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89 Cards in this Set

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  • Back
What % of patients admitted to acute care hospitals acquire infections?
Most commonly acquired hospital infections
Urinary tract 40%
Pneumonia 20%
Surgical site 17%
Bloodstream (IV) 8%
3 ingredients for healthcare associated infections
Susceptible host; Virulent organism; Portal of entry
Mechanism of Transmission:
Contact : defn
Direct person to person; Indirect thru an object like contaminated instruments
Mechanism of Transmission:
Airborne: defn
Organisms having a true airborne phase as pattern of dissemination (<5 microns)
Mechanism of Transmission:
Common-vehicle: defn
Extremely rare in US hosiptals.

Common animate vehicle as agent of transmission (ingested food or water, blood products, IV fluids)
Mechanism of Transmission:
Droplet: defn
Larger particles than airborne (>5 microns); Don't go as far. Brief passage thru air when source and patient in close proximity.
T/F hospital acquired pneumonia mortality is very high
What % of ventilated people develop pneumonia?
1-3 per DAY of intubation
Early onset healthcare associated pneumonia organisms (First 3-4 days of ventilation) have what characteristics?
Antibiotic sensitive; community organisms.

S. pneumoniae, H. influenzae, S. aureus
Late onset associated pneumonia organisms (>4 days of ventilation) have what characteristics?
NOSOCOMIAL. Antibiotic resistant.

Pseudomonas aeruginosa, Acinetobacter spp. Enterobacter.
risk factors for ventilator pneumonia
1) ENDOTRACHEAL INTUBATION!! massive point of entry. Pooling of oral secretions.

2) ICU
4) Sx
5) Chronic lung disease
How to prevent hospital pneumonia?
Pulmonary toilet - changing position every 2 hours.

Elevation of head to 30-45 degrees.

Frequent suctioning.

Bronchoscopy to remove mucous plugging.
incidence of healthcare associated UTI
Of patients who develop bacteriuria, ___% develop bacteremia
Comprise the largest pool of antibiotic-resistant pathogens in hospital
Catheter-associated UTIs
#1 catheter-associated pathogen
E Coli
Most impt prevention of nosocomial UTI
Avoid catheter when possible and discontinue ASAP
3rd most common nosocomial infection
surgical site infections
bacitracin and polymixin have activity against what type of organisms?
bacitracin: gram +
polymixin: gram -
indurated: defn
firm, not spongy and soft
When do most SSIs occur?
Within 30 days of surgery.

BUT implantations can cause infections up to 1 year
Receipt of right choice of perioperative antibiotic: how important is this? When should it be started?
SO IMPORTANT. 30-60 minutes before procedures.
Whenever you see pus, what is ALWAYS in DDX?
S aureus
When should prophylactic perioperative abx be given?
30-60 minutes prior to incision
T/F Hair should be removed by shaving prior to surgery
F. Microscopic exudative rashes and skin abrasions can occur during hair removal.
These rashes and skin abrasions can provide a portal of entry for microorganisms
Blood stream infections are almost always due to what?
Presence of central venous catheter
What is the most common cause of Central Line Associated Bloodstream Infection (CLABSI)?
Coagulase-neg staph. Generally wimpy unless in the presence of foreign material.
Prevention of CLABSI: Hopkins Model (Central Line Bundle): what is it?
1) Designated central line insertion cart

2) Insertion checklist

3) Bedside nurse empowered to stop procedure if step is missed.

