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12 Infectious Disease > Sepsis Pedia > Flashcards

Sepsis Pedia Flashcards

1
Q

criteria for sirs

A

2/4 of:

  • core temp >38.5 or <36
  • tachycardia (mean hr >2 sd above normal in absence of stimuli or drugs)
  • tachypnea (rr >2 sd above normal or acute need for mechanical ventilation)
  • leukocyte count elevated or depressed for age or >10% immature neutrophils
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2
Q

criteria for sepsis

A

fulfillment of criteria for sirs in the presence of suspected or proven infection

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3
Q

criteria for severe sepsis

A

fulfillment of sepsis plus 1 of:

  • cardiovascular organ dysfunction
  • ards
  • > /= 2 organ dysfunctions
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4
Q

criteria for septic shock

A

severe sepsis + cardiovascular organ dysfunction depsire fluid resuscitation

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5
Q

criteria for multi-organ dysfunction syndrome

A

altered organ function such that homeostasis cannot be maintained without medical intervention (late stages of septic shock)

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6
Q

most common pathogens in previously healthy children

A

s aureus
strep sp
n meningitides

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7
Q

most common pathogens in children with chronic diseases

A

s aureus
candida
pseudomonas

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8
Q

transmission of s aureus

A

autoinoculation or direct contact

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9
Q

most significant risk factors for developing s aureus infections

A
  • disruption of intact skin and breaches from wounds
  • skin disease (eczema, burns)
  • catheters or shunts
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10
Q

different mechanisms for invasion by s aureus

A
  • coagulase that escapes phagocytosis
  • antigen masking by protein a
  • clumping factors
  • toxic shock syndrome toxin 1
  • pneumonia: panton valentine leukocidin, protein a, alpha hemolysin
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11
Q

t/f s aureus infections are more common following influenza virus infection in those with cerebral palsy

A

false, those with cystic fibrosis

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12
Q

most important groups of streptococcus species

A

s pneumoniae: alpha hemolytic (partial)

gas and gbs: beta (complete)

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13
Q

s pneumoniae or pneumococcus is the most common cause of

A 
bacteremia
bacterial pneumonia
meningitis
osteomyelitis
septic arthritis
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14
Q

gas: ___
gbs: ___

A

gas: streptococcal toxic shock syndrome and necrotizing fascitiis
gbs: early and late onset sepsis

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15
Q

pneumococcus is an important cause of secondary pneumonia in pts with __

A

influenzae infection

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16
Q

body defenses that limit strep infection

A
  • aspiration of secretions containing strep is hindered by epiglottic reflex
  • respiratory epithelial cilia move infected mucus towards the pharynx and away from the lungs
  • normal ciliary flow from middle ear to eustachian tube and sinuses to nasopharynx

== interference of these can lead to infection

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17
Q

the spread of infection by streptococus is facilitated by ___

A

antiphagocytic properties of its capsule (avoids immune clearance)

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18
Q

the pyrogenic toxin of gas is responsible for ___

A

rash of scarlet fever and streptococcal toxic shock syndrome

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19
Q

clinical syndromes of pneumococcal infections

A 
otitis media
sinusitis
pneumonia
sepsis
bacteremia
primary peritonitis
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20
Q

clinical syndromes of gas

A

pharyngitis
pneumonia (CONSOLIDATION)
scarlet fever (pale zone around the mouth, pharynx and tongue beefy red)
rheumatic fever
gas-tss (shock and multi-organ system failure early)
necrotizing fasciitis (extensive local necrosis)

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21
Q

clinical syndromes of gbs

A

early onset sepsis: within first 6 days of life, associated with maternal ob complications; usually sepsis, pneumonia, and meningitis, GROUND GLASS ON CXR

late onset sepsis: after day 7, bacteremia and meningitis

22
Q

gas infections can be diagnosed retrospectively on the basis of ____

A

an elevated streptococcal antibody titer

23
Q

cxr findings in strep infections

A

s pneumonia: pneumatoceles
pneumococcal/gas: consolidation
gbs in neonates: ground glass appearance

24
Q

substances that can increase during inflammatory response to infection

A

elevated crp
elevated procalcitonin
elevated tnf
elevated il6, il8, il10

25
Q

gold standard of diagnosing strep infection

A

isolation and identification of organism (blood, urine, csf)

26
Q

enzyme secreted by invasive n meningitidis that degrades secretory igA from muucosal surfaces

A

immunoglobulin a1 protease

27
Q

resistance in n meningitidis to complement mediated lysis and phagocytosis is mediated by

