Surgical Infections Flashcards
Hypothermia: is
Hypothermia: is immunosuppressive and affects cardiovascular performance adversely.
T/F: hypothermia is immunosuppressive.
True.
Hypothermia can occur during ___ surgery from evaporative losses.
This can occur if there are evaporative losses during intracavitary (abdominal) surgery.
T/F: *Administration of supplemental oxygen reduces the risk of SSI after elective surgery.
True
Resuscitation is
resuscitation of the immune system is a persistent inflammatory response after injury associated with increased risk of nosocomial infection and death.
blood transfusions: transfusions express immunosuppression through altered leukocyte antigen presentation and increased TH2 cells. Blood transfusions are an example of:
resuscitation
T/F: transfusions increase the risk of infection five fold and the risk for surgical patients is ten fold.
False
Which of the following regarding resuscitation is TRUE?
(1) transfusions do not increase the risk for infection or resuscitation.
(2) Resuscitation is seen with central line and ventilator associated pneumonia.
(3) Transfusions can be given if not necessarily indicated.
(1) Resuscitation is seen with central line and ventilator associated pneumonia.
Moderate hyperglycemia (> 200 mg/dL) at any time on the first post-operative day increases the risk of SSI
Moderate hyperglycemia (> 200 mg/dL) at any time on the first post-operative day increases the risk of SSI FOUR- FOLD after cardiac and non-cardiac surgery.
The target blood glucose control for pre-op patients is:
140 - 180 mg/dL.
The amount of calories and nitrogen required for post-op patients:
Calories and nitrogen in excess of 25 – 30 kcal and 1 g nitrogen/kg/day is required. In burn patients, this number can be 1.5 – 2 times higher.
T/F: Endogenous flora: is the source of most bacterial pathogens.
True
Which of the following regarding surgical site infections (SSIs) is TRUE?
(1) the prevalence of SSIs in the USA is < 5% for emergency colon surgeries and > 20% for clean surgeries.
(2) SSI is not a common nosocomial infection in surgery patients.
(3) Incisional infections are the most common type of SSIs.
(4) The onset is 30 days after a procedure that has involved implantation of a foreign material.
(3) Incisional infections are the most common type of SSIs.
The most common pathogen of SSIs is:
(1) staph aureus
(2) staph coagulase negative
(3) enterococcus
(1) staph aureus
The most common pathogen of SSIs in contaminated procedures are:
e. coli and enterobacteriaceae
T/F: If you are planning for a remote and clean operation (e.g., subcutaneous mass on the foot) and a patient presents with UTI or cellulitis elsewhere, these organisms can develop an SSI at the incision site.
True
Bacterial factors: wound infection is inevitable if the bacterial inoculum is sufficiently large ( *** organisms frequently causes infection; if there is LESS Than this amount, there is usually not an infection).
10^5 organisms frequently causes infection; if there is less than this amount, there is usually not an infection.
Which group of organisms produces biofilms, causing inhibition of phagocytosis (a bacterial factor of SSIs)?
(1) klebsiella, strep pneumoniae, coagulase negative staph
(2) clostridia and strep
(1) Klebsiella, strep pneumoniae, coagulase negative staph
Which group of organisms produces endotoxins and exotoxins, contributing to SSIs?
(1) Klebsiella, strep pneumoniae, coagulase negative staph
(2) clostridia and strep
(2) clostridia and strep
You do a surgery on a patient; when you are finished, you primarily close the incision site with sutures. The surgery was not done in the alimentary, genital or urinary tract. This type of wound is considered:
Clean wound
You do a hysterectomy on a patient under controlled conditions and without contamination. This type of wound is considered:
clean-contaminated.
You are doing a colectomy procedure and accidentally perforate the bowels. This wound is considered:
Contaminated
A patient experienced perforation of the large intestine in a blunt trauma injury. The area healed. When undergoing an unrelated surgery, the area appears infected. This type of wound is:
dirty.
Intraoperative measures to prevent SSIs should include:
(1) use monofilament sutures whenever possible.
