Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
164 Cards in this Set
- Front
- Back
|
what causes the inflammation in an infection
|
-result of vasodilation which allows greater blood flow
-also result of increased WBC to the area (pus) |
|
|
post-op infections (no implant)
|
-Staph aureus (if pt had hx of MRSA, MRSA should be suspected)
|
|
|
post op infection (with implant)
|
staph epidermis or coagulase negative staph (large majority are M resistant)
-NOTE: SA is coag positive whiich gives it its virulence |
|
|
puncture wound OM
|
pseudomonas aeruginosa
|
|
|
celllulitis following a puncture wound
|
staph and strept
|
|
|
infected ulcer in DM pt
|
staph aureus and group B streptococcus(aka strept agalactiae)
|
|
|
clinical signs/symptoms of infection
|
-N/V/F/C/NS
-lumps of stiffness behind the knees or in the groin -red streaking (lymphangitis) |
|
|
does HIV infection have an impact on presentation of LE bacterial infections
|
no, bc most of the immune alterations in HIV invovlves T cells and therfore response to fingal, viral and parasitic infections may be altered
|
|
|
what bacteria should be covered with all IVDA infections
|
-MRSA and P.aeruginosa
-SBA should also be ruled out |
|
|
which abx shouldnt be used with alcohol bc they have disulfirim (Antabuse) reaction of nausea, vomit, tachycardia
|
-bactrim, flagyl
|
|
|
how is cellulitis diagnosed
|
-redness (rubor)
-swelling (tumor) -pain (dolor) -heat (calor) -loss of fxn |
|
|
list some non-infectious inflammatory conditions that can mimic infectious cellulitis
|
-gout
-DVT -chronic indurated celulitis(venous) -charcot -acute trauma -post surgical changes |
|
|
into what nodes do infections of the foot and leg drain to
|
-popliteal and inguinal nodes
|
|
|
when is an intermittant fever seen
|
-in abscesses; which intermittantly see the blood, MC in LE infections
|
|
|
list the drugs that can cause fever
|
-NSAIDS
-phenytoin -phenobarbital -PCN -aspirin -antihistamines |
|
|
differ sepsis from bacteremia
|
-bacteremia is presence of bacteria in the blood, sepsis is clinically significant and presents with symptoms
|
|
|
clincical signs of sepsis
|
-fever (>38 C, 100.4)
-tachy(>90) -change in mental status -inc resp rate (>20) -leukocytosis (<12,000) |
|
|
how many days should you wait for normalization of WBC with abx tx before switching tx options
|
-3 days
|
|
|
what is ANC and what level should it be
|
-absolute neutrophil count
-if <1000, pt should be isolated to prevent exogenous infection |
|
|
normal ESR
|
<17 mm/hr in males
<25 mm/hr in females |
|
|
normal CRP
|
<1 mg/L
>10 in inflammation |
|
|
serum creatinine should be monitored in all parenteral abx pts because it is the best index of renal fxn and thus abx excretion, what is N
|
0.8-1.4 in males
0.6-1.2 in females |
|
|
what tests are in LFT (liver fxn tests)
|
-bilirubin
-ALT -AST |
|
|
list 2 abx metabolized in the liver and thus should be given with LFT
|
-clinda
-erythromycin |
|
|
if you order a gram stain of LE infection; what are the most likely results
|
-gram positive (except in the rare cases of gonococci septic arthritis)
|
|
|
Gram Stain results:
G pos (blue) cocci in grape clusters |
staphylococcus
|
|
|
Gram Stain results:
G pos (blue) cocci in chains |
streptococcus
|
|
|
Gram Stain results:
G pos (blue) rods in chinese characters |
corynebacterium
|
|
|
Gram Stain results:
G pos (blue) rods with raquet shape |
clostridium
|
|
|
Gram Stain results:
G neg (red) curved rod |
pseudomonas
|
|
|
on gram stain; in addition to organisms, what else would be present in an infection
