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ICM Exam 2: Infectious Disease (& CIA) > Staph, Sepsis, MRSA > Flashcards

Staph, Sepsis, MRSA Flashcards

1
Q

Colony appearance by Coag+/- staph

A

S. aureus= gold beta hemolytic

Coag (-) = small white nonhemolytic colonies

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2
Q

___% of healthy people may be _____or _____ colonized with S. aureus

A

25%

persistently or transiently

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3
Q

Colonization rate of S. aureus is higher among…(4)

A

IDDM

HIV

Hemodialysis

Skin Damage

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4
Q

Diseases with increased risk for S. aureus infection (4)

A
  1. DM
  2. PMN defect/deficiency (neutropenia,CGD, Jobs, Chediak-Higashi)
  3. Skin abnormalities
  4. Prosthetic devices
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5
Q

Most MRSA infect

A

Skin and soft tissue

*5-10% have been invasive

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6
Q

Pyogenic bacterium causes ___ at ___ or ____ sites

A

abscess

primary or distant

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7
Q

Cells that infultrate after inflammatory response

A

first PMN

then MQ and FB

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8
Q

Staph vs strep on skin

A

Strep = rapidly producing cellulitis

Staph = Purulent foci

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9
Q

___ is alright for MSSA, but not MRSA

A

Bactrim

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10
Q

Staph produces what three toxins

A
  1. Cytotoxins
  2. Pyrogenic Superantigen toxins
    1. Foodborne (Enterotoxin)
    2. Staphylococcal TSSS (TSST1)
  3. Exfoliative toxin
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11
Q

TSST1 produced at …

A

site of colonization

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12
Q

antistaph antibodies efficacy?

A

Not shown to be protective in vivo. No vaccine available.

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13
Q

Exfoliative toxin mediates…

A

SSSS

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14
Q

For Staph toxins, you want to use ABs that do what?

A

halt protein synthesis

(e.g. Clindamycin)

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15
Q

Clinical manifestations - skin and soft tissue infection (6)

A
  1. Impetigo
  2. Folliculitis
  3. Furuncle/carbuncle, abscess
  4. Hidradentitis suppurativa (intertriginous)
  5. Cellulitis/erysipelas/Fasciitis
  6. Pyomyositis
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16
Q

General clinical manifestations of staph (9)

A
  1. Skin and soft tissue infections
  2. Bacteremia
  3. CV infection
  4. Sepsis and TSS
  5. Splenic abscess
  6. Bone and Joint infection
  7. Pulmonary infection
  8. Meningitis
  9. Bacteruria
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17
Q

S. aureus meningitis most commonly occurs in the setting of…

A

in setting of head trauma or neurosurgery

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18
Q

Blood cultures: never order…

A

just one. (always two)

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19
Q

Three catergories of staph infections

A
  1. Healthcare-associated (nosocomial)
  2. Community acquired
  3. Healthcare associated community onset (long-term care facilities)
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20
Q

Risk factors for bacteremia (4)

A

IV catheters

MRSA colonization

Implants/prosthetic devices

IV drug use

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21
Q

Staph Sx - bone and joint pain

A

Vertebral osteomyelitis

Discitis

Epidural abscess

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22
Q

Staph bacteremia Sx - Protracted fever/sweats

A

endocarditis

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23
Q

LUQ pain in staph bacteremia

A

Splenic infarction, abscess

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24
Q

Staph bacteremia Sx - CVA tenderness

A

Renal infarction

psoas abscess

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25
Q

Staph bacteremia Sx - Headache

A

Septic embolus

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26
Q

Staph Aureus physical exam should look for what 3 things?

A

Cardiac exam for new murmurs or evidence of HF

Stigmata of endocarditis

neurological exam

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27
Q

What are the stigmata of endocarditis

A

Roth spots = retinal hemorrhages with pale centers

Osler’s nodes = Painful immunologic lesions on hands/feet

Janeway’s lesions = Non-tender, non immunologic lesions (hands/feet)

(also petechiae, splenomegaly, murmur, clubbing, fever)

28
Q

Treatment of Staph aureus bacteremia may include ____ depending on sensitivity results

A

Empiric antibiotics

29
Q

DOC for empiric treatment of SA bacteremia

A

Vm

(toxicity is concern)

30
Q

Consider _____ or ______ for MSSA

A

Nafcillin/oxacillin

or cephazolin

31
Q

Followup blood cultures ___ after initiating therapy to demonstrate clearance

A

48-72 hours

(should be daily)

32
Q

Duration of therapy for uncomplicated infection (abscence of cardiac abnormalities)

A

14 days of IV therapy

33
Q

Penicillinase resistant Pens

A

Nafcillin

Oxacillin

34
Q

_______ related infections present special management problems

A

Central IV catheters

35
Q

Enterococcus is resistant stuff. What do you use to treat?

