Fiser Chapter 5: Infection

Question 1

Most common immune deficiency leading to infection.

Answer 1

Malnutrition

Question 2

Microflora in:

Stomach; proximal small bowel; distal small bowel; colon

Answer 2

Stomach: sterile, some GPC, some yeast
Proximal small bowel: GPC (10^5)
Distal small bowel: GPC, GPR, GNR (10^7)
Colon: 10^11 (anaerobes; some GNR, GPC)

Question 3

Most common anaerobe in the colon

Answer 3

Bacteroides fragilis

Question 4

Most common aerobic bacteria in the colon

Answer 4

E. coli

Question 5

Which are more common organisms in the GI tract: aerobic or anaerobes?

Answer 5

Anaerobes

Question 6

Anerobes lack these enzymes making them vulnerable to oxygen radicals.

Answer 6

Superoxide dismutase

Catalase

Question 7

Most common organism that causes GN sepsis

Answer 7

E. coli

Question 8

Pathophysiology of GN sepsis

Answer 8

Endotoxin (Lipopolysaccharide lipid A) is released; triggers release of TNF-alpha; released from macrophages, triggers inflammation, activates complement, actives coagulation cascade

Question 9

Describe hyperglycemia in early vs. late GN sepsis

Answer 9

Early: Decreased insulin; impaired utilization
Late: insulin resistance

Question 10

T/F Hyperglycemia occurs just before the patients becomes clinically septic.

Answer 10

True

Question 11

Optimal glucose level in a septic patient

Answer 11

80-120

Question 12

Diagnostic test for C. diff

Answer 12

ELISA for Toxin A

Question 13

What do you use to treat C. diff in pregnancy?

Answer 13

PO Vanc

Question 14

Treatment for fulminant C. diff colitis?

Answer 14

Total colectomy with end ileostomy

Question 15

What percentage of abdominal abscesses have anaerobes?

Answer 15

90%

Question 16

What percentage of abdominal abscesses have both anaerobes and aerobes?

Answer 16

80%

Question 17

When do intra-abdominal abscesses usually occur?

Answer 17

7-10 days post-op

Question 18

When are antibiotics indicated for intra-abdominal abscesses?

Answer 18

Diabetes, cellulitis, sepsis, fever, prosthetic hardware

Question 19

4 classes of surgical operation

Answer 19

Clean: hernia (2%)
Clean-contaminated: elective colon-resection with prepped bowel (3-5%)
Contaminated: GSW colon with repair (5-10%)
Gross contaminated: abscess (30%)

Question 20

Most common SSI organism

Answer 20

Staph aureus (coag-positive)

Question 21

Is staph epi coag positive or negative?

Answer 21

Negative

Question 22

What is the exoslime released by staph species?

Answer 22

Exo-polysaccharide matrix

Question 23

Most common GNR in surgical wounds?

Answer 23

E. coli

Question 24

Most common anerobe in surgical wound infection?

Answer 24

B. fragilis

Question 25

What does recovery of B. fragilis from surgical wound infection indicate?

Answer 25

Necrosis, abscess, gut translocation

Question 26

How many bacteria required for SSI?

Answer 26

10^5 (less if foreign body)

Question 27

Risk factors for wound infection

Answer 27

Long operation; hematoma or seroma formation; advanced age; chronic disease (COPD, ESRD, liver failure, DM), malnutrition, IS drugs

Question 28

Most common infection in surgery patients

Answer 28

UTI; biggest risk factor is urinary catheter; most commonly E. coli (GNR)

Question 29

Leading cause of infectious death after surgery; most common organisms

Answer 29

Nosocomial pneumonia - Related to length of ventilation, aspiration - S. aureus, Pseudomonas, E. coli - GNR #1 cause in ICU patients

Question 30

3 most common line infections

Answer 30

1. S. epi 2. S. aureus 3. Yeast

Question 31

What % of infected lines can be salvaged?

Answer 31

50%

Question 32

2 most common causes of necrotizing soft tissue infections

Answer 32

GAS; MRSA (exotoxins); C. perf | Or mixed

Question 33

Risk factors for necrotizing soft tissue infections

Answer 33

DM, poor Q, immunocompromised

Question 34

Signs/symptoms of necrotizing soft tissue infection

Answer 34

Pain out of proportion to skin, mental status changes, WBC >20, thin gray drainage, blistering/necrosis, induration/edema, crepitus, soft tissue gas on X-ray

Question 35

T/F Nec fasc spreads along fascial planes

Answer 35

True

Question 36

Which necrotizing organism has alpha toxin?

Answer 36

C. perf

Question 37

Where does Fournier's gangrene occur anatomically?

Answer 37

Perineal, scrotal

Question 38

Most common anatomic location of aspiration pneumonia? Most common organism?