|
-white cells (mainly PMN's)
|
|
|
if gram stain reveals a large number of organisms differing in morphology and culture report only isolates a few, what should be suspected
|
-anerobic bacteria
|
|
|
what is the Levine method
|
-cleanse the wound bed or debride
-roll swab in 1cm square area while applying enough pressure to the swab to express fluid from the wound |
|
|
what do acid fast smears test for
|
-mycobacteria
(to be thorough you can order gram stain, aerobic, anaerobicc, fungal and acid fast) |
|
|
clinical hints that suggest resolution of an infection
|
-decrease in the amount and anger of cellulitis
-presence of skin wrinkles seen with decreased edema -appearance of a band of peeling skin, centered around the area of original cellulitis -post inflammatory hyperpigmentation of a violet color in area of previous cellulitis - may be present for more then one year and isnt warm, so dont confuse with cellulitis |
|
|
if a pt presents with cellulitis and no opening or drainage, should you aspirate the edge to get a culture
|
NO. can cause deep spread of the infection and also results in poor recovery of the organism
|
|
|
MC cause of celulitis
|
-strept and staph
|
|
|
Oral tx for staph/strept cellulitis
|
-Cephalosporin
-augmentin (amox/clav) -Penicillinase resistant PCN (cloxacillin, dicloxicillan) -clinda -doxy if MRSA is suspected |
|
|
parenteral (IV) for staph/strept cellulitis
|
-ancef (1st gen cephalosporin)
-Augmentin, Pip/tazo -nafcillan, oxacillin -clinda -vanco |
|
|
pathognomonic for CA-MRSA
|
-pt got a spider or insect bite, but never saw the insect
-agressive spreading abscess |
|
|
ID masceration, itching and cellulitis over distal foot, red fluorescence under Woods.
Dx, gram stain and Tx |
-erythrasma (gram + bacilli)
Tx: oral erythromycin |
|
|
Honey colored crusts with yellow creamy drainage. Gram stain, Dx, Tx?
|
-Impetigo
-Group A strept, SA, MRSA -G pos cocci in chains and clusters -Mupirocin topical or topical retapamulin- latter is effective against MRSA |
|
|
punched out lesions with greenish yellow crusts with surrounding erythema
|
ecthyma
-caused by strept |
|
|
cellulitis with sharply demarcated geographic borders, raised border
|
erisipelas
-form of cellulitis that involves lymphatic blockage -group A strept |
|
|
necrotizing fascitis: bacteria and clinical presentation
|
-pain out of proportion
-swab can be passed easily b/w tissue planes -Group A, beta hemolytic strept |
|
|
Gas gangrene: MC organism and tx
|
-tense bulla with brown red drainage
-clostridium -Pen G + Clinda -or Ertapenem -or imipenem/cilistain -anything with g neg coverage |
|
|
OM types based on etiology
|
-hematogenous spread
-direct extension or contiguous -OM secondary to vascular insufficiency |
|
|
Anatomic stages of OM
|
-medullary (mc in hematogenous)
-superficial (only outer cortex) -localized (at least one cortex through into the medullary canal) -diffuse (more then one cortex is involved plus medullary- bone is unstable) |
|
|
clinical signs suggestive of OM
|
-mushy crumbly bone on probing
-purulence inside a bone -pinpoint swelling, pain or redness over a bone w/o sinus opening -presence of sinus tract -scars over the area suggesting a healed sinus -ulcer greater then 2 cm |
|
|
lab findings of OM
|
ESR >70
CRP -elevated WBC |
|
|
imaging gold std for OM
|
MRI -
|
|
|
plain film signs of OM
|
-cortical breaking
-periosteal elevation-caused by pus breaking through cortex -lysis and lucency of bone -sequestrum -involucrum -brodie abscess in chronic OM |
|
|
order of imaging for OM
|
