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Surgery > Surgical Infection > Flashcards

Surgical Infection Flashcards

1
Q

Characterized as sepsis combined with the presence of new onset organ failure

A

Severe sepsis

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2
Q

Clinical criteria considered to developed severe sepsis

A

Sepsis
Ventilatory support
Oliguria unresponsive to aggressive fluid resuscitation
Hypotension requiring vasopressors

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3
Q

Acute circulatory failure identified by the presence of persistent arterial hypotension (systolic

A

Septic shock

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4
Q

Criteria for systemic inflammatory response syndrome

General variables

A 
Fever
Hypothermia
Hear rate
Tachypnea
Altered mental status 
Edema
Hyperglycemia
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5
Q

Criteria for systemic inflammatory response syndrome

Inflammatory variables

A 
Leukocytoss
Leukopenia
Band emai
Plasma C-reactive protein ( >2)
Plasma pro calcitonin (>2)
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6
Q

Criteria for systemic inflammatory response syndrome

Hemodynamic variables

A 
Arterial hypotension (SBP 70%
Cardiac index > 3.5 L/min
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7
Q

Criteria for systemic inflammatory response syndrome

Organ dysfunction variables

A 
Arterial Hypoxemia
Acute oliguria
Creatinine increase
Coagulation abnormalities
Ileus
Thrombocytopenia
Hyperbilirubinemia
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8
Q

Criteria for systemic inflammatory response syndrome

Tissue perfusion variables

A

Hyperlactatemia

Decrease capillary filling

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9
Q

PIRO classification syndrome

Per morbid illness that affects probability of survival

A

Predisposition

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10
Q

PIRO classification syndrome

Type of infecting organisms, location of disease, intervention

A

Insult (infection)

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11
Q

PIRO classification syndrome

SIRS, other signs of sepsis, presence of shock, tissue markers

A

Response

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12
Q

PIRO classification syndrome

Organ dysfunction as a number of failing organs or composite score

A

Organ dysfunction

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13
Q

Gram positive bacteria that frequently cause infections in surgical patients include

A

Staphylococcus aureus
Epidermidis
Streptococcus pyogenes
Enterococcus faecalis and faecium

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14
Q

Gram negative bacterial species that are capable of causing infection in surgical patients

A 
E. coli
Klebsiella pneumoniae
Serratia marcescens
Enterobacter
Citrobacter
Acinetobacter
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15
Q

Other gram negative bacilli of note include Pseudomonas spp, including

A

Pseudomonas aeruginosa
Fluorescens
Xanthomonas spp

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16
Q

This infection was once one of the most common causes of death in Europe

A

Mycobacterium tuberculosis

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17
Q

Fungi

Polymicrobial infections or fungemia

A

Candida albicans

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18
Q

Fungi

Rare cause of aggressive soft tissue infections

A

Mucor
Rhizopus
Absidia

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19
Q

Fungi

Opportunistic pathogens that cause infection in the immunocompromised host

A

Aspergillus fumigatus
Niger
Terreus
Blastomyces dermatitidis

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20
Q

Fungi

A - broad spectrum, inexpensive
D- renal toxicity, premeds IV only

A

Amphotericin B

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21
Q

Antifungal

A- broad spectrum
D- expensive, IV only, renal toxicity

A

Liposomal Amphotericin B

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22
Q

Antifungal

A- IV and PO availability
D- narrow spectrum, drug interactions (class)

A

Fluconazole

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23
Q

Antifungal

A- IV and PO
D- narrow spectrum, no CSF penetration

A

Itraconazole

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24
Q

Antifungal

A- IV and PO availability, broad spectrum
D- IV diluent accumulation in renal failure, visual disturbances

A

Voriconazole

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25
Q

Antifungal

A- broad spectrum
D- IV only, poor CSF penetration

A

Caspofungin

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26
Q

Relevant viruses includes

A 
Adenoviruses
Cytomegalovirus
Epstein-Barr virus
Herpes simplex virus
Varicella zoster virus
Hepatitis B and C
HIV
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27
Q

Primary precept of surgical infectious disease therapy consists of

A

Drainage
Debridement
Removal of foreign bodies
Appropriate use of antimicrobial agents

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28
Q

Prophylaxis is limited to the

A

Time prior to and during the operative procedure

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29
Q

Alternative prophylactic for cefazolin on cardiovascular surgery

A

Vancomycin

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30
Q

Alternative prophylactic for cefazolin, cefoxitin, ampicillin sulbactam o gastro duodenal area

A

Fluoroquinolone

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31
Q

Alternative prophylactic for cefotetan, cefoxitin on cholecystitis

A

Fluoroquinone plus clindamycin or metronidazole

32
Q

Alternative prophylactic for cefazolin on head and neck

A

Amino glycoside plus clindamycin

33
Q

Alternative prophylactic for cefazolin on neurosurgical procedure, orthopedic surgery, breast

A

Vancomycin

34
Q

Frequently are nosocomial infections occuring in postoperative patients

A

Monomicrobial infections

35
Q

Eg. Of monomicrobial infections

A

UTI
Pneumonia
Bacteremia

36
Q

Empiric antibiotic therapy

A

Comprises antimicrobial agents
Surgical infection is high
Contamination during surgery
If critically ill patient

37
Q

Empiric antibiotic therapy should

A

Limited to a short course of drug (3-5)

Should be curtailed as soon as possible

38
Q

How much time, culture and sensitivity report

A

24-72 hours

39
Q

Prophylaxis is limited to a single dose administered immediately prior to

A

Creating the incision

40
Q

Therapy for mono microbial infections follows standard guidelines

A

7-10 days for UTI

14-21 days for pneumonia and bacteremia

41
Q

Antibiotic therapy for osteomyelitis, endocarditis. Consist prolonged courses of antibiotic

A

6-12 weeks

42
Q

Infection may require therapy with two or more agents.

