Infection

Question 1

Types of infections that lead to sepsis

Answer 1

Bacterial>fungal>parasitic>viral>others

Question 2

Non-septic infections include

Answer 2

Cystitis, local cellulitis, osteomyelitis, Upper Resp Infection, early onset fungal or viral

Question 3

Diagnosis of sepsis includes

Answer 3

Infection plus greater than or equal to 2 SIRS

Question 4

Diagnosis of severe sepsis

Answer 4

Infection plus 2 or more SIRS plus diminished perfusion, correct with fluids

Question 5

First line for treatment of sepsis

Answer 5

Fluids

Question 6

Diagnosis of septic shock??

Answer 6

Infection plus 2 or more SIRS

Question 7

Treatment for septic shock

Answer 7

Give fluid with vasopressors

Question 8

What is a Quick SOFA (qSOFA)

Answer 8

A new bed side assessment to providing criteria to identify patients with suspected infection who likely will have poor outcomes

Question 9

How many qSOFA criteria are needed to predict prolonged ICU stay and death

Answer 9

2 or more criteria

Question 10

What are the qSOFA criteria

Answer 10

Altered mentation
systolic blood pressure less than 100
Respiratory rate greater than 22

Question 11

patient with suspected infection and positive qSOFA should be assess further for? Treat? Lab?

Answer 11

Assess using SOFA for sepsis,
Treat sepsis using fluids, vasopressors to keep MAP >65
Serum lactate should be <2mmol/L (normal 0.6 to1.2)

Question 12

Management of skin and soft tissue infections

Treatment of mild non-purulent necrotizing infection, cellulitis, or erysipelas

Answer 12

Oral antibiotics:
Penicillin 
Cephalosporins 
Dicloxacillin
Clincamycin

Question 13

Management of skin and soft tissue infections

Treatment of moderate non-purulent necrotizing infection, cellulitis, or erysipelas

Answer 13

IV antibiotics:
Penicillin 
Ceftriaxone
Cefazolin
Clindamycin

Question 14

Management of skin and soft tissue infections

Treatment of severe non-purulent necrotizing infection, cellulitis, or erysipelas

Answer 14

Emergency surgical inspection and debridment inspecting for any necrotizing process
Start empirically on vancomycin and piperacillin/tazobactam (zosyn)
THEN
Culture and sensitivity
Look for monomicrobial or polymicrobial

Question 15

SIRS criteria

Answer 15

increased WBC, fever, increased heart rate, lower bp

Question 16

Purulent abcess Mild (no systemic signs of infection) treatment

Answer 16

I and D

Question 17

Treatment for Purulent infection in patient with: SIRS, >100.4 F, >24 RR, >90 HR, WBC >12,000 cells/mcL

Answer 17

Treat for moderate infect:

I and D
C and S
Empiric 
Doxcycline or bactrium
Define;
MRSA (BACTRIUM)
MSSA (Dicloxacilin or cephalexin

Question 18

Treatment for Purulent infection in patient with: SIRS plus hypotension, WBC <400 cells/mcL, who has went through one round of abx.

Answer 18

Severe treatment:

i and D
C and S
Empiric rx
Vanc or Daptomycin
linezolid
televacin
ceftaroline
Define rx
Mrsa
MSSA

Question 19

celluiltis caused by

Answer 19

Beta hemolytic strep

Question 20

Patient obese asking for antibiotis for bilateral lower extremity edema and erythema, dark pigmentation. Patient says its been going on for a long time. The lesions are nontender with bound down plaques, you look closely and see some serous drainage. what do you tell patient

Answer 20

Explain to the patient this is due to venous stasis, antibiotics will not help.

Question 21

Why is culturing cellulitis not recommeded

Answer 21

staph will grow in culture because of virulent and growth

Question 22

Duration of treatemtn for cellulities

Answer 22

5 days

Question 23

Number one treatment for skin condition

Answer 23

wound care

Question 24

Recurrent cellulitis risk factors

Answer 24

(edema, obesity, eczema, venous insufficiency,

interdigital toe space abnormalities

Question 25

Recurrent cellulitis tx

Answer 25

3 to 4 episodes per year despite preventive measures: Antimicrobial prophylaxis: - pcn, cephalosporin or erythromycin bid x 4–52 wks - intramuscular benzathine penicillin every 2–4 weeks