-plain film
-MRI -bone scan |
|
|
very good bone penetration and coverage for staph OM
|
-clindamycin
|
|
|
why is dead space management used in open wounds and fractures
|
-prevent the collection of fluid that may harbor bacteria
|
|
|
excessive lavage pressure can cause tissue damage and implant organisms deeper in the wound; what pressure should be used
|
60 psi; which is equivalent to 30 mL syringe with 19 gauge needle
-pressure is more imp than any additives to the water (abx, etc) |
|
|
what is the "grandfathered" method for deciding when to close a wound
|
-after 3 negative cultures
|
|
|
what clinical criteria should be met before a wound is closed
|
-no SOI (no area of red, hot, swollen or pain)
-no purulent drainage -no odor -granular appearance of wound bed -staph epi on wound cultures is not a contraindication to closure |
|
|
treatment for foot puncture wound (nail)
|
-amox/calvulanic acid 500 or 875 bid
-clinda 300 mg tid -cephalexin 500 bid-qid -levofloxacin 500 qid (includes pseudomonas coverage) |
|
|
bacteria found in puncture wounds in marine environment
|
-P. aeruginosa
-aeromonas -vibrio -mycobacterium marinum |
|
|
how can a stingray puncture be treated
|
-this is not bacterial
-the venom is heat labile, so soat in hot water for 30-60 minutes |
|
|
how does mycobacterium marinum found in pools and freshwater present in the LE
|
-bluish purple nodules that may drain and ulcerate
|
|
|
why are cat bites more llikely to become infected than dog bites
|
-cats have deeper punctures
|
|
|
what is your window of tx for bite wounds to prevent infection
|
-with in 12 hours
|
|
|
with in how many hours should a bite wound be irrigated and debrided if you are going to primary close it
|
-with in 12 hours
-after 12 hours, leave the wound open |
|
|
drugs of first choice for bite wounds
|
-any beta lactamase inhibitor compound (amox/clav, pip/tazo, ticarcillin/clav, ampicillin sulbactam)
-augmentin -zosyn -timentin -unasyn |
|
|
why is cefazolin commonly used in traumatic fxs and surgery
|
-long half life
-good staph coverage -some gram neg coverage |
|
|
wound less then 1 cm (puncture wound)
|
Gustillo Anderson 1
|
|
|
wound 1- 10 cm with soft tissue coverage
|
Gustillo Anderson 2
|
|
|
Gustillo Anderson 3
|
greater then 10 cm
A: with soft tissue coverage B: with periosteal stripping C: with vascualr damage |
|
|
gustill anderson 1 tx
|
gram positive coverage with cephalosporin
|
|
|
gustillo anderson 2 tx
|
gram pos coverage with cephalosporin, add gram neg coverage with aminoglycoside such as gentamycin (or you can use a newer quinolone or ES cephalosporin - rocephin)
|
|
|
according to lavery, what % of DM ulcers become infected
|
50%
|
|
|
5 yr and 50% with relation to DM amps
|
-5 yr survival of one leg amp is 50%
-pts with 1 limb amp have 50% chance of 2nd limb amp in 5 years |
|
|
triad of factors for DM foot infection
|
-neuropathy
-angiopathy -immunopathy |
|
|
list the 3 neuropathys of DM and their role in ulceration
|
-sensory neuropathy
-motor neuropathy (muscle wasting, imbalance of flexors, dorsal dislocations, claw toes, pseudo-cavus, dorsal dislocation of fat pad) -autonomic neuropathy: impaired sweating, xerosis, sympathetic failure causes vasodilation adn AV shunting causing decreased perfusion, edema |
|
|
what effect does hyperglycemia have on the immune system
|
-decreases chemotaxis to site of infection
-decrease phagocytosis |
|
|
American Diabetes Assoc with regards to DM and PAD
|
In DM the occulsive disease:
