Signs and Sx of infection

Question 1

infection that doesn’t have any Sx

Answer 1

inapparent
silent
subclinical
occulut

Question 2

infection that is inactive or dormant

Answer 2

latent infection

Question 3

examinations carried out for diagnosis of infection and to determine severity

Answer 3

HR
RR
temp
blood tests - FBC (WBCs), CRP

others based on Sx:
- urine dipstick
- CXR

Question 4

What is CRP?

Answer 4

non-specific marker of infection/inflammation

Question 5

normal temp

Answer 5

37 degC

Question 6

normal white cell count

Answer 6

4-11 x 10^9 /L

Question 7

normal CRP

Answer 7

<5 mg/L

Question 8

What would you be looking for in urine dipstick?

Answer 8

leukocytes

blood

proteins

Question 9

advantages of using CRP

Answer 9

levels are high during bacterial infection (40-200mg/L)

but lower during viral infection (10-40mg/L)

-> can distinguish between bacterial or viral cause

Question 10

disadvantages of using CRP

Answer 10

• not reliable to differentiate between viral and bacterial infection because some CRP ranges overlap
• eg. viral infection vs early stage bacterial infection (lower bacterial nos = lower CRP)
• CRP rises in response to inflammation, but there might not be an infection

Question 11

What is empirical Tx?

Answer 11

Tx chosen based on most likely organism/spectrum of ABX

Question 12

How to ID the causative organism?

Answer 12

microscopy

PCR test - tests for genetic material from specific organism

Question 13

Sx of sepsis to look out for

Answer 13

sweaty skin
disorientation
shivering
high HR
extreme pain
SOB

Question 14

patients at high risk of sepsis/more concerned about

Answer 14

• infants, esp U 3mths
• communication difficulties
• immunocompromised, LT steroids
• indwelling catheters/lines (source of infection)
• recent surgery/injury

Question 15

SEPSIS 6

Answer 15

1. oxygen
2. cultures
3. IV ABX
4. fluids
5. blood tets including lactate
6. fluid balance monitoring & urine output

Question 16

What does high lactate levels mean?

Answer 16

patient is very ill

require urgent and effective management

info on severity of infection

monitoring of disease progression

Question 17

What is lactate?

Answer 17

metabolite of glucose produced by tissues in the body under conditions of insufficient oxygen supply

normally cleared by kidneys/liver

normal = 1-1.5 mmol/L

very ill > 2 mmol/L (shock, hypoperfusion)

> 4 mmol/L = ICU admission

Question 18

general RF for infection

Answer 18

• age
• comorbidities
• current Tx (immunosuppression)
• nutritional status
• mechanical barriers -> catheters
• lifestyle -> travel, occupational risk

environment

• invasice procedures
• hosiptal/care settings

Question 19

immunocompromised patients

Answer 19

• congenital
• asplenia (spleen removed, on prophylactic ABX lifelong)
• HIV
• transplantation
• chemotherapy
• steroids

Question 20

ways to avoid infection

Answer 20

• healthy lifestyle (rest, exercise, diet)
• hand hygiene
• avoiding large crowds/people with infections
• mouthcare
• not sharing towels
• shoes to portect feet (esp diabetics)
• avoid cleaning waste products (animal, baby)
• vaccines

Question 21

start smart

Answer 21

• don’t start ABX unless evidence of infection
• take drug & allergy Hx
• start effective ABX Tx within 1hr of diagnosis or asap in patients with sepsis/severe infections
• avoid inappropriate use of broad spec ABX
• comply with local guidelines
• document indication/drug/dose/route on drug chart/clinical notes
• include review/stop date
• get cultures before starting ABX (but son’t delay therapy)

Question 22

FOCUS

Answer 22

review clinical diagnosis and the need for ABX at 48-72hrs and document plan of action