A

polysaccharide capsule and lipopolysaccharide

28
Q

manifestation of acute meningococcal septicemia

A
  • non-specific early symptoms
  • fine maculopapular rash
  • cold extremities, abnormal skin color, prolonged crt, petechial rashes >/= 80% cases
29
Q

manifestation of fulminant meningococcal septicemia

A
  • progresses rapidly (hrs)
  • septic shock: PURPURA FULMINANS, poor peripheral perfusion, tachytachy, hypotensive, coma, coagulopathy, renal/cardiac failure
30
Q

diagnosis of n meningitidis

A
  • child with unexplained rash
  • signs of meningitis/septicemia
  • PE + labs
  • definitive: culture
31
Q

indications for iv ceftriaxone for n meningitidis

A
  • petechiae starts to spread
  • rash becomes purpuric
  • signs of meningitis or septicemia
  • child appears ill
32
Q

antibiotic prophylaxis for n meningitidis

A

ceftriaxone or ciprofloxacin

33
Q

p aeruginosa is commonly isolated among neonates with __ and __

A

bacteremia and malignancy

34
Q

risk factors for p aeruginosa infection

A
  • prolonged hospitalization
  • broad spectrum antibiotics
  • chemotherapy
  • mechanical ventilation
  • urinary catheters
35
Q

manifestations of pseudomonas infection

A
  • ecthyma gangrenosum: characteristic skin lesion*
  • colonization of burns and wounds
  • conjunctivitis, nosocomial bacteremia, pseudomonas ulcer (eyes)
36
Q

60% of ___ patients have chronic respiratory infection by pseudomonas

A

cystic fibrosis

  • bacteria settle into thick mucus
  • ground glass on cxr, bronchial thickening and consolidation
  • respiratory failure cases death
  • vap
37
Q

3rd most common cause of bloodstream infection in premature infants

A

candida albicans

> 10% from vertical transmission

38
Q

drugs that facilitate candida colonization and overgrowth

A

h2 blockers and broad spectrum antibiotics

39
Q

routes by which candida reaches the bloodstream

A
  • git mucosal barrier
  • iv catheter
  • localized infection
40
Q

characteristics of oral candidiasis / thrush

A
  • superficial mucous membrane infection

- pseudomembranous, erythematous, or chronic hypoplastic

41
Q

characteristics of diaper candidiasis

A
  • both immunocompetent and compromised
  • rash with satellite lesions
  • with systemic symptoms
42
Q

characteristics of vulvovaginal candidiasis

A
  • both immunocompetent and compromised
  • common in pubertal and postpubertal females
  • rash with satellite lesions
  • pregnant, ocps, oral antibiotics
43
Q

characteristics with ungual and periungual candidiasis

A
  • both immunocompetent and compromised

- fingers > toes

44
Q

when to suspect sepsis

A

initial localized infection -> develop systemic
initial systemic infection -> worsens (despite treatment)

PLUS fever, lethargy, increased sleepiness, general pain, discomfort or fussiness, nausea/vomiting, headache
PLUS sirs

45
Q

surviving sepsis campaign reduced mortality rate by

A

25%

46
Q

treatment for s aureus

A

mssa: penicillin or 1st gen cephalosporin (+ beta lactamase inhibitor [clavulanic acid, sulbactam, tazobactam])
penicillin allergic or suspected mrsa: vancomycin

47
Q

treatment for strep

A
  • > /=1 mo pneumococcal meningitis: vancomycin + cefotaxime OR ceftriaxone
  • fully immunized uncomplicated cap: ampicillin or penicillin g
  • hospitalized and not fully immunized: 3rd gen parenteral cephalosporin (ceftriaxone or cefotaxime iv)
  • allergic to penicillin and cephalosporin: macrolides
  • gas: penicillin, amoxicillin, cephalosporin
  • gbs: penicillin g
  • group b meningitis: high dose penicillin, ampicillin
48
Q

treatment for n meningitidis

A
  • initial 3rd gen cephalosporin

- confirmed beta lactam sensitive meningococcal: penicillin

49
Q

treatment for p aeruginosa

A
  • ceftazidime (effective for cystic fibrosis)
  • piperacillin or piptazo + aminoglycoside
  • outpatient: ciprofloxacin (not for <18 yo)
50
Q

treatment for candida albicans

A
  • not systemic, full term infant: topical antifungal
  • preterm: systemic therapy
  • remove central venous catheters
  • 21 days of systemic fungal therapy
  • systemic candidiasis: amphotericin b

12 Infectious Disease (10 decks)

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