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Comprehensive Prep > Chapter 5: Infection > Flashcards

Chapter 5: Infection Flashcards

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1
Q

MC cause of immune deficiency.

A

Malnutrition

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2
Q

Microflora: stomach

A

Virtually sterile.
Some GPCs.
Some yeast.

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3
Q

Microflora: proximal small bowel

A

10^5 bacteria.

Mostly GPCs.

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4
Q

Microflora: distal small bowel

A

10^7 bacteria.

GPCs, GPRs, GNRs.

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5
Q

Microflora: Colon

A

10^11 bacteria.

Almost all anaerobes, some GNRs, GPCs.

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6
Q

MC anaerobe in the colon

A

Bacteroides fragilis

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7
Q

MC aerobic bacteria in the colon

A

Escherichia coli

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8
Q

MC source of fever within 48 hours

A

atelectasis

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9
Q

MC fever source 48 hours - 5 days

A

urinary tract infection

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10
Q

MC fever source after 5 days

A

wound infection

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11
Q

MCC gram negative sepsis

A

E coli

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12
Q

mechanism of gram negative sepsis

A

Endotoxin (lipopolysaccharide lipid A) is released and triggers the release of TNF-alpha (from macrophages), activates complement, and activates coagulation cascade

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13
Q

Insulin / glucose: early vs late gram negative sepsis

A

Early: decreased insulin, increased glucose (impaired utilization)
Late: increased insulin, increased glucose secondary to insulin resistance

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14
Q

Often occurs just before the patient becomes clinically septic

A

Hyperglycemia

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15
Q

Optimal glucose level in a septic patient

A

100 - 200 mg/dL

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16
Q

Clostridium difficile colitis
Dx: ?
Tx: ?

A

Dx: C difficile toxin
Tx:
Oral - vancomycin or flagyl
IV - Flagyl; lactobacillus can also help.

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17
Q

Infection: % Clean (hernia)

A

2%

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18
Q

Infection: % Clean contaminated (elective colon resection with prepped bowel)

A

3 - 5%

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19
Q

Infection: % Contaminated (GSW to colon with repair)

A

5 - 10%

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20
Q

Infection: % Gross contamination (abscess)

A

30%

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21
Q

Purpose of prophylactic antibiotics

- Dosing?

A

To prevent surgical site infections

- Stop within 24 hours of end operation time, except cardiac, which is stopped within 48 hours of end operation time.

