Micro Winter 25 Bacteremia, Sepsis, Infective Endocarditis

Front 1

what is it called when there is bacteria in the blood

Back 1

bacteremia

**the categories of bacteremia depend on the cause, length of time in the blood and the organism itself

Front 2

how long does the bacteremia last when its caused by...

1. dental abstracton
2. pneumococcal pneumonia
3. gram - sepsis
4. intra-sbd sepsis
5. infective endocarditis
6. catheter indwelling

Back 2

1. dental abstracton: spike and drop in hours
2. pneumococcal pneumonia- spikeand drop ~ 6hrs
3. gram - sepsis: rise and fall with amt of bacteria increasing with each rise
4. intra-abd sepsis: 2 small humps
5. infective endocarditis: low steady level
6. catheter indwelling: linear increase

Front 3

tell me about bacteremia associated with "normal" events. brushing teeth, normal childbirth, endoscopy, pooping, scraped knuckle etc

Back 3

its NOT a disease state but bacterial level in the blood DO rise

**the body quickly kills the bacteria

**caused by normal flora
-strep viridans of oral cavity

Front 4

what is the classification of bacteremia of strep viridans from the oral cavity after brushing teeth

Back 4

NORMAL! its transient and NOT a disease, some bacteria is in blood but the body quickly clears it

Front 5

how do you dx an intermittent/recurrent bacteremia

Back 5

when there is a focal infection like abcess or UTI it can leak into the blood

several cultures needed to get the dx and also monitor

they tend to increase and clear out and then come back (intra abd sepsis, gram - sepsis)

Front 6

whats an example of continuous bacteremia

Back 6

endocarditis
catheter indwelling

Front 7

if you have bacteremia but DONT have an infection with that same bacteria somewhere else in your body is it primary or secondary. give example

Back 7

primary obviously

**bacteria from IV or arterial line

**caused by normal flora on skin

Front 8

what is secondary bacteremia, what are some examples

Back 8

its when to have bacteremia as a result of a bacterial process somewhere else on your person

ex GI/Skin lesion, abcess, hematogenous spread to kidney lots of times

Front 9

what are some risk factors for bacteremia

Back 9

1. catheters, IV
2. sirgery
3. respiratory infection
4. underlying disease
5. old, young

Front 10

what are the 2 most common organisms of bacteremis

Back 10

1. staph
2. gram neg bacilli


recently there has been an increase in S epidermidis and corynebacterium

Front 11

if your pt is immunocomprimised and was just recently treated with AB and now has bateremia, what is the likely pathogen

Back 11

something unusual like bacteroides, or another anaerobe

**commonly there is an intra-abd or pelvic focus

Front 12

what are some unusual pathogens that cause bacteremia, where do you find the focus, who gets them

Back 12

bacteroides, anaerobes

((intra abd, pelvic

**seen in pts who just took AB and immunosuppressed

Front 13

how do you dx bacteremia if you suspect it? whats the problem with this

Back 13

culture the blood!!! blood is sterile so ALL are considered GUILTY until proven innocent- recall there can be transient bacteremias w/normal flora from brushing teeth or what not.

**if you see bacteria in the blood culture the pathogen is GUILTY, but keep in mind there are several transient bacteremias, may need to time your cultures

Front 14

ok so you think your pt has bacteremia so you culture them and it shows + for one of the following

1. s epidermidis
2. dipeheroids
3. proprionobacteria

transient normal flora or bectermia

Back 14

skin contaminants UNLESS

>5 CFU or repeat cultures are + then you are thinking IE or catheter based bactermia

Front 15

what are the 3 organisms that are considered normal flora unless there are >5 CFU or repeat cultures are +, then its NOT just skin contamination but IE or catheter bactermia

Back 15

1. s epidermidis
3. diptheroides
3. proprioobacteria

Front 16

whats teh tx for bacteremia

Back 16

culture for sensitivities and gram stain

use what works! emperic therapy is initial based on gram stain and adujust after you get sensitivities back

Front 17

what is SIRS

Back 17

systemic inflammatory response system

**dysregulated host inflammatroy response

pt has:
fever, tachycardia, tachypnea, leukophilia

Front 18

what is it called when you have a dysregulated inflammatory response and so get fever, tachycardia, tachypnea, or leukophilia

Back 18

SIRS- systemic, inflammatory response syndrome

Front 19

what are some microbeless triggers for SIRS (systemic inflammatory response syndrome)

Back 19

AI
pancreatitis
vasculitis
burns
surgery

Front 20

whats sepsis

Back 20

its SIRS that is caused by pathogen as ID by culture

**severity based on organ dysfx and hemodynamic compromise

Front 21

ok so you have SIRS (lots of inflamm --> fever, increased HR, RR, WBC) and you cultured something and ID the pathogen, what is it now called

Back 21

sepsis

Front 22

sepsis is defines as

Back 22

SIRS (the dysregulated inflammatory response- fever, increased HR, RR, WBC) due to a culture proven pathogen

