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Surgery 🤓 > Surgical Infection, C27 P170-180 > Flashcards

Surgical Infection, C27 P170-180 Flashcards

1
Q

What are the classic signs/ symptoms of inflammation/ infection?
P170

A

Tumor (mass = swelling/edema)
Calor (heat)
Dolor (pain)
Rubor (redness = erythema)

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2
Q

Define:
Bacteremia
P170

A

Bacteria in the blood

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3
Q

Define:
SIRS
P170

A

Systemic Inflammatory Response Syndrome (fever, tachycardia, tachypnea, leukocytosis)

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4
Q

Define:
Sepsis
P170

A

Documented infection and SIRS

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5
Q

Define:
Septic shock
P170

A

Sepsis and hypotension

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6
Q

Define:
Cellulitis
P170

A

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

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7
Q

Define:
Abscess
P170

A

Collection of pus within a cavity

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8
Q

Define:
Superinfection
P170

A

New infection arising while a patient is

receiving antibiotics for the original infection at a different site (e.g., C. difficile colitis)

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9
Q

Define:
Nosocomial infection
P170

A

Infection originating in the hospital

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10
Q

Define:
Empiric
P170

A

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

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11
Q

Define:
Prophylactic
P170

A

Antibiotics used to prevent an infection

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12
Q

What is the most common nosocomial infection?

P170

A

Urinary tract infection (UTI)

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13
Q

What is the most common nosocomial infection causing death?

P170

A

Respiratory tract infection (pneumonia)

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14
Q

URINARY TRACT INFECTION (UTI)
What diagnostic tests are used?
P171

A

Urinalysis, culture, urine microscopy for WBC

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15
Q

URINARY TRACT INFECTION (UTI)
What constitutes a POSITIVE urine analysis?
P171

A

Positive nitrite (from bacteria)
Positive leukocyte esterase (from WBC)
>10 WBC/HPF
Presence of bacteria (supportive)

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16
Q

URINARY TRACT INFECTION (UTI)
What number of colonyforming units (CFU)
confirms the diagnosis of UTI?
P171

A

On urine culture, classically 100,000 or

105 CFU

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17
Q

URINARY TRACT INFECTION (UTI)
What are the common organisms?
P171

A

Escherichia coli, Klebsiella, Proteus

Enterococcus, Staphylococcus aureus

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18
Q

URINARY TRACT INFECTION (UTI)
What is the treatment?
P171

A

Antibiotics with gram-negative spectrum
(e.g., sulfamethoxazole/trimethoprim
[Bactrim™], gentamicin, ciprofloxacin,
aztreonam); check culture and sensitivity

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19
Q

URINARY TRACT INFECTION (UTI)
What is the treatment of bladder candidiasis?
P171

A
  1. Remove or change Foley catheter
  2. Administer systemic fluconazole or
    amphotericin bladder washings
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20
Q

CENTRAL LINE INFECTIONS
What are the signs of a central line infection?
P171

A

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

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21
Q

CENTRAL LINE INFECTIONS
What is the most common cause of “catheter-related bloodstream infections”?
P171

A

Coagulase-negative staphylococcus (33%),
followed by enterococci, Staphylococcus
aureus, gram-negative rods

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22
Q

CENTRAL LINE INFECTIONS
When should central lines be changed?
P171

A

When they are infected; there is NO
advantage to changing them every 7 days
in nonburn patients

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23
Q

CENTRAL LINE INFECTIONS
What central line infusion increases the risk of
infection?
P171

A

Hyperal (TPN)

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24
Q

CENTRAL LINE INFECTIONS
What is the treatment for central line infection?
P172

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

CENTRAL LINE INFECTIONS
When should peripheral IV short angiocatheters be changed?
P172

A

Every 72 to 96 hours

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26
Q

WOUND INFECTION (SURGICAL SITE INFECTION)
What is it?
P172

A

Infection in an operative wound

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27
Q 
WOUND INFECTION (SURGICAL SITE INFECTION)
When do these infections arise?
P172
A

Classically, PODs #5 to #7

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28
Q

WOUND INFECTION (SURGICAL SITE INFECTION)
What are the signs/symptoms?
P172

A

Pain at incision site, erythema, drainage,

induration, warm skin, fever

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29
Q

WOUND INFECTION (SURGICAL SITE INFECTION)
What is the treatment?
P172

A

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

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30
Q

WOUND INFECTION (SURGICAL SITE INFECTION)
What are the most common bacteria found in postoperative wound infections?
P172

A 
Staphylococcus aureus (20%)
Escherichia coli (10%)
Enterococcus (10%)
Other causes: 
   Staphylococcus epidermidis,
   Pseudomonas, anaerobes, other 
   gram-negative organisms,
   Streptococcus
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31
Q