(2) if there is a risk for wound infection, use secondary healing.
(3) flaps do not have to be adequately perfused.
(1) use monofilament sutures whenever possible.
Which of the following is TRUE?
(1) Give an antibiotic an HOUR before an incision (except for ciprofloxacin and vancomycin).
(2) studies have shown that the pre-op medication is less important than discontinuing antibiotics within 24 hours.
(1) Give an antibiotic an HOUR before an incision (except for ciprofloxacin and vancomycin).
Hip and knee surgeries use:
(1) cephalosporin or vancomycin if the patient has penicillin allergies.
(2) neomycin
(3) erythromycin
Hip and knee surgeries use cephalosporin or vancomycin if the patient has penicillin allergies.
Antibiotics used to decontaminate wounds:
(1) cephalosporins
(2) vancomycin
(3) neomycin and erythromycin
(3) neomycin and erythromycin
the surgical team scrubs their hands and forearms for AT LEAST __ MINUTES for the first time in the day and for __ minutes every consecutive time.
the surgical team scrubs their hands and forearms for AT LEAST 5 MINUTES for the first time in the day and for 3 minutes every consecutive time.
Prophylactic antibiotics are indicated for:
(1) patients undergoing low risk, straightforward clean surgical operations in which no obvious bacterial contamination or insertion of a foreign body has occurred (2) hardware or cardiac surgery cases
Prophylactic antibiotics are indicated for (2) hardware or cardiac surgery cases
T/F: There is no evidence to support the practice of continuing prophylactic antibiotics until central lines, drains and/or chest tubes are removed
True
T/F: Prophylactic antibiotic therapy is effective in clinical situations where continuing contamination is likely to occur: tracheostomies, catheters, central venous lines, drains, most open wounds.
False.
Causative pathogens of surgical infections are usually
mixed (aerobes and anaerobes originating from the patient’s own endogenous flora).
Abscesses of the trunk, head and neck are usually due to
staph aureus and strep
Abscesses of the axillae are usually due to:
gram negative organisms
Abscesses below the wiast (perineum) are usually due to:
aerobic and anaerobic gram negative flora.
Cellulitis is:
(1) A soft tissue infection with no blood supply or viable tissue.
(2) an acute inflammatory response with vessel engorgement and stasis.
(3) Cellulitis can resolve if treatment is initiated after tissue death occurs.
(4) An abscess may be mistaken for cellulitis when the central necrotic portion is located superficial beneath overlying tissuel ayers.
Cellulitis is (2) an acute inflammatory response with vessel engorgement and stasis.
Which of the following is a contraindication to wound closure?
(1) wounds younger than 6 hours
(2) Absence of necrotic or ischemic tissue
(3) Significant crush injuries or human/animal bites.
(4) Tetanus prophylaxis if the most recent tetanus booster was shorter than 5 years ago.
(3) significant crush injuries or human/animal bites.
Which of the following regarding necrotizing fasciitis is TRUE?
(1) It is a layer of necrotic tissue that has been walled off by a surrounding inflammatory reaction and has a clear boundary.
(2) The overlying skin has an abnormal appearance in early stages of infection.
(3) Clostridial myonecrosis requires an amputation.
(4) there is no difference between clostridial and non-clostridial myonecrosis.
(3) Clostridial myonecrosis requires an amputation.
Clostridium perfringens, clostridium novyi and clostridium septicum are all organisms causative of:
clostridial myonecrosis.
Beta hemolytic strep pyogenes is an organism causative of:
(1) clostridial myonecrosis
(2) non-clostridial infections.
(2) non-clostridial infections.
A patient presents with an abscess. There is no erythema and mild edema. Labs show absent WBCs. The patient presents with bronze discoloration, dermal gangrene and crepitus and the infection is affecting the muscle. The patient is tahycardic. The infection is MOST likely:
clostridial myonecrosis.
A patient presents with hemorrhagic bullae and dermal gangrene affecring the muscles. You diagnose the patient with clostridial myonecrosis. Treatment of the condition involves:
aggressive resusciation
(2) penicillin G, broad spectrum antibiotics and clindamycin.