**classified based on degree of organ dys and hemodynamic comprimise

Front 23

describe some findings in SEVERE sepsis

Back 23

1 sign or hypoperfusion or dysfx.

ex
molted skin
cap refil >3 sec
urine output <0.5 ml/kg/hr
lactate >2mmol/L
abrupt change in metal status
abnormal EEG
low platelets
DIC
ARDS

Front 24

if you have sepsis + one of the following what is the classificaition of sepsis

molted skin
long cap refil
low urine output
high lactate
change in mental status (abrupt)

Back 24

its SEVERE, these are all signs of hypoperfusion or dysfx

can also be EEG changes, platelets, DIC, ARDS,

Front 25

ok so if severe sepsis is classified by hypoperfusion or dysfx what defines septic SHOCK

Back 25

low MAP (2/3 DP + 1/3 SP) <60 DESPITE fluid resusitation

need drugs to maintain BP despite adequate fluids

Front 26

ok so your pt is in sepsis adn you think they just went into septic shock, what happend

Back 26

1. MAP decreased despite fluids (hypotensive)
2. need BP drugs to maintain BP despite fluids

Front 27

whats MODS

Back 27

multi organ dysfunction

altered organ fx in acutely ill pts, homeostsis is NOT maintained w/o intervention

primary: direct insult caused organ damage
secondary: due to consequence of host response

Front 28

if you have altered organ fx such that homeostasis is NOT maintained whats the classification

Back 28

MODS- multi organ dysfx

can be 1 or 2

Front 29

what is...

1. bactermia
2. SIRS
3. severe sepsis
3. Septic shock
4. Mods

Back 29

1. bactermia: bug in blood

2. SIRS: immune dysreg bc of bug in blood, fever, increase HR, RR, WBC

3. Severe sepsis: sepsis and sign of hypoperfusion or dysfx

3. Septic shock: hypotensive despite fluids

4. Mods: homeostasis NOT maintained

Front 30

what are the 3 main tx goals of septic shock

Back 30

1. resucutate from sepsis: correct hypoperfision, hypoxia, hypotension,

2. ID source of ifection adn TREAT!

3. maintain organ fx

Front 31

restore perfusion
kill the bug
maintain organs

this is tx protocol for what

Back 31

septic shock

Front 32

is the problem with IE (infective endocarditis) ...

intra or extra cardiac
valves?

Back 32

intra

valves are insufficient so lead to CHF, myocardial abcess

Front 33

if you have intraceable CHF and cardiac abcess alon gwith infective emboli othe rplaces in the body what might be the underlying cause`

Back 33

IE

**wides range of sx- sterile/infected emboli, immunological complezes

Front 34

what can cause IE

Back 34

1. IVDA
2. invasive vascular procedures

can be healthcare related, prosthetic valve related, native valve endocarditis ...

Front 35

can IE result form 1 or 2 bactermia

Back 35

OH ya!

Front 36

who gets IE more often

Back 36

men, old

Front 37

what are some risk factors for IE

Back 37

1. rheumatic fever
2. calcification, aortic stenosis
3. congenital heart disease
4. MVP
5. prosthetic valves
RESIDUAL DAMAGE FROM PREVIOUS IE

Front 38

what are the 3 ways IE is categorized

Back 38

1. tempo of clinical illness
2. site of infection
3. etiology

Front 39

what ist eh most significan risk for getting IE

Back 39

residual valvular damage from previous IE

rheumatic fever, aortic stenosis, congenital heart disease like bicuspid aortic valve, MVP, prosthetic valve

Front 40

acute IE

clinical..
complications..
cause...

Back 40

1. abrupt onset, ALWAYS fever,
2. complications in a week- dyspnea, fatigue, CHF, CNS sx
3. Staph aireus

Front 41

if you have s aureus IE causing fever, dyspnea, fatigue, CHF, adn CNS disease is the onset acute or subacute

Back 41

acute

develops abruptly

Front 42

whats subacute (chronic) IE like

clinical
complications
cause

Back 42

1. fever. onset to dx ~ 6 weeks
2. anorexia, weight loss, flu like sx, RUQ pain, vomit, distress after eating.
3. strep viridans

Front 43

IE and

1. s aureus
2. strep viridans

Back 43

1. acute
2. subacute (chronic)

Front 44

how is IE classified

Back 44

microbe
type and site of valve
presisposing condition

a hemolytic strep, native valve endocarditis
CA-s sureus, tricuspid valve, IVDA
s epidermidis, prosthetic valve arotic valve IE

Front 45

is native valve IE common

Back 45

oh ya

Front 46

do streptococci cause IE

tell me about strep bovis
gram
catalase
AG

Back 46

ya

small, gram +, CATALASE -, non hemolytic, group D AG, coccus

Front 47

what are the HACEK organisms that cause IE

Back 47

1. haemophilus arphrophilus
2. actinobacillus actinomyvetemcomitans
3. Cardiobacterium hominis
4. Eikenella corrodens
5. Kingella kingae