-more widespread and multisegmental -occurs at earlier age -is more frequent -progresses to more advanced stages -presents with more distal involvement -presents with moer gangrene -tends to be bilateral -affects men and women equally |
|
|
which abx should be avoided in DM because of impaired renal fxn in LT DM
|
-aminoglycosides
|
|
|
6 grades of ulcers primarily based on depth
|
wagner
|
|
|
Mantra of DM ulcers
|
NO CLINICAL SOI, NO INFECTION, NO INFECTION, NO CULTURE, NO INFECTION, NO ABX
|
|
|
what is excessive hyperkeratosis around a wound edge a sign of
|
-excessive WB and/or pressure
|
|
|
Biofilm over the granulation tissue of a wound does not indicate infection, however what 2 organisms commonly form biofilms
|
-staph and pseudomonas
|
|
|
normal flora in ulcers (flora in non-infected ulcers)
|
-SA
-staph epi -p mirabilis -p aeruginosa |
|
|
clincial presentation of MILDLY infected ulcers
|
-lack of healthy granulation (pink instead of red) base
-necrosis, eschar formation -red, swollen, heat -purulent drainage -less then 2cm of erythema from wound edge |
|
|
bacteria of mild infections
|
-SA, Group B strept (strept agalactiae)
|
|
|
TX for mild infected ulcers (<2cm erythema around wound, >2 SOI, no systemic signs)
|
-debride and offload
-oral abx -Augmentin 875 bid -Keflex 500 mg tid -clinda 300 mg bid |
|
|
clinical presentation of MODERATE infected ulcer
|
1 or more of these symptoms:
-cellulitis >2 cm from wound edge -lymph streaking -spread anywhere beneath the superficial fascia -no systemic SOI |
|
|
bacteria of MODERATE infections
|
-polymicrobial
-SA, MRSA -Group B strept -Gram pos anaerobes (Pepto) -Gram neg aerobes (Ecoli, proteus, enterobacter, pseudomonas -gram neg anaerobes (B fragilis, bacteroides |
|
|
which group of abx have good bioavialiability orally and parenterally
|
quinolones
|
|
|
Tx for moderate infections
|
-debride and offload
-IV abx -Pip/tazo (Zosyn) 3.375 q6 -linezolid (zyvox) 600 mg q12 -Ertapenem (Invanz) 1 g q24 - |
|
|
MRSA coverage for moderate DM infections
|
-Linezolid 600 mg q12
-vanco 1 g IV q12 -daptomycin 4mg/kg IV q24 -tigecycline 100 mg IV, tehn 50 mg q12 |
|
|
clinical signs of SEVERE foot infection
|
-local wound and systemic signs are present (F/C/N/V/tachy/hypotension)
|
|
|
tx for SEVERE infections
|
-hospitalization and IV abx (same as moderate)
Pip/tazo (Zosyn) 3.375 q6 -linezolid (zyvox) 600 mg q12 -Ertapenem (Invanz) 1 g q24 |
|
|
MC areas for arterial ulcers
|
-distal toes
-medial side of 1st met head -lateral side of 5th met head -heel |
|
|
Clinical symptoms/signs of arterial ulcers
|
-worse at night
-relieved with dependency -necrotic bases with eschar -remain stable for long periods or until vascular intervention |
|
|
what is post-bypass hyperemic flush
|
-occurs after revascularization in arterial ulcer
-may be confused with infection (arterial ulcers are rarely infected) |
|
|
Tx for arterial ulcers
|
-not usually debrided
-topical enzymes for breaking down eschar |
|
|
DM are 4-5 times more likely to get fungal infection, why is it imp to treat these
|
-ID tinea leads to masceration that can lead to secondary bacterial infection
-the anatomy of the webspaces allows infection to spread via many tendons that insert near the webspaces |
|
|
when should surgical prophylactic abx be given
|
-sx lasting longer then 2 hours
-sx on immunocompromised pts (DM, CA, RA, HIV) -trauma sx -implant sx |
|
|
most common post-op pathogen
|
SA
|
|
|
implant infections are MC caused by
|
-staph epidermis
-is often MRSE -can take up to 1 year from sx to show up |
|
|
what is the dosage time for pre-op oral, IV, muscular injections of prophylactic abx