Question 26

Abscess Signs and Symptoms

Answer 26

``` Redness • Heat • Swelling • Pain • Loss of function • Fluctuant upon palpation ``` treat for staph

Question 27

Abscess >5cm

Answer 27

needs draining

Question 28

pantsvalentivne isolated and susceptible to bactrim, | TCN/Doxicillin, arithromycn clithromycin

Answer 28

CA MRSA

Question 29

Recurrent abscess

Answer 29

culture 5-10 day course of abx topical decolonization family sterilized

Question 30

clostridial myonecrosis

Answer 30

cellulitis | gangren

Question 31

Diabetic foot

Answer 31

cellulitis

Question 32

What is a SOFA and what 6 areas are assessed

Answer 32

``` Sequential (sepsis related) organ failure assessment 6 areas studied circulation (MAP) coagulation (platelet) central nervous system (GCS) Liver function (bilirubin) respiratiory (FiO2/PaO2) Renal (creatinine/urine volume) ```

Question 33

normal bilirubin levels

Answer 33

0.1 to 1.2 mg/dL

Question 34

Normal creatinine levels

Answer 34

0.6 to 1.2mg/dL

Question 35

normal serum lactate level

Answer 35

0.5 to 1 mmol/L

Question 36

Treatment of Severe Nonpurulent infection with Streptococcus pyogenes

Answer 36

penicillin plus clindamycin

Question 37

Treatment of Severe Nonpurulent infection with Clostridial sporogenes

Answer 37

penicillin plus clindamycin

Question 38

Treatment of Severe Nonpurulent infection with Vibrio vulnificus

Answer 38

doxycycline plus ceftazidime

Question 39

Treatment of Severe Nonpurulent infection with Aeromonas Hydrophila

Answer 39

doxycycline plus ciprofloxacin

Question 40

Treatment of Severe Nonpurulent infection with polymicrobial infection

Answer 40

vancomycin plus piperacillin/tazobactam

Question 41

Empiric Treatment of Severe purulent infection with?

Answer 41

``` Vancomycin or ceftaroline or Daptomycin or Linezolid or televancin ```

Question 42

Treatment of Severe purulent MRSA infection with

Answer 42

``` Vancomycin or Ceftaroline Daptomycin Linezolid televancin ```

Question 43

Treatment of Severe purulent MSSA infection with

Answer 43

nafcillin cefazolin clindamycin

Question 44

Patient obese asking for antibiotics for lower left extremity erythema. Patient says its been going on for a few days. The lesions are tender , you look closely and see some indistinct borders with streaking what do you tell patient

Answer 44

explain to the patient they will need antibiotic. | start on penicillin

Question 45

When should cellulitis be covered for MRSA

Answer 45

``` Patient has; nasal colonization evidence of MRSA elsewhere hx of iv drug use traumatic injury ```

Question 46

Treatment for cellulitis?

Answer 46

Treat for Beta hemolytic strep penicillin cephalexin and tmp/smx

Question 47

Treat for cellulitis and MRSA?

Answer 47

``` treating for MRSA and strep Vancomycin or linezolid or clindamycin ```

Question 48

What can be used for non-antimicrobial treatment of cellulitis? how long?

Answer 48

corticosteroids (in non-DM) for 5 days

Question 49

Predisposing factors causing reoccurring cellulitis

Answer 49

``` obese venous stasis edema eczema foot wounds (interdigital toe space abnormalities) ```

Question 50

Treatment for a patient with reoccurring cellulitis 3 to 4 times a year despite preventive measures should be?

Answer 50

antimicrobial therapy: PCN, cephalosporin, erythromycin BID x 4 to 52 weeks or intramuscular benzathine penicillin every 2-4 weeks

Question 51

CA-MRSA is most likely when patient meets what criteria

Answer 51

1) MRSA was found 48 hours within admission to hospital 2) no history of admission to any facility or dialysis within last year 3) no medical history of MRSA infection or colonization 4) no indwelling catheter being used 5) Susceptible to >2 non-Beta-lactam antimicrobials

Question 52

Empiric treatment for purulent cellulitis without abscess | with coverage for MRSA

Answer 52

Clindimycin plus Trimethprim-sulfamethoxazole plus doxycycline (minocycline)

Question 53

Treatment for necrotizing faciitis? what to suspect in culture?

Answer 53

1) surgical debride 2) Culture 3) Emipric treatment Vanc plus Zyson plus ceftriaxzone 4) Confirm with Group A Strep (treat with penicillin plus clindamycin)