Blood And Lymph - Dugan - Bacteremia And Blood Cultures

Front 1

List the conditions associated with blood infection from bacteria starting with Bacteremia in increasing severity

Back 1

Bacteremia --> SIRS (systemic inflamm response syndrome) --> Sepsis --> SEVERE Sepsis --> Septic SHOCK --> MULTIPLE ORGAN DYSFUNCTION SYNDROME

Front 2

Whats the criteria to define whether a pt has SIRS?

Back 2

SIRS = Systemic inflamm

TWO or more of the following:

Respirations > 20
Temp. > 38
H.R. > 90
WBC . 12,000 or 10% bands = left shift

Front 3

Define Sepsis

Back 3

SIRS due to infection (SIRS = 2 or more of the following: respirations > 20, Temp > 38, H.R. > 90, or WBC . 12,000)

Front 4

When does sepsis become severe sepsis?

Back 4

When it involves organ dysfunction because of HypOperfusion

Front 5

When does severe sepsis become Septic Shock?

Back 5

When persistent HypOtension and low perfusion persists even tho you replace fluid

Front 6

Define multiple organ dysfunction syndrome

Back 6

When the balance of homeostasis (=fibrinolysis and coag) can't be maintained without intervention

Front 7

Who is predisposed to septic shock?

Back 7

Anyone who is predisposed to get bacterial infections

Front 8

What are the 3 possible patterns of bacteremia we can have?

Back 8

transient = body clears infection quickly
intermittent = comes and goes..ex = subacute endocarditis
continuous = ...continuous, duh...ex. = subacute endocarditis, deep seated infections, etc

Front 9

Whats the series of events from bacteria infecting blood to shock and organ failure?

Back 9

Bacterial Infection --> Bacteremia --> Host inflamm. response --> Inc. Inflamm and Coag/ Dec. Fibrinolysis --> Changes in endo and microvasculature --> shock and organ faliure

Front 10

What is the leading cause of death in non-cardiac critically ill pts?

Back 10

sepsis progressing to septic shock

Front 11

How do you collect blood to be cultures to see if theres bacteria in it?

Back 11

Decontaminate skin preferably with iodine tincture or chlorhexidine gluconate (or povidon iodine) --> collect sample when fever peaks --> Take appropriate # of samples (acute = 2-3 30 min apart subacute = 3 or more over 1-2 days)

Front 12

Who needs their blood cultured?

Back 12

Need Either: 1 Major or 2 Minor:

MAJOR = Endocarditis suspected, Temp > 39.4 (103), Indwelling Vascular Catheter

MINOR = Temp. 38.3 - 39.3, Age >65, Symptoms (chills, Vomit, HypOtension), Labs (BWC > 18,000, Bands> 5%, platelets < 150,000 cells/mm3, Creatinine > 2 mg/dL)

Front 13

A pt has A temp of 39.0 and the following:bands = 7%, WBC = 20,000, Creatinine = 3 mg/dL. Do you draw their blood to check for bacteria?

Back 13

YES

Front 14

A pt has symptoms of endocarditis, a temp of 39.5, has been catheterized in the hospital for 1 week....Should you draw their blood t ocheck for bacteremia?

Back 14

YES

Front 15

A pt has been experiencing chills for the past 2 nights, and has a temp of 38. Should you draw their blood to check for bacteria?

Back 15

NO,

They only have ONE of the MINOR criteria (ie chills...for MINOR criteria temp has to be above 38.3)

Front 16

List some of the blood culture systems (if he asks us about these i will shoot him)

Back 16

Traditional Bottles
Septi-check
Lysis Centrifugation
Automated continuous monitoring culture system ie Bactec 9000 = Detects CO2
BacT/Alert = detects CO2

Front 17

What are the advantages of the continuous monitoring blood culture systems that monitor CO2?

Back 17

Earlier detection
Dec. Lab workload

Front 18

What is *critical* in culture interpretation of blood?

Back 18

TO ID THE DAMN* ORGANISM

Front 19

Besides ID-ing the organism, what else is important in blood culture interpretation?

Back 19

Getting a positive result for an organism more than once means that there is more of a chance that the positive culture is NOT due to contamination

BOTH anaerobic and aerobic bottles positive

Turns positive rapidly (24-48 hrs = more organisms)

Front 20

You have a pt whose blood samples have been positive twice in the past few days for coag neg staph, and it turned positive within 24 hrs. Should you be concerned?

Back 20

Yep

Front 21

What species of bacteria have the highest percentages of false positive rates?

Back 21

Coag. Neg. Staph= 44%

Corynebacterium spp = 33%

Front 22

You have a pt whose blood samples have been positive twice in the past few days for coag neg staph, and it turned positive within 24 hrs. How should you proceed?

Back 22

Start empiric Tx with Abx within 1 hr of presentation with broad-spectrum Abx coverage against BOTH gram neg and Gram pos. bact.

Ex. = Vancomycin + Gram neg coverage (Carbapenem, Cefepime, Piperacillin/tazobactam, consider adding aminoglycoside)

THEN go onto bact-specific tx even if pt is responding to your empiric tx

Front 23

T/F: The identity of the organism in a blood culture can help determine if the culture is contaminated

Back 23

TRUE

Front 24

Tx for S. aureus meth-resistant?

Back 24

vanco + genta

Front 25

Tx for S. aureus meth-sensitive?

Back 25

Nafcillin + genta

Front 26

Tx for E. coli?

Back 26

3rd gen cephalosporin (easy to remember b/c "E" is like a backwards "3")

Front 27

Tx for P. aeruginosa?

Back 27

Extended spectrum pens (piperacillin/tazobactam) + aminoglycoside

Front 28

What factors lead to poor prognosis for treatment of bacteremia?

Back 28

Inc. Age
Nosocomial (ie hospital-acquired) bacteria
Enterococcal, gram neg. or fungal etiology
underlying

Front 29

You obtain 2 blood samples from a pt you think may have endocarditis. Both are positive for gram neg. staph. Should you be suspicious?

Back 29

Yes, because although gram neg staph (as well as Corynebacterium) are the most common false negative bacterial species found, the fact that two of the samples were contaminated means you should think bacteremia

Usually 2/2 positive blood cultures for the same specimen this represents real disease (assuming blood cultures were obtained from separate venipuctures or catheter draws

Front 30

T/F: Usually only ONE of the blood culture specimens will be positive if its positive due to contaimination

Back 30

TRUE