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107 Cards in this Set
- Front
- Back
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What are the classic signs/symptoms of inflammation / infection? |
- Tumor (mass = swelling / edema) - Calor (heat) - Dolor (pain) - Rubor (redness = erythema) |
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What is the definition of bacteremia? |
Bacteria in the blood |
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What is the definition of SIRS? |
Systemic Inflammatory Response Syndrome (fever, tachycardia, tachypnea, leukocytosis) |
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What is the definition of sepsis? |
Documented infection and SIRS |
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What is the definition of septic shock? |
Sepsis and hypotension |
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What is the definition of cellulitis? |
Blanching erythema from superficial dermal / epidermal infection (usually strep ore than staph) |
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What is the definition of abscess? |
Collection of pus within a cavity |
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What is the definition of super-infection? |
New infection arising while a patient is receiving antibiotics for the original infection at a different site (eg, C. difficile colitis) |
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What is the definition of nosocomial infection? |
Infection originating in the hospital |
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What is the definition of empiric? |
Use of antibiotic based on previous sensitivity information or previous experience awaiting culture results in an established infection |
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What is the definition of prophylactic? |
Antibiotics used to prevent an infection |
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What is the most common nosocomial infection? |
UTI |
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What is the most common nosocomial infection causing death? |
Respiratory tract infection (pneumonia) |
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What diagnostic tests are used to confirm a UTI? |
- Urinalysis - Culture - Urine microscopy for WBC |
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What constitutes a positive urine analysis? |
- Positive nitrite (from bacteria) - Positive leukocyte esterase (from WBC) - >20 WBC/HPF - Presence of bacteria (supportive) |
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What number of colony-forming units (CFU) confirms the diagnosis of UTI? |
On urine culture, classically 100,000 or 10^5 CFU |
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What are the common organisms causing UTIs? |
- E. coli - Klebsiella - Proteus
- Enterococcus - S. aureus |
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What is the treatment for a UTI? |
Antibiotics with G- spectrum (eg, Bactrim, Gentamicin, Ciprofloxacin, Aztreonam)
Check culture and sensitivity |
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What is the treatment of bladder candidiasis? |
1. Remove or change Foley catheter 2. Administer systemic Fluconazole or Amphotericin bladder washings |
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What are the signs of a central line infection? |
- Unexplained hyperglycemia - Fever - Mental status change - Hypotension - Tachycardia --> shock - Pus - Erythema at central line site |
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What is the most common cause of "catheter-related bloodstream infections"? |
Coagulase negative staphylococcus (33%), followed by Enterococci, S. aureus, G- rods |
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When should central lines be changed? |
When they are infected; there is no advantage to changing them every 7 days in non-burn patients |
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What central line infusion increases the risk of infection? |
Hyperal (TPN) |
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What is the treatment for central line infection? |
1. Remove central line (send for culture) +/- IV antibiotics 2. Place NEW central line in a different site |
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When should peripheral IV short angiocatheters be changed? |
Every 72-96 hours |
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What do surgical site wound infections arise? |
Classically, POD #5-#7 |
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What are the signs/symptoms of surgical site wound infections? |
- Pain at incision site - Erythema - Drainage - Induration - Warm skin - Fever |
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What is the treatment of surgical site wound infections? |
- Remove skin sutures / staples - Rule out fascial dehiscence - Pack wound open - Send wound culture - Administer antibiotics |
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What are the most common bacteria found in post-op wound infections? |
- S. aureus (20%) - E. coli (10%) - Enterococcus (10%) - Others: S. epidermidis, Pseudomonas, anaerobes, other G- organisms, Strep |
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Which bacteria cause fever and wound infection in the first 24 hours after surgery? |
1. Streptococcus 2. Clostridium (bronze-brown weeping tender wound) |
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What is a "clean" wound? |
- Elective, non-traumatic wound without acute inflammation - Usually closed primarily without use of drains |
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What is the infection rate of a "clean wound"? |
<1.5% |
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What is a clean-contaminated wound? |
Operation on GI or respiratory tract without unusual contamination or entry into biliary or urinary tract? |
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Without infection present, what is the infection rate of a clean-contaminated wound? |
<3% |
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What is a contaminated wound? |
Acute inflammation, traumatic wound, GI tract spillage, or a major break in sterile technique? |
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What is the infection rate of a contaminated wound? |
~5% |
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What is a dirty wound? |
Pus present, perforated viscus, or dirty traumatic wound |
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What is the infection rate of a dirty wound? |
~33% |
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What are the possible complications of wound infections? |
