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ICM - Infectious Disease > Staph: bacteremia, sepsis, and MRSA > Flashcards

Staph: bacteremia, sepsis, and MRSA Flashcards

1
Q

What type of colonies does Staph form on blood agar

A

Coag + = Golden B-hemolytic

Coag - = Small, White non-hemolytic

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2
Q

Coagulase negative infections as important causes of infections with…

A

Prosthetic Devices

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3
Q

Most virulent of staph aureus species?

A

Staph aureus

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4
Q

Is S. Aureus an exogenous bacteria?

A

Normal human flora

25-50% of healthy persons

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5
Q

Heavier S. Aureus colonization happens among…

A

Insulin-dependent Diabetics
HIV patients
Hemodialysis patients
Skin Damaged Patients

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6
Q

Sites of human colonization

A 
Anterior nares
Skin
Vagina
Axilla
Perineum
Oropharynx
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7
Q

Diseases assocaited with increased S. Aureus risk?

A

Diabetes
PMN defects (chronic gran. disease, neutropenic, Job’s or Chediak-Higashi syndrome)
Skin Abnormalities
Prosthetics

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8
Q

How does MRSA tend to present?

A

Mostly infections of skin, tissue

approx 5-10% invasive

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9
Q

Pathogenesis of S. Aureus?

A

Pyogenic organism causes abscess at primary/distant sites
Inflammatory Response -> Initial PMNS -> Mac and Fibro infiltration
Contained or spreads to adjacent tissues/bloodstream

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10
Q

Whay give Bactrim?

A

A kind of shitty option for MRSA
Hyperkalemia, Nausea
Not a good Strep drug

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11
Q

Why give Kephlex?

A

Strep and Methycillin sensitive

Not MRSA

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12
Q

Toxin mediated S. Aureus disease

A

Cytotoxins at site
Pyogenic toxin superantigens (food bourne, TSS)
Exfoliative toxin (Staphylococcal scalded skin syndrome)

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13
Q

TSS treatment

A

Clindamycin

Stops bacterial protein synthesis to stop toxin production

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14
Q

Vaccination for S. Aureus?

A

Anti-S. Aureus antibodies have only been shown to be protective in vitro, but never in clinical trials

No. No Vaccine for you. Go away now.

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15
Q

Skin and soft tissue manifestations of S. Aureus

A

Impetigo (Epidemal Infection)
Folliculitis (Infections of superficial dermis)
Fununcles, Carbuncles, and Abscesses
Hidradenitis suppurativa (follicular inflam of intertriginous areas)
Cellulitis, Erysipelas, and fascitis (Infection of SubQ)
Pyomytosis (Infection of skeletal muscle)

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16
Q

CV manifestations of S. Aureus

A

Infective Endocarditis
Cardiac Device Infection
Intravascular catheter infection
Septic thrombophlebitis

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17
Q

Bone, Joint Infection

A

Osteomyelitis
Prosthetic Joint Infection
Septic Arthritis/Bursitis

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18
Q

S. Aureus manifestations (not including Skin, CV, or Bones)

A 
Bacteremia, Sepsis/TSS
Splenic Abscess
Pulm Infection
Meningitis (usually head trauma, neuratrauma)
Bacteriuria (indwelling catheter)
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19
Q

Is strep viridins in the blood bad

A

Real bad…endocarditis and such

Also…don’t ignore yeast in the blood

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20
Q

How many blood cultures to you order

A

Two or more

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21
Q

S. Aureus sepsis is usually preceded by..

A

Bacteremia

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22
Q

Leading cause of community and healthcare acquired bacteremia

A

S. Aureus

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23
Q

What is bacteremia

A

presence of viable bacteria in the blood

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24
Q

Three categories of S. Aureus

A

Healthcare-associated hospital onset
Community Acquired
Healthcare acquired community onset (long term care)

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25
Q

Risk factors for S. Aureus sepsis

A

IV Catheters
MRSA colonization
Implanted prosthetic devices
Injection drug use

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26
Q

Typical S. Aureus infection history

A 
Recent skin, soft tissue infection
Presence of indwelling prosthetic devices
Injection Drug Use
Recent Hospital Exposure
IV catheter
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27
Q

Symtoms of metastatic S. Aureus bacteremia

A 
Bone/Joint Pain
Protracted fever/Sweats
Abdominal Pain (Splenic Infarction)
CVA tenderness (renal infarction, psoas abscess)
Headache (Septic Emboli)
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28
Q

Physical exam findings in S. Aureus bacteremia?

A

Careful cardiac exam for new murmurs, evidence of HF
Stigmata of endocarditis
Neurological exam

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29
Q

Diagnostic Evaluation of S. Aureus bacteremia

A

Blood Cultures
Echocardiography
Other imaging may be necessary based on symptoms

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30
Q

Treatment of S. Aureus bacteremia

A

Control source of infection
Empiric ABs pending Sensitivity – Vanco
Tailored therapy once sensitivities apparent
Blood Cultures 48-72 hours after clearancy
Treat for 14 days of IV therapy is no complications

31
Q

Typical treatment for MSSA?

A

Nafcillin/Oxacillin, Cafasolin

Nafs the best, but has to be infused every 4 hours and causes phlebitis

32
Q

Special management problems with central catheter related infections?

