseptic technique; remove; appropriate care; condom catheters
NO: antibiotic prophylaxis; antibiotics in urine bag; prophylaxis (cranberry); catheter irrigation; regular testing
Candida albican’s rare ‘unprovoked’ illnesses.
rare in healthy people, usually colonisation.
however the most common to cause human illness 90%,
nappy rash
thrush
oesophageal candidiasis (AIDS, immune suppression)
fingernails
candidaemia
disseminated candidiasis (neutropenia, leukaemia)
ocular, skin and urinary candidiasis (CA-UTI, candiduria rare in healthy people, usually colonisation)
presence of candida albicans in catheter what should be done?
If evidence of elsewhere infection, no treatment for it
Will not cause septic shock
Removal of catheter is usually sufficient
May take another sample for clearance but no further symptoms usually okay
What is a biofilm
Microbial community of cells that attach to a substrate (hard material) or interface with each other embedded in a matrix of extracellular polymeric substance. (sticky,polysaccharide)
Factors for pathogenesis of device associated infections
Bacteria device and host
Bacterial factors in device associated infections
Common bacteria form biofilms: staph epidermidis, aureus and E coli
Other factors: non specific such as hydrophobicity and electrostatic forces; adhesive proteins (MSCRAMMS), PIA
Devices and common pathogens + common micro organisms
CVC: staph aureus
UCA: Staph epidermidis, e coli
Mostly GP: SA, Staph epidermidis. rest GN’s such as E coli. Some fungi, candida
Device factors
Device material: PVC> teflon, latex>silicon
Source:synthetic>biomaterial
Surface: textured> smooth
shape: polymeric tubing>mesh
bacteria have preferences
Host factors
Aid bacterial adhesion, fibronectin
immune respone
problems with biofilm associated bacteria
Antibiotics more difficult to reach bacteria
Change phenotype
change surface proteins
slower growth rate
blood tests may say clear of bactaraemia but biofilm persists
Prevention of DAI’s
reconsider equipment use, hand washing, aseptic technique, monitor, remove unnecessary
treatment of infected catheter wit pus
Take swab and send off, remove cannula and in this case due to staph being very likely, start flucloxacillin
Source of hospital acquired infection in GI tract and mode of transmission
____, normal part of gut flora. Makes ____ which spread. (are a ____ structure, not _____)
5% people carrier, 20% in hosp
Mode of transmission is the diarrhoea/toilet so faecal matter on door handle. ____ ____ route
C.diff, normal part of gut flora. Makes endospores whch spread. (are a survival structure, not reproductive)
5% people carrier, 20% in hosp
Mode of transmission is the diarrhoea/toilet so faecal matter on door handle. Faecal oral route