- Fistula - Sinus tracts - Sepsis - Abscess - Suppressed wound healing - Superinfection (ie, a new infection that develops during antibiotic tx for the original infection) - Hernia |
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What factors influence the development of infections? |
- Foreign body (eg, sutures, drains, grafts) - Decreased blood flow (poor delivery of PMNs and antibiotics) - Strangulation of tissues with excessively tight sutures - Necrotic tissue or excessive local tissue destruction (eg, too much Bovie) - Long operations (>2 hours) - Hypothermia in OR - Hematomas or seromas - Dead space that prevents delivery of phagocytic cells to bacterial foci - Poor approximation of tissues |
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What patient factors influence the development of infections? |
- Uremia - Hypovolemic shock - Vascular occlusive states - Advanced age - Distant area of infection |
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What are examples of an immunosuppressed state? |
- Immunosuppressant treatment - Chemotherapy - Systemic malignancy - Trauma or burn injury - Diabetes mellitus - Obesity - Malnutrition - AIDS - Uremia |
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Which lab tests are indicated in a patient with a wound infection? |
- CBC: leukocytosis or leukopenia (as an abscess may act as a WBC sink) - Blood cultures - Imaging studies (eg, CT scan to locate an abscess) |
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What is the treatment for a wound infection? |
- I & D - an abscess must be drained (note: fluctuation is a sign of a subcutaneous abscess; most abdominal abscesses are drained percutaneously) - Antibiotics for deep abscesses |
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What are the indications for antibiotics after drainage of a subcutaneous abscess? |
- Diabetes mellitus - Surrounding cellulitis - Prosthetic heart valve - Immunocompromised state |
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What is a peritoneal abscess? |
Abscess within the peritoneal cavity |
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What are the causes of a peritoneal abscess? |
- Post-op status after a laparotomy - Ruptured appendix - Peritonitis - Any inflammatory intraperitoneal process - Anastomotic leak |
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What are the sites of peritoneal abscess occurrence? |
- Pelvis - Morison's pouch - Subphrenic - Paracolic gutters - Periappendiceal - Lesser sac |
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What are the signs/symptoms of a peritoneal abscess? |
- Fever (classically spiking) - Abdominal pain - Mass |
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How is the diagnosis of peritoneal mass made? |
Abdominal CT scan (or ultrasound) |
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When should an abdominal CT scan be obtained looking for a post-op abscess? |
After POD #7 (otherwise, abscess will not be "organized" and will look like a normal post-op fluid collection) |
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What CT scan findings are associated with abscess? |
Fluid collection with fibrous rind, gas in fluid collection |
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What is the treatment of a peritoneal abscess? |
Percutaneous CT-guided drainage |
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What is an option for drainage of a pelvic abscess? |
Transrectal drainage (or transvaginal) |
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All abscesses must be drained except for which type? |
Amebiasis |
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What is necrotizing fasciitis? |
Bacterial infection of underlying fascia (spreads rapidly along fascial planes) |
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What are the causative agents of necrotizing fasciitis? |
- Classically, group A Streptococcus pyogenes - Most often polymicrobial with anaerobes / G- organisms |
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What are the signs/symptoms of necrotizing fasciitis? |
- Fever - Pain - Crepitus - Cellulitis - Skin discoloration - Blood blisters (hemorrhagic bullae) - Weeping skin - Increased WBCs - Subcutaneous air on x-ray - Septic shock |
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What is the treatment of necrotizing fasciitis? |
- IVF - IV antibiotics - Aggressive early extensive surgical débridement - Cultures - Tetanus prophylaxis |
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Is necrotizing fasciitis an emergency? |
YES, patients must be taken to OR immediately |
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What is clostridial myositis? |
Clostridial muscle infection |
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What is another name for clostridial myositis? |
Gas gangrene |
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What is the most common causative organism of gas gangrene? |
Clostridium perfringens |
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What are the signs/symptoms of gas gangrene / clostridial myositis? |
- Pain - Fever - Shock - Crepitus - Foul-smelling brown fluid - Subcutaneous air on x-ray |
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What is the treatment of gas gangrene / clostridial myositis? |
- IV antibiotics - Aggressive surgical débridement of involved muscle - Tetanus prophylaxis |
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What is suppurative hidradenitis? |
Infection / abscess formation in apocrine sweat glands |
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In what three locations does suppurative hidradenitis occur? |
Sites of apocrine glands: - Perineum / buttocks - Inguinal area - Axillae |
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What is the most common causative organism of suppurative hidradenitis? |
S. aureus |
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What is the treatment of suppurative hidradenitis? |
- Antibiotics - I&D (excision of skin with glands for chronic infections) |
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What is pseudomembranous colitis? |
Antibiotic induced colonic overgrowth of C. difficile, 2/2 to loss of competitive non-pathogenic bacteria that comprise the normalc olonic flora
Note: it can be caused by any antibiotic, but especially penicillins, cephalosporins, and clindamycin |
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What are the signs/symptoms of pseudomembranous colitis? |
- Diarrhea (bloody in 10% of patients) - ± Fever - ± Increased WBCs - ± Abdominal cramps - ± Abdominal distention |