A

Vm, Pen, Linezolid

(ceph, macrolides, fluoroquinolone = NO)

36
Q

In sepsis, signs occur…

A

in tissues remote from the site of infection

37
Q

SIRS =

A

clinical syndrome complicating a noninfectious insult

(–> pancreatitis, pulmonary contusion)

38
Q

Sepsis Step

A

2 SIRS

*and*

Confirmed or suspected infection

39
Q

Step for Severe sepsis

A
  • Sepsis + Signs of end organ damage
  • Hypotension
  • Lactate >4mmol
40
Q

Step for Septic Shock

A
  • Severe sepsis + signs of end organ damage

*and*

  • PERSISTENT hypotension
  • Lactate >4mmol
41
Q

Septic Shock =

A

Sepsis-induced HoTN persisting despite fluid resuscitation

42
Q

Septic shock is a _____ shock

A

Vasodilatory

43
Q

Sepsis risk factors

A
  • ICU with nosocomial
  • Bacteremia
  • >65
  • IC patients
  • IDDM
  • Cancer
  • CA-PNA
  • Genetic stuff
44
Q

Incidence of sepsis is greatest among…

A

African american males >65 in winter

45
Q

Sepsis is more frequently caused by gram __ organisms

A

positive

46
Q

Four steps in clincial eval of Septic patient

A
  1. Determine source
  2. Assess respiratory status
  3. assess perfusion
  4. assess end organ effects (lactate,renal/hepatic fxn)
47
Q

Ways to evaluate LRT-associated sepsis

A
  • Sputum
  • Rapid influenza test
  • Urinary antigen testing (pneumococcus, legionella)
  • Bronchiolar lavage
48
Q

General early management of sepsis (3)

A

Airway control

Venous access

Maintain perfusion

49
Q

Control of septic focus by ___ or _______

A

early ABs

Possible debridement/surgery

50
Q

Vasoactive agents in septic shock

Which are dilatory?

A

Dobutamine**

DA/EPI/NE

Phenylephrine

Amrinone**

51
Q

Phenylephrine has no effect on ___ or _____

A

heart rate or contractility

52
Q

Sepsis mortality estimate

A

10-50%

53
Q

Methicillin resistance is mediated by

A

PBP-2a

encoded by the mecA gene

54
Q

mecA gene is located on a ______

A

mobile genetic element

Staph chromosomal cassette= SCCmec

55
Q

HA-MRSA occurs __ after hospitalization or within ____ of exposure to healthcare

A

48 hrs

12months

56
Q

HA-MRSA is the leading cause of

A

Surgical site infections

57
Q

HA MRSA electrophoresis pattern

A

USA100

USA200

58
Q

CA-MRSA is associated with _____ infections

A

skin and soft tissue infections in healthy young persons

59
Q

CA-MRSA electrophoresis pattern

A

USA300 or USA400

60
Q

ABs that may have played a role in development of MRSA

A

Ceph

FQ

61
Q

In both examples of AB resistance spread (human and animal),the resistent bacteria develop within ____

A

the GIT

62
Q

The association of antimicrobial drugs and MRSA was stronger for persons who had recieved…

A

more Rx’s ofany class of antimicrobials

63
Q

Community acquired or health care associated greater?

A

HCA

64
Q

MRSA increased drastically (2k–368k) from…

A

1993 to 2005

65
Q

Key interventions for prevention of MRSA (4)

A
  • Hand hygeine
  • Decontamination
  • Contact precautions
  • Active surveillance cultures (ASCs)
66
Q

Next threat on the horizon

A

VRSA

67
Q

Major Vm issue

A

ototoxicity

ICM Exam 2: Infectious Disease (& CIA) (10 decks)

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