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Surgical Recall > Surgical Infection > Flashcards

Surgical Infection Flashcards

1
Q

What are the classic signs and symptoms of inflammation or infection?

A

Tumor, Calor, Dolor, Rubor

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2
Q

What is bacteremia?

A

Bacteria in the blood

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3
Q

What is SIRS?

A

Systemic Inflammatory Response Syndrome:

Fever, tachycardia, tachypnea, leukocytosis

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4
Q

What is sepsis?

A

Documented infection and SIRS

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5
Q

What is septic shock?

A

Sepsis and hypotension

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6
Q

What is cellulitis?

A

Blanching erythema from superficial dermal or epidermal infection (usually strep more than staph)

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7
Q

What is an abscess?

A

Collection of pus within a cavity

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8
Q

What is a superinfection?

A

New infection arising while a patient is receiving antibiotics for the original infection at a different site

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9
Q

What is a nosocomial infection?

A

Infection originating in the hospital

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10
Q

What is empiric antibiotic treatment?

A

Use of antibiotics based on previous sensitivity information or previous experience awaiting culture results in an established infection

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11
Q

What is prophylactic antibiotic treatment?

A

Antibiotics used to prevent an infection

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12
Q

What is the most common nosocomial infection?

A

UTI

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13
Q

What is the most common nosocomial infection causing death?

A

Pneumonia

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14
Q

What diagnostic tests are used for UTIs?

A

U/A, urine culture, urine microscopy for WBC

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15
Q

What constitutes a positive U/A?

A

Positive nitrite (from bacteria), positive leukocyte esterase (from WBC), > 10 WBC/HPF, presence of bacteria (supportive)

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16
Q

What number of colony-forming units (CFU) confirms the diagnosis of UTI?

A

On urine culture, classically 100,000 CFU

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17
Q

What are the common organisms in UTIs?

A

E. coli, Klebsiella, Proteus, (Enterococcus, Staphylococcus aureus)

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18
Q

What is the treatment for UTIs?

A

Antibiotics with gram-negative coverage (e.g. sulfamethoxazole/trimethoprim, gentamicin, ciprofloxacin, aztreonam).
Check culture and sensitivity.

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19
Q

What is the treatment of bladder candidiasis?

A
  1. Remove or change Foley catheter

2. Administer systemic fluconazole or amphotericin bladder washings

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20
Q

What are the signs of a central line infection?

A

Unexplained hyperglycemia, fever, mental status change, hypotension, tachycardia, pus, erythema at central line site

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21
Q

What is the most common cause of catheter-related bloodstream infections?

A

Coagulase-negative Staphylococcus (33%), Enterococci, Staphylococcus aureus, gram-negative rods

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22
Q

When should central lines be changed?

A

When they are infected.

There is no advantage to changing them every 7 days in non-burn patients.

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23
Q

What central line infusion increases the risk of infection?

A

Hyperal (TPN)

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24
Q

What is the treatment for central line infection?

A
  1. Remove central line (send for culture) +/- IV antibiotics.
  2. Place new central line in a different site.
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25
Q

When should peripheral IV short angiocatheters be changed?

A

Every 72-96 hours

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26
Q

When doe wound infections arise?

A

Classically, PODs #5-7

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27
Q

What are the signs and symptoms of wound infections?

A

Pain at incision site, erythema, drainage, induration, warm skin, fever

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28
Q

What is the treatment for wound infections?

A

Remove skin sutures/staples, rule out fascial dehiscence, pack wound open, send wound culture, administer antibiotics

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29
Q

What are the most common bacteria found in postoperative wound infections?

A 
Staphylococcus aureus (20%), E. coli (10%), Enterococcus (10%)
Others: Staphylococcus epidermidis, Pseudomonas, anaerobes, other gram-negatives, Streptococcus
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30
Q

Which bacteria cause fever and wound infection in the first 24 hours after surgery?

A
  1. Streptococcus

2. Clostridium (bronze-brown weeping tender wound)

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31
Q

What is a clean wound?

A

Elective, non-traumatic wound without acute inflammation.

Usually closed primarily without the use of drains.

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32
Q

What is the infection rate of a clean wound?

A

< 1.5%

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33
Q

What is a clean-contaminated wound?

A

Operation on the GI or respiratory tract without unusual contamination or entry into the biliary or urinary tract

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34
Q

Without infection present, what is the infection rate of a clean-contaminated wound?

A

< 3%

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35
Q

What is a contaminated wound?

A

Acute inflammation, traumatic wound, GI tract spillage, or a major break in sterile technique

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36
Q

What is the infection rate of a contaminated wound?

A

5%

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37
Q

What is a dirty wound?

A

Pus present, perforated viscus, or dirty traumatic wound

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38
Q

What is the infection rate of a dirty wound?

A

33%

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39
Q

What are the possible complications of wound infections?