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What causes the diarrhea associated with pseudomembranous colitis? |
Exotoxin released by C. difficile |
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How is the diagnosis of pseudomembranous colitis made? |
- Assay stool for exotoxin titer - Fecal leukocytes may or may not be present - On colonoscopy you may see an exudate that looks like a membrane (hence, "pseudomembranous") |
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What is the treatment of pseudomembranous colitis? |
- PO metronidazole (Flagyl, 93% sensitive) or PO vancomycin (97% sensitive) - Discontinue causative agent if possible - Never give anti-peristaltics |
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What are the indications for prophylactic IV antibiotics? |
- Accidental wounds with heavy contamination and tissue damage - Accidental wounds requiring surgical therapy that has had to be delayed - Prosthetic heart valve or valve disease - Penetrating injuries of hollow intra-abdominal organs - Large bowel resections and anastomosis - Cardiovascular surgery with the use of a prosthesis / vascular procedures - Pts with open fractures (start in ER) - Traumatic wounds occurring >8 hours prior to medical attention |
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What must a prophylactic antibiotic cover for procedures on the large bowel / abdominal trauma / appendicitis? |
Anaerobe coverage |
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What commonly used antibiotics offer anaerobic coverage? |
- Cefoxitin (Mefoxin) - Clindamycin - Metronidazole (Flagyl) - Cefotetan - Ampicillin-Sulbactam (Unasyn) - Zosyn - Timentin - Imipenem |
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What antibiotic is used prophylacticly for vascular surgery? |
Cefazolin / Ancef (if pt is significantly allergic to PCN - hives/swelling/SOB - then erythromycin or clindamycin are options) |
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When is the appropriate time to administer prophylactic antibiotics? |
Must be in adequate levels in blood stream prior to surgical incision! |
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What is parotitis? |
Infection of parotid gland |
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What is the most common causative organism of parotitis? |
Staphylococcus |
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What are the associated risk factors for parotitis? |
- Age >65Y - Malnutrition - Poor oral hygiene - Presence of NG tube - NPO - Dehydration |
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What ist he most common time of occurrence of parotitis? |
Usually 2 weeks post-op |
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What are the signs of parotitis? |
Hot, red, tender parotid gland and increased WBCs |
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What is the treatment of parotitis? |
- Antibiotics - Operative drainage may be necessary |
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What is a "stitch" abscess? |
Subcutaneous abscess centered around a subcutaneous stitch, which is a "foreign body"; treat with drainage and stitch removal |
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Which bacteria can be found in the stool (colon)? |
- Anaerobic - Bacteroides fragilis - Aerobic - E. coli |
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Which bacteria are found in infections from human bites? |
- Strep viridans - S. aureus - Peptococcus - Eiknella (tx with Augmentin) |
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What are the most common ICU pneumonia bacteria? |
G- organisms |
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What is Fournier's gangrene? |
Perineal infection starting classically in the scrotum in pts with diabetes; tx with triple antibiotics and wide débridement - a surgical emergency! |
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Does adding antibiotics to peritoneal lavage solution lower the risk of abscess formation? |
No ("dilution is the solution to pollution") |
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What is the classic finding associated with a Pseudomonas infection? |
Green exudate and "fruity" smell |
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What are the classic antibiotics for "triple" antibiotics? |
- Ampicillin - Gentamycin - Metronidazole (Flagyl) |
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Which antibiotic is used to treat amoeba infection? |
Metronidazole (Flagyl) |
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Which bacteria commonly infects prosthetic material and central lines? |
Staphylococcus epidermidis |
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What is the antibiotic of choice for Actinomyces? |
Penicillin G (exquisitively sensitive) |
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What is a furuncle? |
Staphylococcal abscess that forms in a hair follicle (Follicle = Furuncle) |
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What is a carbuncle? |
Subcutaneous staphylococcal abscess (usually an extension of a furuncle), most commonly seen in pts with diabetes (ie, rule out diabetes) |
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What is a felon? |
Infection of finger pad |
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What microscopic finding is associated with Actinomyces? |
Sulfur granules |
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What organism causes tetanus? |
Clostridium tetani |
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What are the signs of tetanus? |
- Lockjaw - Muscle spasm - Laryngospasm - Convulsions - Respiratory failure |
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What are the appropriate prophylactic steps in tetanus-prone (dirty) injury to a patient with three previous immunizations? |
None (tetanus toxoid only if >5 years since last toxoid) |
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What are the appropriate prophylactic steps in tetanus-prone (dirty) injury to a patient with two previous immunizations? |
Tetanus toxoid |
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What are the appropriate prophylactic steps in tetanus-prone (dirty) injury to a patient with one previous immunization? |
Tetanus immunoglobulin IM and tetanus toxoid IM (at different sites!) |
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What are the appropriate prophylactic steps in tetanus-prone (dirty) injury to a patient with no previous immunizations? |
Tetanus immunoglobulin IM and tetanus toxoid IM (at different sites) |
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What is Fitz-Hugh-Curtis Syndrome? |
RUQ pain from gonococcal peri-hepatitis in women |