WOUND INFECTION (SURGICAL SITE INFECTION)
Which bacteria cause fever and wound infection in the first 24 hours after surgery?
P172

A
  1. Streptococcus
  2. Clostridium
    (bronze-brown weeping tender wound)
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32
Q

CLASSIFICATION OF OPERATIVE WOUNDS
What is a “clean” wound?
P172

A

Elective, nontraumatic wound without acute inflammation; usually closed primarily without the use of drains

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33
Q

CLASSIFICATION OF OPERATIVE WOUNDS
What is the infection rate of a clean wound?
P172

A

1.5%

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34
Q

CLASSIFICATION OF OPERATIVE WOUNDS
What is a clean-contaminated wound?
P173

A

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

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35
Q

CLASSIFICATION OF OPERATIVE WOUNDS
Without infection present, what is the infection rate of a clean-contaminated wound?
P173

A
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36
Q

CLASSIFICATION OF OPERATIVE WOUNDS
What is a contaminated wound?
P173

A

Acute inflammation, traumatic wound,

GI tract spillage, or a major break in sterile technique

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37
Q

CLASSIFICATION OF OPERATIVE WOUNDS
What is the infection rate of a contaminated wound?
P173

A

≈5%

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38
Q

CLASSIFICATION OF OPERATIVE WOUNDS
What is a dirty wound?
P173

A

Pus present, perforated viscus, or dirty

traumatic wound

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39
Q

CLASSIFICATION OF OPERATIVE WOUNDS
What is the infection rate of a dirty wound?
P173

A

≈33%

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40
Q

CLASSIFICATION OF OPERATIVE WOUNDS
What are the possible complications of wound
infections?
P173

A

Fistula, sinus tracts, sepsis, abscess,
suppressed wound healing, superinfection
(i.e., a new infection that develops during
antibiotic treatment for the original infection), hernia

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41
Q

CLASSIFICATION OF OPERATIVE WOUNDS
What factors influence the development of infections?
P173

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 (e.g., too much Bovie)
  • Long operations (2 hrs)
  • Hypothermia in O.R.
  • Hematomas or seromas
  • Dead space that prevents the delivery of
    phagocytic cells to bacterial foci
  • Poor approximation of tissues
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42
Q

CLASSIFICATION OF OPERATIVE WOUNDS
What patient factors influence the development
of infections?
P173

A 
Uremia
Hypovolemic shock
Vascular occlusive states
Advanced age
Distant area of infection
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43
Q

CLASSIFICATION OF OPERATIVE WOUNDS
What are examples of an immunosuppressed state?
P174

A 
Immunosuppressant treatment
Chemotherapy
Systemic malignancy
Trauma or burn injury
Diabetes mellitus
Obesity
Malnutrition
AIDS
Uremia
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44
Q

CLASSIFICATION OF OPERATIVE WOUNDS
Which lab tests are indicated?
P174

A

CBC: leukocytosis or leukopenia (as an abscess may act as a WBC sink), blood cultures, imaging studies (e.g., CT scan to locate an abscess)

45
Q

CLASSIFICATION OF OPERATIVE WOUNDS
What is the treatment?
P174

A

Incision and drainage—an abscess must be
drained (Note: fluctuation is a sign of a
subcutaneous abscess; most abdominal
abscesses are drained percutaneously)
Antibiotics for deep abscesses

46
Q

CLASSIFICATION OF OPERATIVE WOUNDS
What are the indications for antibiotics after drainage of a subcutaneous abscess?
P174

A

Diabetes mellitus, surrounding cellulitis,

prosthetic heart valve, or an immunocompromised state

47
Q

PERITONEAL ABSCESS
What is a peritoneal abscess?
P174

A

Abscess within the peritoneal cavity

48
Q

PERITONEAL ABSCESS
What are the causes?
P174

A

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

49
Q

PERITONEAL ABSCESS
What are the sites of occurrence?
P174

A

Pelvis, Morison’s pouch, subphrenic,

paracolic gutters, periappendiceal, lesser sac

50
Q

PERITONEAL ABSCESS
What are the signs/symptoms?
P174

A

Fever (classically spiking), abdominal pain, mass

51
Q

PERITONEAL ABSCESS
How is the diagnosis made?
P174

A

Abdominal CT scan (or ultrasound)

52
Q

PERITONEAL ABSCESS
When should an abdominal CT scan be obtained looking for a postoperative abscess?
P175

A

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

53
Q

PERITONEAL ABSCESS
What CT scan findings are
associated with abscess?
P175

A

Fluid collection with fibrous rind, gas in

fluid collection

54
Q

PERITONEAL ABSCESS
What is the treatment?
P175

A

Percutaneous CT–guided drainage

55
Q

PERITONEAL ABSCESS
What is an option for
drainage of pelvic abscess?
P175

A

Transrectal drainage (or transvaginal)

56
Q

PERITONEAL ABSCESS
All abscesses must be
drained except which type?
P175

A

Amebiasis!