A

Fistula, sinus tracts, sepsis, abscess, suppressed wound healing, superinfection, hernia

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40
Q

What factors influence the development of infections?

A

Foreign body (e.g. suture, drains, grafts); decreased blood flow (poor delivery of PMNs and antibiotics); strangulation of tissues with excessively tight sutures; necrotic tissue or excessive local tissue destruction; long operations (> 2 hrs); hypothermia in OR; hematomas or seromas; dead space that prevents the delivery of phagocytic cells to bacterial foci; poor approximation of tissues

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41
Q

What patient factors influence the development of infections?

A

Uremia; hypovolemic shock; vascular occlusive states; advanced age; distant area of infection

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42
Q

What are examples of an immunosuppressed state?

A

Immunosuppressant treatment; chemotherapy; systemic malignancy; trauma or burn injury; diabetes; obesity; malnutrition; AIDS; uremia

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43
Q

Which lab tests are indicated for wound infections?

A

CBC (leukocytosis or leukopenia), blood cultures, imaging (CT to locate abscess)

44
Q

What is the treatment for wound infections?

A

I&D, antibiotics for deep abscesses

45
Q

What are the indications for antibiotics after drainage of a subcutaneous abscess?

A

Diabetes, surrounding cellulitis, prosthetic heart valve, or an immunocompromised state

46
Q

What is a peritoneal abscess?

A

Abscess within the peritoneal cavity

47
Q

What are the causes of peritoneal abscesses?

A

Postoperative status after a laparotomy, ruptured appendix, peritonitis, any inflammatory intraperitoneal process, anastomotic leak

48
Q

What are common sites for peritoneal abscesses?

A

Pelvis, Morison’s pouch, subphrenic, paracolic gutters, periappendiceal, lesser sac

49
Q

What are the signs and symptoms of peritoneal abscesses?

A

Fever (classically spiking), abdominal pain, mass

50
Q

How is the diagnosis of peritoneal abscess made?

A

Abdominal CT (or U/S)

51
Q

When should an abdominal CT be obtained looking for a postoperative abscess?

A

After POD #7 (otherwise, abscess will not be organized and will look like a normal postoperative fluid collection)

52
Q

What CT findings are associated with peritoneal abscess?

A

Fluid collection with fibrous rind, gas in fluid collection

53
Q

What is the treatment for peritoneal abscess?

A

Percutaneous CT-guided drainage

54
Q

What is an option for drainage of pelvic abscess?

A

Transrectal drainage (or transvaginal)

55
Q

All abscesses must be drained except which type?

A

Amebiasis

56
Q

What is necrotizing fasciitis?

A

Bacterial infection of underlying fascia (spreads rapidly along fascial planes)

57
Q

What are the causative agents of necrotizing fasciitis

A

Classically, group A Streptococcus pyogenes, but most often polymicrobial with anaerobes and gram-negative organisms

58
Q

What are the signs and symptoms of necrotizing fasciitis?

A

Fever, pain, crepitus, cellulitis, skin discoloration, blood blisters (hemorrhagic bullae), weeping skin, increased WBCs, subcutaneous air on XR, septic shock

59
Q

What is the treatment for necrotizing fasciitis?

A

IVF, IV antibiotics and aggressive early extensive surgical debridement, cultures, tetanus prophylaxis

60
Q

Is necrotizing fasciitis an emergency?

A

Yes, patients must be taken to the OR immediately

61
Q

What is clostridial myositis?

A

Clostridial muscle infection

62
Q

What is another name for clostridial myositis?

A

Gas gangrene

63
Q

What is the most common causative organism of clostridial myositis?

A

Clostridium perfringens

64
Q

What are the signs and symptoms of clostridial myositis?

A

Pain, fever, shock, crepitus, foul-smelling brown fluid, subcutaneous air on XR

65
Q

What is the treatment for clostridial myositis?

A

IV antibiotics, aggressive surgical debridement of involved muscle, tetanus prophylaxis

66
Q

What is suppurative hidradenitis?

A

Infection or abscess formation in apocrine sweat glands

67
Q

In what 3 locations does suppurative hidradenitis occur?

A
  1. Perineum/buttocks
  2. Inguinal area
  3. Axillae
68
Q

What is the most common causative organism of suppurative hidradenitis?

A

Staphylococcus aureus

69
Q

What is the treatment for suppurative hidradenitis?

A

Antibiotics, I&D (excision of skin with glands for chronic infections)

70
Q

What is pseudomembranous colitis?

A

Antibiotic-induced colonic overgrowth of C. difficile, secondary to loss of competitive nonpathogenic bacteria that comprise the normal colonic flora

71
Q

What are the signs and symptoms of pseudomembranous colitis?

A

Diarrhea (bloody in 10%), fever, increased WBC, abdominal cramps, abdominal distention

72
Q

What causes the diarrhea in pseudomembranous colitis?

