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22 Cards in this Set
- Front
- Back
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What do different types of immunosuppressive agents put you at risk for? |
1. Steroids - increase infection w/ bacteria, viruses and fungi 2. Lymphocyte depleting agents - increase risk for viral infections (CMV, polyoma BK virus, PCP and other fungi) |
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What organisms should be evaluated for prior to transplant? |
EBV, CMV, HIV, Tb, HBV/HCV |
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What infections are solid organ transplant patients at risk within one month of transplant? |
Staph, icnluding MRSA Nosocomial GN bacterial infections Cdiff Candida Aspergillus Surgical site infections Nosocomial PNA Catheter related bacteremia UTIs |
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What infections are solid organ transplant patients at risk for within 6 months of transplant? |
CMV EBV including PTLD HSV VZV PCP Toxo Listeria Legionella Nocardia Tb reactivation Fungal infections HBV and HCV |
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What infections are solid organ transplant patients at risk for at > 6 months after transplant? |
EBV (including PTLD) VZV CAP, UTIs POlyoma BK virus CMV infection Listeria Nocardia |
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How does disseminated CMV present? |
NOnspecific febrile illness Can cause leukopenia, thrombocytopenia or organ specific disease Penumonitis Colitis Esophagitis Hepatitis CMV is immunommodulatory (active infection results in nonspecific changes in immune system function), and it is assocaited w/ organ rejection, secondary infection and PTLD, graft loss and death |
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How does EBV manifest? |
PTLD: present in any patient presenting with fever and LAD or an extranodal mass - Treatment: reduction of immunosuppression and rituxan or other chemotherapy |
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How does HHV6 infection occur? |
Fever, myelosuppression, hepatitis, encephalitis, pneumonitis |
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What are manifestations of common bacterial infections? |
Resistant staph GN infections Listeria: meningoencephalitis Legionella: progressive multilobar PNA Nocardia: presents with lung nodules but can be disseminated at presentation, often to the brain Tb: 2/3 cases occur within the first year, 30-50% of these are extrampulmonary or disseminated at presentation |
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What fungal infections are common after transplant? |
1. Invasive candida 2. Invasive aspergillosis: pulmonary aspergillosis presents w/ fever, dry cough, chest pain and can disseminate to the brain, causing HA, focal deficits or MS changes 3. Mucor 4. Cryptococcus meningitis: subacute or chronic onset fever, headache, MS changes 5. DIsseminated histo/coccidio, blasto 6. Toxo: middle to late period after transplant, most often with brain abscesses with fever, headache, focal dificits seizures and multiple ring enhancing lesions on brain imaging |
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What antimicrobrials are used for ppx? |
1. Valganciclovir if CMV seronegative recipient and CMV seropositive donor; or preemptive therapy (monitoring for reactivation by nucleic acid amplification testing) 2. Bactrim through neutropenic period - also has some activity againist norcardia and listeria, toxo, can sometimes continue for 12 months or longer 3. Fluconazole or voriconaozle |
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What are the guidelines for immunization in solid organ transplant? |
Before transplant, PCV13 followed by PPSV 23 8 weeks later, 5 years post transplant PPSV 23 Influenza yearly Tdap: complete series before transplant, including Tdap booster MMR - contraindicated AFTER transplant Inactivated polio: before transplant HAV/HBV complete before transplant VZV: complete >4 weeks prior to transplant, cinluding zoster. These are contraindicated after transplant |
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What are the immunization recommendations for patients receiving HSCT? |
3-6 monthjs after transplant: 3-4 doses of PCV 13 12 months after tranplant: 1 dose of PPSV23 TdaP: 6 monhts after transplant - 3 doses MMR: 24 months after transplant, 1-2 doses but only if no GVHD or immune suppression Inactivated polio: 6-12 months after trnasplant 3 doses, same wiht H influenza HBV?HAV: 6-12 months after transplant: 3 doses if indications for nontransplant patients are met VZV: > 4 weeks before trnasplant: varicella if not immune, 24 months after transplant 2 doses of varicella if seronegative and only if no GHVD or immunosuppresion |
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What is the epi of CAUTI? What are the pathogens implicated? |
40% of Hospital Acquired Infections 3-7% daily risk of developing a UTI Cause 17% of hospital acquired bacteremias - Pathogens: E coli, PsA, K. PNA, C. albicans and Enterococcus faecalis |
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What are the indications for foley catheterization? |
Urinary retention and bladder outlet obstruction Measurement of urinary output in critically ill patients, perioperative use for selected surgical procedures Assistance w/ healing of perineal or sacral wounds in patients w/ incontinence Prolonged immobilization Contribution to comfort at the end of life |
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What are the most common organisms that cause surgical site infections? |
STaph Coag neg staph E coli Enterococcus PsA |
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What are the most common organisms that cause CLABSI? |
Staph, staph epi Strep PsA GNRs - K PNA, enterococcus, enterobacter, Ecoli, PsA Candida |
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Why should you get peripheral cultures? |
Cultures from the catheter site have a high rate of false positive, but also very high negative predictive value if neg |
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Which selected patients can be treated with only 14d of antibiotics for staph infection? |
Fever and bacteremia resolve within 72 hours Catheters have been removed No diabetes No immunosuppression NO implanted prosthetic devices No e/o endocarditis by echo No e/o infected thrombophelbitis (no e/o metastatic infection) Bcx have begom enegative w/ removal of the central line |
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When should vanc not be used in MRSA bacteremia? |
When MIC > 2 Dapto should not be used in pPNA because it is inactivated by surfactant |
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What are the most common organisms in VPA? |
< 5 days after admission/intubation: staph PNA, H, influenza, staph aureus Late onset: mor elikely to be resistant organisms, including PsA, K PNA, Acinetobacter, stenotrophomonas, burkoholeria cepacia and MRSA |
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What are the most common MDROs? |
1. ESBL producing enterobacteriacae 2. Carbapenem resistant enterbacteria (production of K PNA carbapenemase enzyme is most common in US) PSA Acinetobacter |