57
Q

NECROTIZING FASCIITIS
What is it?
P175

A

Bacterial infection of underlying fascia

spreads rapidly along fascial planes

58
Q

NECROTIZING FASCIITIS
What are the causative agents?
P175

A

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

59
Q

NECROTIZING FASCIITIS
What are the signs/symptoms?
P175

A 
Fever, pain, crepitus, cellulitis, skin
discoloration, blood blisters (hemorrhagic
bullae), weeping skin, increased
WBCs, subcutaneous air on x-ray, septic
shock
60
Q

NECROTIZING FASCIITIS
What is the treatment?
P175

A

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

61
Q

NECROTIZING FASCIITIS
Is necrotizing fasciitis an
emergency?
P175

A

YES, patients must be taken to the O.R.

immediately!

62
Q

CLOSTRIDIAL MYOSITIS
What is it?
P175

A

Clostridial muscle infection

63
Q

CLOSTRIDIAL MYOSITIS
What is another name for
this condition?
P175

A

Gas gangrene

64
Q

CLOSTRIDIAL MYOSITIS
What is the most common
causative organism?
P176

A

Clostridium perfringens

65
Q

CLOSTRIDIAL MYOSITIS
What are the signs/symptoms?
P176

A

Pain, fever, shock, crepitus, foul-smelling

brown fluid, subcutaneous air on x-ray

66
Q

CLOSTRIDIAL MYOSITIS
What is the treatment?
P176

A

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

67
Q

SUPPURATIVE HIDRADENITIS
What is it?
P176

A

Infection/abscess formation in apocrine

sweat glands

68
Q

SUPPURATIVE HIDRADENITIS
In what three locations does
it occur?
P176

A

Perineum/buttocks, inguinal area, axillae

site of apocrine glands

69
Q

SUPPURATIVE HIDRADENITIS
What is the most common
causative organism?
P176

A

Staphylococcus aureus

70
Q

SUPPURATIVE HIDRADENITIS
What is the treatment?
P176

A

Antibiotics
Incision and drainage (excision of skin
with glands for chronic infections)

71
Q

PSEUDOMEMBRANOUS COLITIS
What is it?
P176

A

Antibiotic-induced colonic overgrowth
of C. difficile, secondary to loss of
competitive nonpathogenic bacteria that
comprise the normal colonic flora
(Note: it can be caused by any antibiotic,
but especially penicillins, cephalosporins,
and clindamycin)

72
Q

PSEUDOMEMBRANOUS COLITIS
What are the signs/symptoms?
P176

A

Diarrhea (bloody in 10% of patients),
± fever, ± increased WBCs, ± abdominal
cramps, ± abdominal distention

73
Q

PSEUDOMEMBRANOUS COLITIS
What causes the diarrhea?
P176

A

Exotoxin released by C. difficile

74
Q

PSEUDOMEMBRANOUS COLITIS
How is the diagnosis made?
P176

A 
Assay stool for exotoxin titer; fecal
leukocytes may or may not be present;
on colonoscopy you may see an exudate
that looks like a membrane (hence,
“pseudomembranous”)
75
Q

PSEUDOMEMBRANOUS COLITIS
What is the treatment?
P177

A

PO metronidazole (Flagyl®; 93% sensitive)
or PO vancomycin (97% sensitive);
discontinuation of causative agent
Never give antiperistaltics

76
Q

PROPHYLACTIC ANTIBIOTICS
What are the indications for
prophylactic IV antibiotics?
P177

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 procedures
Patients with open fractures (start in ER)
Traumatic wounds occurring > 8 hours
   prior to medical attention
77
Q 
PROPHYLACTIC ANTIBIOTICS
What must a prophylactic
antibiotic cover for
procedures on the large
bowel/abdominal
trauma/appendicitis?
P177
A

Anaerobes

78
Q 
PROPHYLACTIC ANTIBIOTICS
What commonly used
antibiotics offer anaerobic
coverage?
P177
A

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

79
Q 
PROPHYLACTIC ANTIBIOTICS
What antibiotic is used
prophylactically for vascular
surgery?
P177
A

Ancef (if patient is significantly allergic
to PCN—hives/swelling/shortness of
breath—then erythromycin or
clindamycin are options)

80
Q 
PROPHYLACTIC ANTIBIOTICS
When is the appropriate
time to administer
prophylactic antibiotics?
P177
A

Must be in adequate levels in the blood

stream prior to surgical incision!