A

Exotoxin released by C. difficile

73
Q

How is the diagnosis of pseudomembranous colitis made?

A

Assay stool for exotoxin titer; fecal leukocytes may or may not be present; colonoscopy may show exudate that looks like a membrane

74
Q

What is the treatment for pseudomembranous colitis?

A

PO metronidazole or PO vancomycin; discontinuation of causative agent

75
Q

What are the indications for prophylactic IV antibiotics?

A

Accidental wounds with heavy contamination and tissue damage; accidental wounds requiring surgical therapy that has had to be delayed; prosthetic heart valve or valve disease; penetrating injuries of hollow intra-abdominal organs; large bowel resections and anastomosis; cardiovascular surgery with the use of a prosthesis/vascular procedure; patients with open fractures; traumatic wounds occurring > 8 hours prior to medical attention

76
Q

What must a prophylactic antibiotic cover for procedures on the large bowel, abdominal trauma, or appendicitis?

A

Anaerobes

77
Q

What commonly used antibiotics offer anaerobic coverage?

A

Cefoxitin (Mefoxin), clindamycin, metronidazole, cefotetan, ampicillin-sulbactam (Unasyn), Zosyn, Timentin, Imipenem

78
Q

What antibiotic is used prophylactically for vascular surgery?

A

Ancef (if patient is significantly allergic to penicillin, then erythromycin or clindamycin are options)

79
Q

When is the appropriate time to administer prophylactic antibiotics?

A

Must be in adequate levels in the blood stream prior to the surgical incision

80
Q

What is parotitis?

A

Infection of the parotid gland

81
Q

What is the most common causative organism of parotitis?

A

Staphylococcus

82
Q

What are the associated risk factors with parotitis?

A

Age older than 65 years, malnutrition, poor oral hygiene, presence of NG tube, NPO, dehydration

83
Q

What is the most common time of occurrence of parotitis?

A

Usually 2 weeks post-op

84
Q

What are the signs of parotitis?

A

Hot, red, tender parotid gland and increased WBCs

85
Q

What is the treatment for parotitis?

A

Antibiotics, operative drainage as necessary

86
Q

What is a stitch abscess?

A

Subcutaneous abscess centered around a subcutaneous stitch, which is a foreign body.
Treat with drainage and stitch removal.

87
Q

Which bacteria can be found in the stool?

A

Anaerobic: Bacteroides fragilis
Aerobic: E. Coli

88
Q

Which bacteria are found in infections from human bites?

A

Streptococcus viridans, Staphylococcus aureus, Peptococcus, Eikenella.
Treat with Augmentin.

89
Q

What are the most common ICU pneumonia bacteria?

A

Gram-negative organisms

90
Q

What is Fournier’s gangrene?

A

Perineal infection starting classically in the scrotum in patients with diabetes.
Treat with triple antibiotics and wide debridement.

91
Q

Does adding antibiotics to peritoneal lavage solution lower the risk of abscess formation?

A

No

92
Q

What is the classic finding associated with a Pseudomonas infection?

A

Green exudate and fruity smell

93
Q

What are the classic antibiotics for triple antibiotics?

A

Ampicillin, gentamicin, and metronidazole

94
Q

Which antibiotic is used to treat amoeba infection?

A

Metronidazole

95
Q

Which bacteria commonly infect prosthetic material and central lines?

A

Staphylococcus epidermidis

96
Q

What is the antibiotic of choice for Actinomyces?

A

Penicillin G

97
Q

What is a furuncle?

A

Staphylococci abscess that forms in a hair follicle

98
Q

What is a carbuncle?

A

Subcutaneous staphylococcal abscess (usually an extension of a furuncle), most commonly seen in patients with diabetes

99
Q

What is a felon?

A

Infection of the finger pad

100
Q

What microscopic finding is associated with Actinomyces?

A

Sulfur granules

101
Q

What organism causes tetanus?

A

Clostridium tetani

102
Q

What are the signs of tetanus?

A

Lockjaw, muscle spasms, laryngospasm, convulsions, respiratory failure

103
Q

What is the appropriate prophylactic step in a patient with a dirty wound and three previous tetanus immunizations?

A

None (tetanus toxoid only if > 5 years since last toxoid)

104
Q

What is the appropriate prophylactic step in a patient with a dirty wound and two previous tetanus immunizations?

A

Tetanus toxoid

105
Q

What is the appropriate prophylactic step in a patient with a dirty wound and one previous tetanus immunization?

A

Tetanus immunoglobulin IM and tetanus toxoid IM (at different sites)

106
Q

What is the appropriate prophylactic step in a patient with a dirty wound and no previous tetanus immunizations?

A

Tetanus immunoglobulin IM and tetanus toxoid IM (at different sites)

107
Q

What is Fitz-Hugh-Curtis syndrome?

A

RUQ pain from gonococcal perihepatitis in women

Surgical Recall (68 decks)

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