A

Serious or recrudescent

43
Q

We can administer IV for 1-2 weeks if

A

The oral drug is completed

44
Q

12-24 hours of therapy for penetrating gastrointestinal trauma in the absence of

A

Extensive contamination

45
Q

3-5 days of therapy for

A

Perforated gangrenous appendicitis

46
Q

5-7 days of therapy for

A

Peritoneal soilage

47
Q

7-14 days of therapy to

A

Extensive peritoneal soilage due to immunosuppressed host.

48
Q

Under these circumstances, antibiotics can be discontinued with impunity.

A

Absence of an elevated WBC count
Lack of band forms of PMNs on peripheral smear
Lack of fever

49
Q

Allergy to microbial agents

A 
Severe allergic manifestations to a specific class of agents preclude the use of any agents in that class.
ST
50
Q

Misuse of antimicrobial agents is rampant in the inpatient and outpatient setting, associated with

A

Financial
Adverse reactions
New infections

51
Q

The development of SSIs is related to three factors

A

Degree of microbial contamination of the wound during surgery
The duration of the procedure
Host factors such as diabetes, malnutrition.

52
Q

Risk factors for development of surgical site infections

Patient factors

A

Kung ano yung hindi mabanggit. Haha

53
Q

Risk factors for development of surgical site infections

Local factors

A 
Poor skin preparation
Contamination of instrument
Inadequate antibiotic prophylaxis
Prolonged procedure 
Local tissue necrosis
Hypoxia, hypothermia
54
Q

Risk factors for development of surgical site infections

Microbial factors

A

Prolonged hospitalization
Toxin secretion
Resistance to clearance

55
Q

Example and infected rates of

Clean class 1

A

Hernia repair
Breast biopsy

1.0-5.4%

56
Q

Example and infected rates of

Clean/contaminated class2

A

Cholecystectomy
Elective GI surgery

2.1-9.5%

57
Q

Example and infected rates of

Contaminated class 3

A

Penetrating abdominal trauma
Large tissue injury
Enterotomy during bowel obstruction

3.4-13.2%

58
Q

Example and infected rates of

Dirty class 4

A

Perforated diverticulitis
Necrotizing soft tissue infections

3.1-12.8%

59
Q

Intra abdominal infections

Microbial contamination of the peritoneal cavity is termed

A

Peritonitis or intra abdominal infection

60
Q

Intra abdominal infections

Occurs when microbes invade the normally sterile confines ofthe peritoneal cavity via hematogenous dissemination from distant source of infection or direct inoculation.

A

Primary microbial peritonitis

61
Q

Intra abdominal infection

More common among patients with

A

Retain large amounts of peritoneal fluid due to ascites

Treated for renal failure via peritoneal dialysis

62
Q

Intra abdominal infections

These infections invariably are

A

Monomicrobial

Rarely require surgical intervention

63
Q

Intra abdominal infections

Diagnosis

A 
Diffuse tenderness and guarding without localized findings
Absence of pneumoperitineum
Upright roentgenograms
Presence of more than 100WBCs/ml
Microbes with a single morphology
64
Q

Intra abdominal infections

Subsequent cultured demonstrate

A 
E. coli
K pneumoniae
Pneumococci
Streptococci
Entero cocci
C. albicans
65
Q

Intra abdominal infections

Treatment

A

Antibiotics 14-21 days of therapy

Removal of indwelling devices

66
Q

Intra abdominal infections

Occurs subsequent to contamination of the peritoneal cavity due to perforation or severe inflammation and infection of an intra abdominal organ.

A

Secondary microbial peritonitis

Example includes.

Appendicitis
Perforation of any portion of the gastrointestinal tract or diverticulitis.

67
Q

Organ specific infections

Account for approximately 80% of cases.

A

Pyrogenic abscesses

68
Q

Organ specific infections

Remaining 20%

A

Divide among parasitic and fungal forms

69
Q

Organ specific infections

Formerly, pyogenic liver abscesses were caused by

A

Pylephlebitis due to neglected appendicitis or diverticulitis

70
Q

Organ specific infections

Now the more common cause of liver abscess is

A

Manipulation of biliary tract to treat variety of disease

71
Q

Organ specific infections

The most common aerobic bacteria identified in recent series include

A 
E. coli
K. pneumoniae 
Enteric bacilli
Enterococci
Pseudomonas spp
72
Q

Organ specific infections

Most common anaerobic bacteria

A

Bacteroides spp
Anaerobic streptococci
Fusobacterium spp
Candida albicans

73
Q

Organ specific infections

Small (1

A

4-6 weeks course of antibiotics

74
Q

Organ specific infections

Operation for hepatic abscess

A

Marsupialization

75
Q

Organ specific infections

Operation for splenic abscess

A

Splenectomy

76
Q

Organ specific infections

Secondary pancreatic infections occur in approximately

A

10-15% of patients who develop severe hemorrhagic pancreatitis

77
Q

Strict criteria for SIRS

A

Tachypnea
Tachycardia
Fever
Elevated WBC

Surgery (7 decks)

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