Answer 38

RLL (sup seg); S. pneumonia MC organism

Question 39

Test with highest sensitivity for OM?

Answer 39

MRI

Question 40

Treatment for brown recluse spider bite?

Answer 40

Oral dapson; avoid early surgery

Question 41

Treatment for acute septic arthritis? Most common organisms?

Answer 41

Drainage, CTX + Vanc | - Gonococcus, staph, H. flu, strep

Question 42

Most common cause of cat/dog/human bite?

Answer 42

S. pyogenes

Question 43

What bacteria is found in human bites?

Answer 43

Eikenella; can cause joint damage

Question 44

What bacteria can be found in cat/dog bites

Answer 44

Pasturella multocida

Question 45

Treatment for cat, dog, human bites?

Answer 45

Augmentin

Question 46

Most common cause of impetigo, erysipelas, cellulitis, folliculitis

Answer 46

Staph (MC), strep

Question 47

Diffrerence beteween furuncle and carbuncle

Answer 47

Furuncle: boil (S. epi/S. aureus) Carbuncle: Multi-loculated furunce

Question 48

Symptoms of PD catheter infection

Answer 48

Cloudy fluid, abdominal pain, fever (monobacterial)

Question 49

MCC PD catheter infections

Answer 49

S. epi (#1), S. aureus, Pseudomonas; fungal difficult to treat

Question 50

Treatment PD catheter infection

Answer 50

IP Vanc/Gent; increased dwell time, IP heparin; IV ABX not as helpful

Question 51

When do you remove PD catheter for infection?

Answer 51

After 4-5 days of infection

Question 52

What about fecal peritonitis in PD catheter infection?

Answer 52

Ex lap to find perforation

Question 53

Which infections require removal of PD catheter infections

Answer 53

Pseudomonas, fungal, tuberculous

Question 54

Treatment of sinusitis

Answer 54

BS ABXB; rare to have to tap sinus for systemic illness

Question 55

Best prevention strategy for nosocomial infections

Answer 55

Hand washing

Question 56

Highest risk patients for nosocmial infections

Answer 56

Burn patients

Question 57

Best practices to prevent surgical site infections

Answer 57

``` Clippers pre-op (over razor) Glucose 80-120 PaO2 -- 100% FiO2 Patiente warm Chlorhexidine prep with iodine-impregnated drapes ```

Question 58

Yellow sulfer granules on Gram stain; symptoms, treatment

Answer 58

Actinomyces; pulm symptoms | - Drainage and PCN G

Question 59

Treatment of Nocardia

Answer 59

Drainage and Bactrim

Question 60

MCC fungemia

Answer 60

Candida | Tx: Fluconazome

Question 61

Treatment for Candiduria

Answer 61

Remove foley catheter

Question 62

Treatment for aspergillosis

Answer 62

Voriconazole

Question 63

Treatment of Histoplasmosis (MS and Ohio River Valleys)

Answer 63

Ampho

Question 64

Treatment for Cryptococcus

Answer 64

Ampho

Question 65

Treatment of Coccidiomycosis

Answer 65

Ampho

Question 66

MCC SBP

Answer 66

E coli, Strep, Klebsiella

Question 67

How many PMN's needed for diagnosis of SBP?

Answer 67

250

Question 68

Treatment SBP?

Answer 68

CTX

Question 69

Polymicrobial SBP?

Answer 69

R/O intra-abdominal source

Question 70

PPX SBP

Answer 70

q weekly flouroquinolones

Question 71

T/F HIV is an RNA virus with reverse transcriptase

Answer 71

True

Question 72

T/F HIV anti-virals should be given within 1 hour of exposure

Answer 72

True

Question 73

Most common indication for laparotomy in HIV patients

Answer 73

CMV; second most common is lymphoma

Question 74

Most common intestinal manifestation of AIDS

Answer 74

CMV colitis; pain, bleeding, perforation

Question 75

Most common neoplasm in AIDS

Answer 75

Kaposi's sarcoma

Question 76

Most common location of lymphoma in HIV patients

Answer 76

Stomach, then rectum | - NHL (B; cell)

Question 77

UGI vs. LGI bleed in AIDS patients

Answer 77

UGI: Kaposi, lymphoma LGI: CMV, bacterial, HSV

Question 78

CMV is transmitted by (this cell)

Answer 78

Leukocytes

Question 79

Most common infection in transplant patients?

Answer 79

CMV

Question 80

Most common manifestation of CMV infection

Answer 80

Febrile mononucleosis

Question 81

Most common deadly form of CMV

Answer 81

CMV pneumonititis

Question 82

CMV biopsy

Answer 82

Cellular inclusion bodies; CMV serology

Question 83

Treatment of CMV

Answer 83

Ganciclovir; CMV immune globulin (neg patient receive positive organ)