**all are aerobic bacilli
normal flora of upper respiratory tract and oropharynx
*cause subacute IE
complications include massive emboli, and CHF

Front 48

what are some clinical features of IE

Back 48

fever
petechiae
subungual hemorrhage
osler nodules
janeway lesion
roth spots

can have CNS diesase also

Front 49

if you have a fever, subungual hemorrhage, petechiae, osler nodules, roth spots and janeway lesions whats the deal

Back 49

IE

Front 50

what are signs of R heart diease
what are signs of L heart disease

w/IE

Back 50

R: pulm infarcts

L: systemic emboli

Front 51

how do vegetations occur in IE

Back 51

1. heart endo damage
2. pressure grad against valves
3. fibrin platelet deposition
3. bacteria --> colonized fibrin deposition
4. more thrombus deposits
5. vegetation that increases in size and breaks away

Front 52

what are the 2 stages of vegetation formation

Back 52

1. NON bacterial thrombotic vegetation (aggregation of platelets and fibrin- caused by TRAUMA, defective valves, endo changes relation to renal failure, stress, malnutrition, neoplasia)

2. Bacteremia: bug adheres to damaged area and begins to replicate and more aggregation

Front 53

what is the non infectious stage of vegetation formation caused by

Back 53

fibrin and platelets deposit bc of.

1. trauma: iv, catheter etc
2. valve defects:
3. changes in endo bc of: stress, renal failure, malnutrition, neoplaisa

Front 54

tell me about the second stage of vegetation formation

Back 54

its when you get bacteria in it! the bacteria can replicate and more fibrin/platelets are laid down

can get to be cm large! can break off and cause septic emboli and get into circulation. immune complexese are everywhere now!

Front 55

what are Janeway lesions

Back 55

1. flat painless, red/blue, macules/nocules

-result of septic emboli from L sided IE. found on palms and soles! seen in Acute IE

Front 56

what are hte leions on the palms and soles seen in IE called

Back 56

janeway lesions

*8the are flat, painless, and red/blue,

Front 57

what is a sunungual lesion

Back 57

splinter petechiae, linear hemorrhage in nail beds. seen in IE- along wi/osler nodules, jane way lesion, roth spots

Front 58

whats a flea bitten kidney

Back 58

its result of the circulating immune complexes in IE.

bleeding into glomerular spaves appears as petechiae

glomerulonephritis

Front 59

vegestions in IE can cause...

1. microemboli
2. immune complexes
3. continuous bacteremia

what are some examples in each

Back 59

1. Microemboli- janeway lesion, splinter (subungual) hemorrhage,

Immune complex: flea bitten kidney, glomerulonephritis, oslers nodules, roth spots

Front 60

what are oslers nodules

Back 60

PAINFUL (janeway is emboli and not painful) node bc of IMMUNE cOMPLEX

intradermal transient nodule seen in fingers and toes. small.

Front 61

what are roth spots

Back 61

result of IE, immune complex

White area in retina, lymphocytes, edema, hemorrhage

Front 62

if you have IE do you have continuous or transient bacteremia

Back 62

continuous

Front 63

with IE we knoe sx include>

janeway, osler, roth, subungual. what are some others

Back 63

petechia,
finger clubbing
gangrene 2 to embolization
bacteremia
stroke
fever

Front 64

what is the duke criteria for IE

Back 64

the new dx

2 major
1 major + 3 minor
5 minor (pathogens hard to culture, little vegetation)

MAJOR: + blood culture, evidence of endocardial involvement

MINOR: predisposition, fever, vascular phanomenon, immunological phenomenon, microbial evidence, ECG

Front 65

what are the major and minor criteria for IE

Back 65

Major
+ blood culture
evidence of endocardial damage

Minor:
predisposition, fever, vascular, immunologica, microbial, ECG

**need for dx
1. 2 major
2. 1 major and 2 monor
3. 5 minor

Front 66

whats the tx for IE

Back 66

get C and Sensitivity

HIGH dose AB. bacteriCIDAL conc. for like 4-6 weeks. monotor w/culture

Front 67

is IE easy to treat

Back 67

nope

decreased metabolic state of bacteria, need a CIDAL AB, tx so long you can get resistance to enterococci and staphylococci

Front 68

bc IE is so hard to treat w/AB what are other approaches to tx

Back 68

surgery to remove vegetation

**previous IE is HUGE risk factor for another infection

Front 69

w ehave heard of ppl w/MVP getting prophylactiv AB before dental procedures to prevent IE, is this still done

Back 69

ya. if you have fake valve, previous IE, congenital heart disease, etc

they are prophylaxed for invasive things like: gingival manipulation, periapical tooth, or perforation of oral mucosa

NOT: lidocaine injections, x rays, removal of dentures adn things, orthodontics

Front 70

w/the new guidlines do you prophylax ppl w/Gi/GU procedures

Back 70

nope