Staph Infections

Question 1

What do we have to concerned with coag-negative stpah?

Answer 1

Less virulent but often on prosthetic devices (also a huge source of contamination)

Question 2

Staphlococci gram staining

Answer 2

Gram positive, catalase positive

Question 3

How many are colonized by s. aureus?

Answer 3

25-50%

Question 4

Increased incidence of s. aureus colonization?

Answer 4

1. DM
2. HIV
3. Dialysis
4. Skin damage (psoriasis, eczema, etc)

Question 5

What type of congenital IDs that lead to increased S. aureus infection

Answer 5

• Neutropenia
• CGD
• Job’s, Chediak-Higashi syndrome

Question 6

When does MRSA begin to proliferate?

Answer 6

Late 1990’s

Question 7

What are toxins produced by s. aureus?

Answer 7

1. Cytotoxin
2. Superantigens
   • Enterotoxin (food poisoning)
   • Toxic shock
3. Exfoliative toxin (scalded skin syndrome)

Question 8

Symptoms for toxic shock syndrome?

Answer 8

• Fever over 102
• Hypotension
• Funny rash (diffuse macular erythorderma)
• Desquamation of skin after 1-2 weeks
• IG upset
• Pains
• Renal problems
• Hepatic problems
• Low platelets
• CNS distortions 
*******this is a very vague presentation and is hard to diagnose

Question 9

Less common s. aureus infections?

Answer 9

1. Respiratory

2. Urinary (often due to indwelling cath)

Question 10

Rare s. aureus infections?

Answer 10

1. CNS symptoms

2. GI symptoms

Question 11

4 COMMON s. aureus infections?

Answer 11

1. Skin and soft tissue
2. Bacteremia
3. Septic arthritis and osteomyelitis
4. Prosthetic joint and device infiltration

Question 12

What is impetigo?

Answer 12

Dermal infection of s. aureus, mostly seen in children

Question 13

How can you decolonize s. aureus?

Answer 13

• Effective cleaning
• Nasal decolonization with mupirocin (not very effective)
• Bleach baths twice weekly 3-4 months

Question 14

If you don’t know how Staph got in to the blood, what do we need to be more concerned with?

Answer 14

Metastatic process (it could be hiding out in other pockets like a joint or bone)

Question 15

What do you want to do with blood work for a s. aureus, bacteremic patient?

Answer 15

You want to get repeat blood cultures every day to make sure the infection is clearing

Question 16

Where is a common non-skin site of abscesses for s. aureus infection?

Answer 16

Psoas abscess

Question 17

If you have a right sided s. aureus endocarditis, what do you have to think about?

Answer 17

The infection can seed the lungs and show as small nodules (might change your treatment choices)

Question 18

If you have one set of blood cultures thats positive and one thats negative, what might this imply?

Answer 18

That one bottle was simply contaminated

Question 19

What is the safest central line insertion site (according to Dr. Meyers)?

Answer 19

Subclavian

Question 20

Why is enterococcus in the blood stream an odd bug?

Answer 20

It can cause endocarditis and there aren’t a lot of good options for treatment

Question 21

Whats the main difference between sepsis and SIRS?

Answer 21

SIRS is from an inflammatory process that isn’t infectious

Question 22

What is a problem with candida blood infections?

Answer 22

It doesn’t always grow in cultures and can be hard to diagnose.

Question 23

What is the leading cause of bacteremia?

Answer 23

Staph

Question 24

What measure in the ICU could help reduce S. aureus infections?

Answer 24

Daily chlorhexidine baths

Question 25

WBC count for sepsis?

Answer 25

Less than 4 or greater than 12

Question 26

What is severe sepsis?

Answer 26

• Evidence of end-organ damage
• Lactate < 4
• Hypotension SBP < 90

Question 27

What patient population has the highest rates of sepsis?

Answer 27

African-American males, age >65, in winter