4) Ask every day during rounds whether catheters can be removed
Most feared airborne particle?
What mask needs to be worn to enter room?
For airborne precautions, what do you need?
1) Negative pressure (air in but not out)

2) Private room

3) Door kept closed

4) Wear N95 mask
What kind of precautions does meningoccocal infection require?
Agent of choice to keep bacteria down
2 major types of pneumonia
Community Acquired Pneumonia (CAP)- typical vs. atypical
Healthcare Associated Pneumonia (HAP)
2 kinds of community acquired pneumonia
1) typical
2) atypical
Leading cause of infection related death in hospitalized pts
pneumonia (33-50%)
6th most common cause of death in community
most common cause of pneumonia worldwide
streptococcus pneumoniae
4 ways someone can develop pneumonia
1) Microaspirations: small amounts of lower resp secretions get into lungs

2) Macroaspirations

3) Hematogenous spread (eg., endocarditis)

4) Direct spread from contiguous focus
Virulence factors : Chlamydophila pneumoniae
Chlamydia inhibits activity of cilia (ciliostatic)
Virulence factors : Mycoplasma pneumoniae
Shears off cilia
Virulence factors : influenza virus
Causes thickening of tracheal mucus that can persist for months postinfection
Virulence factors :S. pneumoniae
produces proteases that can split secretory IgA. Capsulation is a virulence factor (inhibits phagocytosis). Neuraminidase, hyaluronidase.
Virulence factors: mycobacterium spp., nocardia spp., legionella spp.
Resistant to microbicidal activity of phagocytes
Alterations in the level of consciousness: how does it affect pneumonia?
predispose to macroaspiration of stomach contents and to microaspiration of upper airway secretions during sleep
Most common viral causes of pneumonia
Influenza virus is the most common viral cause of CAP in adults; less often parainfluenza, RSV, adenovirus, varicella
Stayed in cabin in Rocky Mountains for a week: raises suspicion for what?
Characteristics of typical pneumonia
High fever

Quick onset

Pleuritic chest pain (on inspiration)

Focal findings on exam except one spot where it hurts

Can see it on chest x ray
Causes of typical pneumonia
S. pneumoniae; H influenzae; S aureus, Group A Strep; Moraxella catarrhalis, aerobic gram negative
Characteristics of atypical pneumonia
Subacute; Dry cough, may or may not have fever, extrapulmonary manifestations (headache, nausea, vomiting);
diffuse, patchy, cavitary findings on CXR
Causes of atypical pneumonia
Legionella spp

Mycoplasma pneumoniae

Chlamydophila spp.

anaerobic bacteria (tend to be less virulent than aerobic and so have more indolent course), Mycobacteria spp., viral pathogens, PJP, endemic fungi
______, also called Whitmore's disease, is an infectious disease caused by the bacterium Burkholderia pseudomallei.
Infiltrate: defn
abnormal shadow
focal infiltrate: defn
one area of lung where you see a shadow. Fluid and inflammatory cells.
pleural effusion
Fluid around the lung.

very virulent bacteria can cause it.
Diffuse scattered infiltrates associated with what?
PJP, legionella, viral
Multiple nodule infiltrates associated with what?
S aureus, fungi, nocardia
Typical lesion of TB
upper lobe cavities
What pathogens cause cavities?
anaerobic bacteria, Mycobacteria (TB), Rhodococcus equi, Aspergillus species
fastest way to dx legionella?
urinary antigen
nasopharyngeal swab is useful for what diseases?
flu, adenovirus
bronchoalveolar lavage (BAL) with special stains: used to dx what?
(MTB, Pneumocystis, fungi), biopsy (cytomegalovirus) and others
CURB 65: score. What is it?
Confusion of new onset

Urea (BUN) greater than 19 mg/dL

Respiratory rate of 30 breaths per minute or greater

Blood pressure less than 90 mmHg systolic or diastolic blood pressure 60 mmHg or less

age 65 or older
PSI (Pneumonia Severity Index) : what does it help assess?
How sick the patient is and whether they should be admitted to hospital
What kind of pneumonia would Mycoplasma pneumoniae cause?
Atypical presentation, aka "walking pneumonia"

Ex. 3 weeks wtih extrapulmonary manifestations

Hemolytic anemia. Erythema multiform.

Usually young adults from a communal setting (eg., military recruits, college kids)

Very subacute course. Possibly low grade fever. Dry cough. Lots of different complains.