A patient presents with bullae with mild erythema and moderate swelling. There is purulent exudate with elevated WBCs. The subcutanous tissue is affected, and the patient is tachycardic. The diagnosis is MOST likely:
Non-clostridial infection.
Treatment of non-clostridial infection is:
aggressive resuscitation
(2) third generation cephalosoprin or ciprofloxacin plus anti-anaerobic.
(3) Clindamycin
A patient is MORE likely to require an amputation if they have:
(1) Clostridial myonecrosis
(2) non-clostridial infection.
(1) clostridial myonecrosis
The presence of gas in soft tissue infection implies ____ metabolism.
The presence of gas in soft tissue infection implies anaerobic metabolism.
T/F: The majority of gas-producing infections do not involve clostridium species but are instead necrotizing infections involving other bacterial pathogens.
True
Which of the following is an exception to surgical intervention?
(1) pylonephritis
(2) salpingitis
(3) amebic liver abscesses
(4) enteritis, spontaneous bacterial peritonitis.
(5) Uncompliated diverticulitis
(6) Some cases of cholangitis
All of the above are exceptions to surgical intervention.
T/F: In diabetics, recurrent infections are common and 10 - 30% of affected patients eventually require amputation.
True.
The optimal duration of therapy for diabetic foot infections has not beedn determined, but common practice is to treat ___
treat mild infections for one week, however two weeks of therapy may be required.
T/F: cardiac valves are an example of devices that should be left in because they are life sustaining.
True.
The most common non-surgical infection is:
urinary tract infection
The third most common cause of nosocomial infections in surgical patients and the leading cause of death due to nosocomial infections.
Lower respiratory tract infections.
Respiratory tract infections (especially VAP) are common superinfections that occur during the treatment of:
intraabdominal infection.
If patient with no pneumonia or catheter related UTI or cellulitis, the cause of sepsis is CLABSI until proven otherwise.
True.
In the case of CLABSI and catheter related UTIs, routine changes of central lines has been proven to reduce infection rates.
False.
The causative organisms of CLABSI:
MRSE
(2) MRSA
(3) Enterococcus
T/F: Most febrile post operative patients are infected.
False.
The most common non-surgical causes of postoperative infectiona nd fever:
UTI
(2) respiratory infection
(3) IV catheter associated infection
A patient has a fever two days post-op. The patient MOST likely:
(1) has a fever due to an infectious case.
(2) has a fever due to a non-infectious cause.
The patient MOST likely (2) has a fever due to a non-infectious cause.
A patient has a fever seven days post-op. The patient MOST likely:
(1) has a fever due to an infectious cause.
(2) has a fever due to a non-infectious cause.
The patient MOST likely (1) has a fever due to an infectious cause.
T/F: toxic shock syndrome is a common cause of infection in the first 28 hours after operation.
False.
most common pathogen associated with infections in wounds and incisions not subject to endogenous contamination.
Staph aureus
Increased incidence: patients in long term care facilities, previously hospitalized or treated with antibiotics, those with diabetes or on dialysis. It is especially common in cases of ENDOCARDITIS associated with IVDU.
MRSA
trauma, extensive surgery, metabolic disease, patients with invasive vascular devices, endocarditis, prosthetic joint infections, vascular graft infections, post-surgical mediastinitis.
MOST ARE METHICILLIN RESISTANT.
Coagulase negative staph
these cause significant disease in the urinary tract and the biliary tract, as well as subacute endocarditis. They contribute to morbidity and mortality from intraabdominal infections
Enterocci
The most effective antibiotic combination is
gentamicin + ampicillin or vancomycin
Enterobacter, morganella, providencia, serratia these organisms exhibit
greater intrinsic antimicrobial resistance.
the most numerous inhabitants of the normal IG tract, including the mouth. These infections imply a defect in the anatomic integrity of the GI tract
Anaerobes
T/F: MOST ANAEROBIC INFECTIONS REQUIRE SURGICAL INTERVENTION.
True.