81
Q

PAROTITIS
What is it?
P178

A

Infection of the parotid gland

82
Q

PAROTITIS
What is the most common
causative organism?
P178

A

Staphylococcus

83
Q

PAROTITIS
What are the associated risk
factors?
P178

A

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

84
Q

PAROTITIS
What is the most common
time of occurrence?
P178

A

Usually 2 weeks postoperative

85
Q

PAROTITIS
What are the signs?
P178

A

Hot, red, tender parotid gland and

increased WBCs

86
Q

PAROTITIS
What is the treatment?
P178

A

Antibiotics, operative drainage as

necessary

87
Q

MISCELLANEOUS
What is a “stitch” abscess?
P178

A

Subcutaneous abscess centered around a
subcutaneous stitch, which is a “foreign
body”; treat with drainage and stitch
removal

88
Q

MISCELLANEOUS
Which bacteria can be found
in the stool (colon)?
P178

A

Anaerobic—Bacteroides fragilis

Aerobic—Escherichia coli

89
Q

MISCELLANEOUS
Which bacteria are found in
infections from human bites?
P178

A

Streptococcus viridans, S. aureus,
Peptococcus, Eikenella (treat with
Augmentin®)

90
Q

MISCELLANEOUS
What are the most common
ICU pneumonia bacteria?
P178

A

Gram-negative organisms

91
Q

MISCELLANEOUS
What is Fournier’s
gangrene?
P178

A

Perineal infection starting classically in
the scrotum in patients with diabetes;
treat with triple antibiotics and wide
débridement—a surgical emergency!

92
Q 
MISCELLANEOUS
Does adding antibiotics to
peritoneal lavage solution
lower the risk of abscess
formation?
P178
A

No (“Dilution is the solution to

pollution”)

93
Q 
MISCELLANEOUS
What is the classic
finding associated with a
Pseudomonas infection?
P179
A

Green exudate and “fruity” smell

94
Q 
MISCELLANEOUS
What are the classic
antibiotics for “triple”
antibiotics?
P179
A

Ampicillin, gentamycin, and

metronidazole (Flagyl®)

95
Q

MISCELLANEOUS
Which antibiotic is used to
treat amoeba infection?
P179

A

Metronidazole (Flagyl®)

96
Q 
MISCELLANEOUS
Which bacteria commonly
infect prosthetic material
and central lines?
P179
A

Staphylococcus epidermis

97
Q

MISCELLANEOUS
What is the antibiotic of
choice for Actinomyces?
P179

A

Penicillin G (exquisitely sensitive)

98
Q

MISCELLANEOUS
What is a furuncle?
P179

A 
Staphylococcal abscess that forms in a
hair follicle (Think: Follicle = Furuncle)
99
Q

MISCELLANEOUS
What is a carbuncle?
P179

A

Subcutaneous staphylococcal abscess
(usually an extension of a furuncle), most
commonly seen in patients with diabetes
(i.e., rule out diabetes)

100
Q

MISCELLANEOUS
What is a felon?
P179

A

Infection of the finger pad

Think: Felon = Finger printing

101
Q

MISCELLANEOUS
What microscopic finding is
associated with Actinomyces?
P179

A

Sulfur granules

102
Q

MISCELLANEOUS
What organism causes
tetanus?
P179

A

Clostridium tetani

103
Q

MISCELLANEOUS
What are the signs of
tetanus?
P179

A

Lockjaw, muscle spasm, laryngospasm,

convulsions, respiratory failure

104
Q 
MISCELLANEOUS
What are the appropriate
prophylactic steps in
tetanus-prone (dirty) injury
in the following patients:

Three previous
immunizations?
P179

A

None (tetanus toxoid only if >5 years

since last toxoid)

105
Q 
MISCELLANEOUS
What are the appropriate
prophylactic steps in
tetanus-prone (dirty) injury
in the following patients:

Two previous
immunizations?
P180

A

Tetanus toxoid

106
Q 
MISCELLANEOUS
What are the appropriate
prophylactic steps in
tetanus-prone (dirty) injury
in the following patients:

One previous
immunization?
P180

A 
Tetanus immunoglobulin IM and tetanus
toxoid IM (at different sites!)
107
Q 
MISCELLANEOUS
What are the appropriate
prophylactic steps in
tetanus-prone (dirty) injury
in the following patients:

No previous
immunizations?
P180

A 
Tetanus immunoglobulin IM and tetanus
toxoid IM (at different sites!)
108
Q

MISCELLANEOUS
What is Fitz-Hugh-Curtis
syndrome?
P180

A

Right upper quadrant pain from

gonococcal perihepatitis in women

Surgery 🤓 (29 decks)

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