|
-oral should be given 1 hour before incision
-45 minutes for IM route -IV should be given before tourniquet inflation |
|
|
how many days of post op abx is suggested to decrease infection rate
|
3-5 days
|
|
|
why is cefazolin used for preop abx (ancef)
|
-long half life to last in cases around 2 hours
-covers staph and some gram negs -inexpensive |
|
|
if in a hospital with high MRSA or implant surgery (activity against coag neg staph) what pre-op abx should be used
|
-vanco
-1 g begun 1 hour before sx and infused over that hour |
|
|
what is the alternaative for PCN allergic pts (cant use ancef) or beta lactam allergic pts (cant use vanco)
|
clinda 600-900 mg IV
|
|
|
why shouldnt cipro be used in surgery prophy
|
-doesnt cover staph well
|
|
|
newer quinolones are just as bioavailable in their oral as their IV form; give example
|
levofloxacin (levaquin)
|
|
|
what are the current guidelines for pre-op abx (who gets them)
|
-all pts during the first two years after a joint replacement
-immune compromised pts -pts with comorbidities (previous joint infections, malnutrition, hemophillia, HIV, DM, CA) |
|
|
what was the first FDA approved topical therapy for onychomycosis
|
ciclopirox 8% lacquer (penlac)
-broad spectrum effective against fungus, yeast, molds and some g pos, g negs |
|
|
name the three dermatophytes that cause human fungal infections
|
-trichophyton
-microsporum -epidermophyton |
|
|
MC causes of tinea pedis
|
T rubrum
T mentagrophytes E floccosum |
|
|
what pathogen is most likely to cause ID infection
|
C. albicans
|
|
|
explain the phrase "gram neg tinea"
|
-fungus breaks down the ID tissue which leads to secondary bacterial infection by pseudomonas and proteus
|
|
|
name 3 predisposing factors for tinea pedis in pts
|
-genetics (some lack the genetics in T cells to fight dermatophytes)
-environment (pts who work in wet shoes etc) -anatomic occlusion (pts with lack of room b/w their toes) |
|
|
fungus of skin and nail unit: fungus produces hyperkeratosis that builds up under the nail plate and lifts it up
|
DSO- distal subungual
-MC |
|
|
name the 3 types of onychomycosis and describe them
|
-DSO; thickened nails with peri nail involvement
-WSO: white superficial with out nail thickening -Proximal white onychomycosis: common in HIV and immune compromised |
|
|
best oral drug for onychomycosis
|
Terbinifine (lamisil)
|
|
|
when culture material is gathered on a swab, what should be ordered
|
-Gram stain with culture and sensitivity
|
|
|
what is the time frame on gram stain
|
-24 hours
|
|
|
what is the time frame on a complete culture report (what bacteria are present)
|
48 hours
|
|
|
what are 2 methods for determining sensitivity of bacteria
|
-Kirby Bauer disc diffusion (qualitative)
-MIC with microdilution (quantitative) |
|
|
abx can killa by "concentration dependent killing" or "time dependent killing"; list examples of each
|
-as concentration increases above MIC, so does killing (quinolones, aminoglycosides)
-minimal increase in rate of healing above MIC (PCN, ceph) |
|
|
what happens when a G6PD pts take sulfonamides
|
hemolysis
|
|
|
how are most abx cleared from the body
|
-the kidneys
-so renal pts should have the dose adjusted or time interval b/w doses altered |
|
|
liver metabolized abx
|
clinda, erythromycin, chloramphenicol
|
|
|
abx associated with ototoxicity; which are reversible
|
-aminoglycosides (gentamycin) and erythromycin, vancomycin
-erythromycin is reversible -vanco ototoxicity was thought to be related to impurities |
|
|
