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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
Staph bacteremia Sx - Headache
Septic embolus
26
Staph Aureus physical exam should look for what 3 things?
Cardiac exam for new murmurs or evidence of HF Stigmata of endocarditis neurological exam
27
What are the stigmata of endocarditis
**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
Treatment of Staph aureus bacteremia may include ____ depending on sensitivity results
Empiric antibiotics
29
DOC for empiric treatment of SA bacteremia
Vm (toxicity is concern)
30
Consider _____ or ______ for MSSA
Nafcillin/oxacillin or cephazolin
31
Followup blood cultures ___ after initiating therapy to demonstrate clearance
48-72 hours | (should be daily)
32
Duration of therapy for uncomplicated infection (abscence of cardiac abnormalities)
14 days of IV therapy
33
Penicillinase resistant Pens
Nafcillin Oxacillin
34
\_\_\_\_\_\_\_ related infections present special management problems
Central IV catheters
35
Enterococcus is resistant stuff. What do you use to treat?
Vm, Pen, Linezolid (ceph, macrolides, fluoroquinolone = NO)
36
In sepsis, signs occur...
in tissues remote from the site of infection
37
SIRS =
clinical syndrome complicating a **noninfectious** insult (--\> pancreatitis, pulmonary contusion)
38
Sepsis Step
2 SIRS \*and\* Confirmed or suspected infection
39
Step for Severe sepsis
* Sepsis + Signs of end organ damage * Hypotension * Lactate \>4mmol
40
Step for Septic Shock
* Severe sepsis + signs of end organ damage \*and\* * PERSISTENT hypotension * Lactate \>4mmol
41
Septic Shock =
Sepsis-induced HoTN persisting despite fluid resuscitation
42
Septic shock is a _____ shock
Vasodilatory
43
Sepsis risk factors
* ICU with nosocomial * Bacteremia * \>65 * IC patients * IDDM * Cancer * CA-PNA * Genetic stuff
44
Incidence of sepsis is greatest among...
African american males \>65 in winter
45
Sepsis is more frequently caused by gram __ organisms
positive
46
Four steps in clincial eval of Septic patient
1. Determine source 2. Assess respiratory status 3. assess perfusion 4. assess end organ effects (lactate,renal/hepatic fxn)
47
Ways to evaluate LRT-associated sepsis
* Sputum * Rapid influenza test * Urinary antigen testing (pneumococcus, legionella) * Bronchiolar lavage
48
General early management of sepsis (3)
Airway control Venous access Maintain perfusion
49
Control of septic focus by ___ or \_\_\_\_\_\_\_
early ABs Possible debridement/surgery
50
Vasoactive agents in septic shock Which are dilatory?
Dobutamine\*\* DA/EPI/NE Phenylephrine Amrinone\*\*
51
Phenylephrine has no effect on ___ or \_\_\_\_\_
heart rate or contractility
52
Sepsis mortality estimate
10-50%
53
Methicillin resistance is mediated by
PBP-2a encoded by the mecA gene
54
mecA gene is located on a \_\_\_\_\_\_
_mobile genetic element_ Staph chromosomal cassette= **SCCmec**
55
HA-MRSA occurs __ after hospitalization or within ____ of exposure to healthcare
48 hrs 12months
56
HA-MRSA is the leading cause of
Surgical site infections
57
HA MRSA electrophoresis pattern
USA100 USA200
58
CA-MRSA is associated with _____ infections
skin and soft tissue infections in healthy young persons
59
CA-MRSA electrophoresis pattern
USA300 or USA400
60
ABs that may have played a role in development of MRSA
Ceph FQ
61
In both examples of AB resistance spread (human and animal),the resistent bacteria develop within \_\_\_\_
the GIT
62
The association of antimicrobial drugs and MRSA was stronger for persons who had recieved...
more Rx's ofany class of antimicrobials
63
Community acquired or health care associated greater?
HCA
64
MRSA increased drastically (2k--368k) from...
1993 to 2005
65
Key interventions for prevention of MRSA (4)
* Hand hygeine * Decontamination * Contact precautions * Active surveillance cultures (ASCs)
66
Next threat on the horizon
VRSA
67
Major Vm issue
ototoxicity

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

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