CXR: interstitial pattern.
bullous myringitis is suggestive of what?
Mycoplasma pneumoniae infection
Quellung reaction: what is it?
anticapsular antiserum reacts w/ capsular polysaccharide, reveals distinctly outlined capsule
What type of pneumonia does s. pneumoniae cause?
Symptoms of s. pneumoniae pneumonia?
Acute onset, fevers and chills, cough, lobar pneumonia. Beware if no spleen. Austrian’s triad-pneumonia, bacteremia, meningitis.
Gram positive diplococci, Quellung reaction
Bacterial infections in general, and pneumococcal pneumonia in particular, are much more frequent in HIV+ patients even at high CD4. Trimethoprim/sulfamethoxazole (Bactrim) reduces risk of pneumococcal CAP. Pneumovax every 5 yrs is recommended, 23 serotypes.
Resistance a growing problem, use ceftriaxone, +/-vancomycin. Beta-lactam antibiotics are preferred.
What is Austrian's triad?
Pneumonia, bacteremia, meningitis
Why is having no spleen a risk factor of s. pneumoniae?
ppl with no spleen are susuceptible to ENCAPSULATED bacteria
What is TMP/SMX used to treat in AIDS patients?
S. pneumoniae, PJP
What kind of pneumonia does PJP cause?
Usually in HIV CD4 <200.

Subacute course, often with relatively asymptomatic severe hypoxia at presentation. Dry cough, clear lungs, diffuse infiltrates on CXR.
What kind of pneumonia does Klebsiella cause?
Classic “Friedlander” pneumonia occurs in an alcoholic and is severe, necrotizing upper lobar pneumonia, often with cavitation.
Associated with viscous, dark-brown “currant jelly” sputum
One of most common causes of gram-negative pneumonias and important cause nosocomial pneumonias (HAP and VAP)
What patients are at risk for klebsiella infection?
Patients with COPD (chronic obstructive pulmonary disease), diabetes, nursing home residents, and neutropenic (very low WBC, eg w chemotherapy) patients also at risk.
Aspiration pneumoniae is associated with what type of bacteria?
What kind of pneumonia do anaerobic bacteria cause?
Subacute course, often resulting in abscess formation and pleural collection of pus (empyema).

Foul smelling sputum, poor response to “usual” antibiotics (lack anaerobic coverage).
Treatment of aspiration/anaerobic pneumonia
penicillin, clindamycin: gram positive anaerobes (oral flora)
Patients at risk for aspiration pneumonia
alcoholics, seizure disorder, stroke, swallowing difficulties
What kind of pneumonia does Group A Strep cause?
Very severe typical pneumonia. Can happen after flu.

Clues are viral prodrome, then very high fever, pleuritic chest pain, early pleural effusions/empyema (bilateral “syn-pneumonic” effusions are classic - happen at same time).
What kind of pneumonia does Legionella cause?
Clues are high fever, severe illness (altered mental status), temp-pulse dissociation (Faget’s sign), gastrointestinal symptoms, headache, low sodium, hepatitis, purulent gram stain w/o organisms, rapid deterioration
Difference between Legionairre's disease and Pontiac Fever?
Legionnaire’s disease is the more common syndrome of pneumonia. Pontiac fever is acute, febrile, self-limited illness, no treatment necessary. Often associated with water sources—Hot tubs.
Treatment of Legionella
Antibiotic with intracellular coverage: Macrolides, quinolones
Risk factors for TB
At risk are elderly, malnourished, homeless, HIV+, incarcerated
What kind of pneumonia does TB cause?
Often a nonspecific presentation as “the dwindles”, often mistaken for congestive heart failure. Clues are low sodium, anemia (anemia of chronic disease), high ESR (erythrocyte sedimentation rate- marker of inflammation).
erythrocyte sedimentation rate: what is this?
nonspecific marker of inflammation
About 60% of people with cystic fibrosis have a chronic respiratory infection caused by a bacteria called ______ that settles into the thick mucus trapped in the airways.
Pseudomonas aeruginosa