A

If you have a CL + a Fever –> Blood Cultures + ABs
No source for fever –> switch line over wire (the half assed answer)

This is probably actually bullshit

33
Q

Definition for sepsis

A

Clinical syndrome complicating severe infection

Signs occur in tissues remote from infection site

34
Q

What is SIRS?

A

Systemic Inflammatory Response Syndrome
Clinical syndrome complicating a noninfectious insult
(ex. pancreatitis, pulmonary contusion)

35
Q

Diagnostic Criteria for SIRS

A 
Temp above 38 (100.4) or below 36 (96.8)
HR over 90
RR abover 20
PaCO2 below 32 mmHg
WBC above 12K
10% immature forms (bands)
SBP under 90 mmHg
36
Q

Perks of Daptomycin for S. Aureus?

A

Bloodstream infection

Doesn’t get into lungs very well

37
Q

Four steps of sepsis

A

SIRS
Sepsis
Severe Sepsis
Septic Shock

38
Q

On the sepsis steps, definition for sepsis?

A

2 SIRS + COnfirmed or Suspected Infection

39
Q

On the sepsis steps, definition for Severe Sepsis

A

Sepsis
End Organ Damage
Hypotension (below 90)
Lactate above 4 mmol

40
Q

Enterococci don’t kill

A

He said something like this?

Give entero Pen

41
Q

On the sepsis steps, definition for Septic SHock

A

Severe Sepsis

Persistent Hypotension, End organ damage, and lactate below 4

42
Q

Septic Shock =

A

Sepsis-induced hypotension persisting despite adequate fluid resuscitation

43
Q

Sepsis according to Meyer

A

When a person is really sick
Doesn’t need bacteremia
?

44
Q

Risk Factors for sepsis

A 
ICU patient with nosocomial infection
Bacteremia
Age over 65
Diabetes
Cancer
Comm. acquired pneumonia
45
Q

The patient most likely to get epsis

A

An African, American male over 65 in winter

46
Q

Pathogens most likely to cause sepsis

A
  1. G+
  2. G-
  3. Fungal
47
Q

Important clinical evaluation of the septic patient

A

Determine source of infection (H&P)
Assess respiratory status (O sat, resp. effort)
Assess perfusion (BP, Capillary refill, pulses)
Assess end-organ effects (lactate level, renal and hepatic function, mental status)

48
Q

Are eyes important

A

Yes

Eyes are important, as they say

49
Q

Early management of sepsis?

A 
Control of Airway (supp ox, intubation)
Establish venous access
Maintain perfusion (IV fluids, vasopressors)
50
Q

Control of Septic focus?

A 
Early ABs (empiric, then tailored)
Possible debridement/surgical intervention
51
Q

Vasoactive agents used in septic shock?

A 
Dobutamine
Dopamine
E
NE
Phenylephrine
Amrinone
52
Q

How are Dobutamine and Amrinone different from other septic shock vasoactive agents?

A

Arterial dialation, rather than constriction

53
Q

Is getting dead crap out a good thing?

A

yes.

yes, it is.

54
Q

More sick = more mortality.

T or F

A

T

SIRS (7%) to Septic Shock (46%)

55
Q

Should you save a 95 yo Dr. Meyer in Septic Shock.

A

No

He requested to be let go.

56
Q

Methicillin resistance medicated by…

A

PBP-2 (penicillin binding protein protein encoded by mecA gene_

57
Q

Viewpoint on Kevorkian?

A

a few bad things happened?
Death with dignity should be your practice?
Is this presentation still about S. Aureus?

58
Q

Where is the MecA gene located

A

Mobile genetic element (SCCmec)

59
Q

name the Healthcare assocaited MRSAs

A

USA 100, USA 200 pulse field electrophoresis pattern

60
Q

Name the community associated MRSAs

A

USA 300, USE 400

61
Q

Where did MRSA come from?

A

Antibiotic Selective Pressure

62
Q

Healthcare providers are…

A

Pigs.

Learn to wash your god damn hands

63
Q

Use of which antibiotics are assocaited with MRSA risk

A

Cephalosporin

Fluoroquinoline

64
Q

Timeline that counts as HA-MRSA

A

Within 48 hours of hospitalization

Within 12 months of healthcare exposure

65
Q

Is MRSA becoming more common?

66
Q

CA or MRSA – who kills more now?

67
Q

Key interventions to prevent the spread of MRSA

A

Hand Hygiene
Decontamination of Environment and Equipment
Contact Precautions for infected+colonized patients
Active Surveillance Cultures

68
Q

The sequel?

A

VRSA

Vanco Resistant

69
Q

Things that pre-dispose you to VRSA?

A

Prior MRSA
Underlying Conditions(diabetes, chronic ulcers)
Previous Vanco Exposure)

Still super rare

70
Q

Measurements of MRSA that could be valuable?

A

Prevalence Survey
Active Surveillance
MRSA infections
Compliance with Hand Hygienes

71
Q

What does Dr. Meyer do to people at Arnett that don’t follwo precautions

A

Chew their asses out in a polite, but professional way

72
Q

If you want to know how to fix problems, who should you ask

A

People who deal with them

73
Q

Don’t forget an important side effect of Vanco…what is it

A

Hearing loss

ICM - Infectious Disease (11 decks)

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