Bacteremia/Sepsis Flashcards

1
Q

what are endotoxins a part of? when the body responds to the bacteria, what happens?

A

cell wall of gram-negative bacteria; it causes a cascade of events that leads to illness

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2
Q

what are exotoxins?

A

proteins released into the surrounding area by the bacteria during cell growth

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3
Q

what do exotoxins do to your body? what do they lead to?

A

enzymatically inactivate or modify key cellular parts, leading to cell death or dysfunction

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4
Q

what does botulism exotoxin do?

A

decreases the release of NT from cholinergic neurons causing flaccid paralysis

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5
Q

what does tetanus exotoxin do?

A

decreases the release of NT from inhibitory transmitters causing spastic paralysis

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6
Q

what does cholera exotoxin do?

A

induces fluid secretions into the intestinal lumen causing diarrhea

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7
Q

what is one specific category of exotoxins?`

A

superantigens

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8
Q

what happens when bacteria is engulfed by APCs? (normal process)

A

after ingested, epitopes are put on the cell surface, CD4 cells recognize the epitope, expansion of the specific CD4 cell and immunity to newly introduced antigen

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9
Q

what happens with exotoxins and APCs? what does this cause excessive activation of?

A

they do not get ingested by APCs, it binds directly to it and cross links with CD4 cells (activates up to 20% of lymphocytes); excessive activation of lymphocytes and macrophages (uncontrolled synthesis and release of inflammatory cytokines)

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10
Q

definition of infection

A

presence of bacteria with LOCAL inflammatory response

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11
Q

definition of bacteremia

A

presence of viable bacteria in the blood

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12
Q

definition of sepsis…what is it clinically characterized by

A

evidence of infection plus life threatening organ dysfunction, clinically characterized by an acute change in 2 pts or greater in SOFA score

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13
Q

definition of septic shock

A

sepsis with fluid, unresponsive hypotension, serum lactate level greater than 2mmol/L and needing vasopressors to maintain mean arterial pressure of 65mm Hg or greater

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14
Q

three things that can cause cardiogenic shock

A

MI, valve damage, surgery

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15
Q

three things that can cause hypovolemic shock

A

loss of whole blood, loss of plasma, loss of extracellular fluid

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16
Q

two things that can cause obstructive shock

A

inability to fill heart (tamponade) and embolus

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17
Q

three things that can cause distributive shock?

A

neurogenic shock, presence of vasodilating substances in the blood (anaphylactic shock), presence of inflammatory mediators (septic shock)

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18
Q

mortality is higher for pts who progress to ________ ________

A

septic shock

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19
Q

which two age groups are more likely to get sepsis? are men or women more likely to get it?

A

neonatal period (birth to one month) and >65 yrs; men

20
Q

predisposing host factors of sepsis (6)

A

extremes of age, immunosuppressive therapy, recent surgery, granulocytopenia, hyposplenism, diabetes

21
Q

what is the SOFA used for?

A

sequential organ failure assessment- used to monitor for potential sepsis in ICU pt (constant, routine monitoring)

22
Q

what are the seven variables for SOFA?

A

1). PaO2/FIO2 ratio
2). glascow coma scale score
3). mean arterial pressure
4). administration of vasopressors with type/dose/rate of infusion
5). serum creatinine or urine output
6). bilirubin
7). platelet count
score 0-24

23
Q

what is qSOFA (quick SOFA) used for?

A

used in ED pts with known infection and to see if they are septic

24
Q

what are the three assessment measures for qSOFA?

A

low BP (SBP <100), high RR (>22), and altered mentation (GCS <14)

25
Q

what does bacteria do to procoagulation?

A

it increases procoagulation, so it alters the procoagulation/anticoagulation balance

26
Q

cell damage leads to ________ _________ which leads to fluid leaking from the ______ to the ________ __________

A

vascular damage; vessels; interstitial space

27
Q

what are the mechanism steps of sepsis starting from hypovolemia (5 steps)

A

hypovolemia, hypotension, hypoperfusion of organs (leads to signs and symptoms), organ failure, death

28
Q

what are the initial signs and symptoms (sepsis)- 4

A

fever, vasodilation, warm flushed skin, +/- visible source of infection

29
Q

what are the 3 main signs of organ involvement (septic shock)

A

neurologic, renal, cardiac

30
Q

what are circulation, pulm, neuro, renal, GI, cardiac, and hematologic signs/symptoms of hypoperfusion

A
Circulation- hypotension
Pulmonary- pulmonary edema- ARDS
Neuro- altered mental status
Renal- oliguria--- acute renal failure
GI- infarcted bowel---GI bleeding
Cardiac- angina (Hypoperfusion of muscle!)
Hematologic- DIC
31
Q

a patient presents with ______ and _________ suspect sepsis

A

fever and hypotension

32
Q

look for what kind of source for sepsis?

A

bacterial

33
Q

tx for sepsis

A

1) . IV fluid and vasoconstrictive agents- circulation support
2) . ongoing assessment of labs for progression of sepsis
3) . ABX- broad spectrum until culture results are back

34
Q

what cells are impaired in hyperglycemia?

A

phagocytes

35
Q

what does insulin prevent during sepsis? what level should blood sugar be kept between?

A

apoptotic cell death that is caused from hyperglycemia; 80-100

36
Q

when are corticosteroids used in sepsis tx? what are guidelines for dosage?

A

those with vasopressor dependent septic shock; no greater than 300 mg/day for at least 5 days then tapered

37
Q

what staph bacteria is a part of the normal flora? what does this cause?

A

S Aureus; skin infections

38
Q

what does staphylococcal bacteremia invade? by invading this, what three things can it lead to?

A

bloodstream; endocarditis, osteomyelitis (60% of cases are caused by S aureus), other metastatic deep infections

39
Q

tx of uncomplicated bacteremia

A

vancomycin 1 g q 12 hrs PLUS either impenem, meropenem, or piperacillin-tazobactam

40
Q

90% of toxic shock syndrome cases occur in what population?

A

women of childbearing age

41
Q

what two bacteria produces toxins for toxic shock syndrome?

A

staph aureus and strep pyogenes

42
Q

what is the most common toxin of toxic shock syndrome?

A

toxin 1 (TSST-1), which is a superantigen produced by S aureus

43
Q

how does a toxin cause toxic shock syndrome?

A

toxin is produced in a certain area (not a spread of bacteria like sepsis) and then the toxin is sent to the bloodstream, causing massive inflammatory rxn

44
Q

presentation of TSS (7)

A

fever, macular rash (desquamation 1-2 weeks after onset), systemic hypotension, vomiting, diarrhea, myalgias, conjunctivitis

45
Q

what are some non-menstrual conditions that can cause TSS (11)

A

diaphragm or contraceptive sponge use, IV drug use, osteomyelitis, pilonidal abscess, septic arthritis, cellulitis, burns, empyema, lung abscess, postpartum infection, postop wound infection

46
Q

tx of TSS

A

supportive measures, ABX (staph- nafcillin or oxacillin, strep- PenG + clinda), cardiac/renal/pulm monitoring, surgery

47
Q

what are the four types of shock?

A

cardiogenic, hypovolemic, obstructive, distributive