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30 Cards in this Set
- Front
- Back
List the conditions associated with blood infection from bacteria starting with Bacteremia in increasing severity
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Bacteremia --> SIRS (systemic inflamm response syndrome) --> Sepsis --> SEVERE Sepsis --> Septic SHOCK --> MULTIPLE ORGAN DYSFUNCTION SYNDROME
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Whats the criteria to define whether a pt has SIRS?
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SIRS = Systemic inflamm
TWO or more of the following: Respirations > 20 Temp. > 38 H.R. > 90 WBC . 12,000 or 10% bands = left shift |
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Define Sepsis
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SIRS due to infection (SIRS = 2 or more of the following: respirations > 20, Temp > 38, H.R. > 90, or WBC . 12,000)
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When does sepsis become severe sepsis?
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When it involves organ dysfunction because of HypOperfusion
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When does severe sepsis become Septic Shock?
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When persistent HypOtension and low perfusion persists even tho you replace fluid
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Define multiple organ dysfunction syndrome
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When the balance of homeostasis (=fibrinolysis and coag) can't be maintained without intervention
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Who is predisposed to septic shock?
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Anyone who is predisposed to get bacterial infections
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What are the 3 possible patterns of bacteremia we can have?
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transient = body clears infection quickly
intermittent = comes and goes..ex = subacute endocarditis continuous = ...continuous, duh...ex. = subacute endocarditis, deep seated infections, etc |
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Whats the series of events from bacteria infecting blood to shock and organ failure?
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Bacterial Infection --> Bacteremia --> Host inflamm. response --> Inc. Inflamm and Coag/ Dec. Fibrinolysis --> Changes in endo and microvasculature --> shock and organ faliure
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What is the leading cause of death in non-cardiac critically ill pts?
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sepsis progressing to septic shock
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How do you collect blood to be cultures to see if theres bacteria in it?
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Decontaminate skin preferably with iodine tincture or chlorhexidine gluconate (or povidon iodine) --> collect sample when fever peaks --> Take appropriate # of samples (acute = 2-3 30 min apart subacute = 3 or more over 1-2 days)
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Who needs their blood cultured?
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Need Either: 1 Major or 2 Minor:
MAJOR = Endocarditis suspected, Temp > 39.4 (103), Indwelling Vascular Catheter MINOR = Temp. 38.3 - 39.3, Age >65, Symptoms (chills, Vomit, HypOtension), Labs (BWC > 18,000, Bands> 5%, platelets < 150,000 cells/mm3, Creatinine > 2 mg/dL) |
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A pt has A temp of 39.0 and the following:bands = 7%, WBC = 20,000, Creatinine = 3 mg/dL. Do you draw their blood to check for bacteria?
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YES
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A pt has symptoms of endocarditis, a temp of 39.5, has been catheterized in the hospital for 1 week....Should you draw their blood t ocheck for bacteremia?
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YES
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A pt has been experiencing chills for the past 2 nights, and has a temp of 38. Should you draw their blood to check for bacteria?
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NO,
They only have ONE of the MINOR criteria (ie chills...for MINOR criteria temp has to be above 38.3) |
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List some of the blood culture systems (if he asks us about these i will shoot him)
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Traditional Bottles
Septi-check Lysis Centrifugation Automated continuous monitoring culture system ie Bactec 9000 = Detects CO2 BacT/Alert = detects CO2 |
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What are the advantages of the continuous monitoring blood culture systems that monitor CO2?
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Earlier detection
Dec. Lab workload |
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What is *critical* in culture interpretation of blood?
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TO ID THE DAMN* ORGANISM
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Besides ID-ing the organism, what else is important in blood culture interpretation?
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Getting a positive result for an organism more than once means that there is more of a chance that the positive culture is NOT due to contamination
BOTH anaerobic and aerobic bottles positive Turns positive rapidly (24-48 hrs = more organisms) |
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You have a pt whose blood samples have been positive twice in the past few days for coag neg staph, and it turned positive within 24 hrs. Should you be concerned?
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Yep
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What species of bacteria have the highest percentages of false positive rates?
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Coag. Neg. Staph= 44%
Corynebacterium spp = 33% |
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You have a pt whose blood samples have been positive twice in the past few days for coag neg staph, and it turned positive within 24 hrs. How should you proceed?
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Start empiric Tx with Abx within 1 hr of presentation with broad-spectrum Abx coverage against BOTH gram neg and Gram pos. bact.
Ex. = Vancomycin + Gram neg coverage (Carbapenem, Cefepime, Piperacillin/tazobactam, consider adding aminoglycoside) THEN go onto bact-specific tx even if pt is responding to your empiric tx |
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T/F: The identity of the organism in a blood culture can help determine if the culture is contaminated
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TRUE
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Tx for S. aureus meth-resistant?
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vanco + genta
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Tx for S. aureus meth-sensitive?
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Nafcillin + genta
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Tx for E. coli?
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3rd gen cephalosporin (easy to remember b/c "E" is like a backwards "3")
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Tx for P. aeruginosa?
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Extended spectrum pens (piperacillin/tazobactam) + aminoglycoside
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What factors lead to poor prognosis for treatment of bacteremia?
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Inc. Age
Nosocomial (ie hospital-acquired) bacteria Enterococcal, gram neg. or fungal etiology underlying |
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You obtain 2 blood samples from a pt you think may have endocarditis. Both are positive for gram neg. staph. Should you be suspicious?
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Yes, because although gram neg staph (as well as Corynebacterium) are the most common false negative bacterial species found, the fact that two of the samples were contaminated means you should think bacteremia
Usually 2/2 positive blood cultures for the same specimen this represents real disease (assuming blood cultures were obtained from separate venipuctures or catheter draws |
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T/F: Usually only ONE of the blood culture specimens will be positive if its positive due to contaimination
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TRUE
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