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22
Q
  • Coagulase positive

- MC organism overall in surgical wound infections

A

Staphylococcus aureus

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23
Q

Coagulase negative organism

A

Staphylococcus epidermidis

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24
Q

MC anaerobe in surgical wound infections

A

B. fragilis

  • Recovery from tissue indicates necrosis or abscess (only grows in low redox state)
  • Also implies translocation from the gut
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25
How many bacteria are needed for wound infection?
> 10^5 bacteria. | - Less bacteria is needed if foreign body is present
26
Risk factors for wound infection
Long operations. Hematoma or serum formation. Advanced age. Chronic disease (e.g., COPD, renal failure, liver failure, DM), malnutrition, immunosuppressive drugs.
27
Surgical infections within 48 hours of procedure
- Injury to bowel with leak - Invasive soft tissue infection - Clostridium perfringens and beta-hemolytic strep can present within hours postoperatively (produce exotoxins)
28
MC infection in surgery patients
UTI
29
Leading cause of infectious death after surgery
Nosocomial pneumonia
30
What is nosocomial pneumonia related to?
Length of ventilation; aspiration from duodenum thought to have a role.
31
MC organisms in ICU pneumonia
``` #1 S aureus #2 Pseudomonas ```
32
#1 class of organisms in ICU pneumonia
GNRs
33
MCC line infections
``` #1. S epidermidis #2. S. aureus #3. Yeast ```
34
% Line salvage rate with infection
50% line salvage rate with antibiotics; much less likely with yeast line infections.
35
Necrotizing soft tissue infections
- Beta-hemolytic Strep (group A), C perfringens, or mixed organisms - Usually occur in patients who are immunocompromised (DM) or who have poor blood supply. - Can present very quickly after surgical procedures (within hours)
36
Necrotizing fasciitis
- Usually beta-hemolytic GAS - Overlying skin may be pale red and progress to purple with blister or bullae development. - Overlying skin can look normal in the early stages. - Thin, gray, foul-smelling drainage; crepitus. - Tx: early debridement, high-dose penicillin, may want broad spectrum if thought to be polyorganismal
37
C. perfringens infections
- Pain out of proportion to exam, may not show signs with deep infection. - Gram stain shows GPRs without WBCs - Myonecrosis and gas gangrene (common presentation) - Can occur with farming injuries - Tx: early debridement, high dose penicillin
38
Pathophysiology C. perfringens infection
Necrotic tissue decreases oxidation-redux potential, setting up environment for C. perfringens.
39
C. perfringens: toxin.
Alpha toxin
40
Actinomyces
- Pulmonary symptoms most common; can cause tortuous abscesses in cervical, thoracic, and abdominal areas Tx: drainage and penicillin G
41
Nocardia
- Not a true fungus - Pulmonary and CNS symptoms most common Tx: drainage and sulfonamides (Bactrim)
42
Candida
Fungus: common inhabitant of the respiratory tract. Tx: fluconazole (some Candida resistant), anidulafungin for severe infections
43
Aspergillosis
Voriconazole for severe infections
44
Histoplasmosis
Pulmonary symptoms usual Mississippi and Ohio River Valleys Tx: Liposomal amphotericin for severe infections
45
Cryptococcus
CNS symptoms most common; usually in AIDS patients. | Tx: Liposomal amphotericin for severe infections.
46
Coccidioidomycosis
Pulmonary symptoms Southwest Tx: liposomal amphotericin for severe infections
47
Risk factor for spontaneous bacterial peritonitis
Low protein
48
Organisms in primary SBP
Monobacterial - 50% E. coli - 30% Streptococcus - 10% Klebsiella
49
Pathophysiology of spontaneous bacterial peritonitis
Secondary to decreased host defenses (intrahepatic shunting, impaired bactericidal activity in ascites); not due to transmucosal migration
50
Cultures in spontaneous bacterial peritonitis
Fluid cultures are negative in many cases
51
Dx: spontaneous bacterial peritonitis
PMNs > 500 cells/cc diagnostic
52
spontaneous bacterial peritonitis: treatment, prophylaxis
Tx: Ceftriaxone or other 3rd generative cephalosporin Prophylaxis: fluoroquinolonges good (norfloxacin)
53
What do you need to r/o in primary spontaneous bacterial peritonitis?
Intra-abdominal source (eg, bowel perforation) if not getting better on antibiotics or if cultures are polymicrobial - Liver transplant not an option with active infection
54
Secondary bacterial peritonitis
- Intra-abdominal source (implies perforated viscus) - Polymicrobial (B fragilis, E coli Enterococcus MC organisms) Tx: Usually need laparotomy to find source
55
Exposure risk: HIV blood transfusion
70%
56
Exposure risk: infant from positive mother with HIV
30%
57
Exposure risk: Needle stick form HIV positive patient
0.3%
58
Exposure risk: HIV positive Mucous membrane exposure
0.1 %
59
HIV: helps decrease seroconversion after exposure
AZT (zidovudine, reverse transcriptase inhibitor) and ritonavir (protease inhibitor) within 1-2 hours of exposure
60
MCC for laparotomy in HIV patients
Opportunistic infections. MC: CMV 2nd MC: Neoplastic disease
61
MC intestinal manifestation of AIDS (can present with pain, bleeding or perforation)
CMV colitis
62
MC neoplasm in AIDS patients (although surgery rarely needed)
Kaposi's sarcoma
63
MC site of lymphoma in HIV patients
Stomach most common followed by rectum.
64
Lymphoma in HIV patients is mostly due to .... and treatment is....
Mostly due to non-Hodgkin's (B cell) | Tx: chemotherapy usual, may need surgery with significant bleeding or perforation
65
GIB in HIV: lower or upper more common?
Lower more common than upper
66
HIV: cause upper GIB
Kaposi's sarcoma, lymphoma
67
HIV: cause lower GIB
CMV, bacterial, HSV
68
CD4 counts - Normal - Symptomatic disease - Opportunistic infections
Normal: 800 - 1200 Symptomatic: 300-400 Opportunistic: <200
69
Hepatitis C Percentages - Chronic infection - Cirrhosis - Hepatocellular carcinoma
- Chronic infection: 60% - Cirrhosis: 15% - HCCa: 1-5%
70
Tx: brown recluse spider bites
Tx: dapsone initially, may need resection of area and skin graft for large ulcers later
71
Acute septic arthritis: - Bugs? - Tx?
- Bugs: Gonococcus, staph, H, influenza, strep | - Tx: Drainage, 3rd generation cephalosporin and vancomycin until cultures show organisms
72
Diabetic foot infections - Bugs? - Tx?
Bugs: Mixed staph, strep, GNRs, anaerobes Tx: broad-spectrum antibiotics (Unasyn)
73
Bugs: found in cat and dog bites | Tx?
Pasteurella multocida Tx: broad-spectrum antibiotics (Augmentin)
74
Tx: peritoneal dialysis catheter infections
Tx: intraperitoneal vancomycin and gentamicin; increased dwell time and intraperitoneal heparin may help. - Remove catheter: peritonitis that lasts for 4-5 days. - Fecal peritonitis: requires laparotomy to find perforation

Comprehensive Prep (45 decks)

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