why should aminoglycosides always be administered over 30 minute period and never in a bolus
|
-due to their NM blockade and affect ACh uptake and release
|
|
|
abx that cause nephrotoxicity
|
-aminoglycosides
-vanco -PCN and cephs |
|
|
abx that are liver toxic
|
-tetracycline
-erythromycin (reversible) |
|
|
what abx can cause neutropenia (WBC drop)
|
-sulfonamides can cause agranulocytosis
-chloramphenicol -beta lactams (augmentin, cillins, cephs) -vanco -linezolid |
|
|
although this abx is rarely used in the foot; can be used for gram pos cocci in chains, OM where strept is only pahtogen, septic arthritis in young individual where gonococcus is suspected
|
Penicillin G
|
|
|
SA (not MRSA) infection
|
-nafcillin, cloxacillin, dicloxacillin
|
|
|
first choice for staph - methicillin sensitive
|
antistaph oral (cephalosporin)
-keflex -ceftin -omnicef -cefzil |
|
|
IV for non MRSA staph
|
-Ancef
|
|
|
oral for strept
|
same as staph (cephs)
-keflex, ceftin, omnicef, cefzil |
|
|
oral for staph (MRSA)
|
Zyvox (linezolid), bactrim, mino/doxy
|
|
|
IV for staph (MRSA)
|
-dapto
-vanco |
|
|
drug for VRE
|
linezolid (zyvox) - oral and IV
|
|
|
oral drug for enterococcus (not VRE)
|
-Amoxicillin
-amox/clav -linezolid |
|
|
IV for enterococcus (not VRE)
|
-linezolid
-vanco |
|
|
oral for ecoli
|
cephalosporin (similar to staph and strept coverage) or quinolone
|
|
|
IV for ecoli
|
ancef
|
|
|
oral for pseudomonas
|
cipro
|
|
|
anti anaerobic agents
|
-metronidazole (flagyl)
-clinda |
|
|
anti gram positive abx
|
-vanco
-synercid (quinupristin/dalfopristin) -zyvox (linezolid) -cubicin (daptomycin) -tygacil (tigecycline) -rifampin |
|
|
quinolones
|
-avelox
-cipro -levaquin |
|
|
aerobic gram pos cocci
|
-staph is clusters
-strept is chains -enterococci |
|
|
aerobic gram pos cocci enterococci
|
-enterococci (E. faecalis)
-found in gut -VRE |
|
|
anerobic gram pos cocci
|
-peptostreptococcus
|
|
|
gram pos bacilli
|
-rods
-clostridium tetani - c perfringens -corynebacterium |
|
|
gram neg cocci
|
neisseria gonorrhea
neisseria meningitides |
|
|
anerobic gram neg rods
|
bacteroides
|
|
|
aerobic gram neg rods
|
enterobacteriacea; citrobacter, enterobacter, ecoli, klebsiella, proteus, salmonella, serratia, pseudomonas
|
|
|
greatest cause of steven johnson reaction
|
sulfa drugs
|
|
|
later generation tetracyclines can be used for CA-MRSA; list them and the dose
|
-doxycycline
-minocycline -100 mg q12 po |
|
|
If there is an "S" next to Clinda, can you use clinda?
|
no, look at the macrolide line usually represented by erythromycin. If it is resistant to erythromycin, cant use clinda.
|
|
|
what is the MIC creep for vanco
|
-in the past MRSA strains could be inhibited by 0.5 micrograms, it is now creeping to 1 and even 2
-if greater then 2, choose another drug |
|
|
only oral drug for MRSA soft tissue infections
|
Zyvox - linezolid
|
|
|
4 FDA approved abx for MRSA
|
-vanco
-linezolid (zyvox); only oral -daptomycin (cubicin) -tigecycline (tygacil) |
|
|
how does celulitis and erysipelas differ
|
-cellulitis has a less demarcated borders
-erysipelas is a form of cellulitis, but the lesion is indurated, scarlet red and often complicated by lymphangitis -erysipelas is more superficial then cellulitis |
|
|
hypotension is a SOI, what is considered hypotensive
|
-systolic <90 20mmHg below baseline
|
|
|
SSI (surgical site infections)-fever or clinical evidence of soft tissue infection with in the first 48 hours after a surgery (usually they show 5 days-2 wks); which bacteria are implicated with an infection this early post op
|
S pyogenes
Clostridium |
