Infection

Question 1

MC organism in GI tract

Answer 1

Anaerobes

Question 2

MC anaerobe in colon/SSI

Answer 2

Bacteroides Fragilis

Question 3

MC aerobic organism in colon

Answer 3

E. coli

Question 4

MC cause of post op FEVER in:

1) 48 hours
2) 3 days
3) 5 days
4) 5-7 days
5) >= 7 days

Answer 4

1) Atelectasis
2) UTI
3) DVT
4) Wound infection
5) Wonder drugs

Question 5

MC organism in GN sepsis

Answer 5

E. coli

Question 6

What is Lipid A

Answer 6

Endotoxin release by GNRs

Question 7

What does Lipid A cause the release of

Answer 7

TNF-a -> stimulates inflammation/macrophages/complement/coag cascade

Question 8

Insulin/Glucose response to sepsis:

1) Early response
2) Late response

Answer 8

1) DEC insulin, INC glucose

2) INC insulin, INC glucose

Question 9

Optimal Glucose control in septic patient

Answer 9

80-120 mg/DL

Question 10

Optimal preventative measures for surgical site infection

Answer 10

Use clippers over razor
Glucose control 80-120
Inc Pre-induction PO2 by giving 100% O2
Keep patient warm (bair hugger)
Chlorhexidine prep

Question 11

What does Chlorhexidine prep cover that Betadyne does not?

Answer 11

FUNGUS
Chlorhexidine: Fungus, GNR, GPR, GPC
Betadyne: GNR, GPR, GPC

Question 12

C diff dx

Answer 12

ELISA for Toxin A

WBCs often 30s-40s

Question 13

C diff Tx:

Answer 13

Mild (WBC < 15, Cr < 1.5): PO Vanc or PO fidoxamicin
Severe (WBC > 15, Cr >= 1.5): PO Vanc or PO fidoxamicin
Fulminant (HypoTN, Shock, ileus, megacolon): Enteric Vanc + IV Metronidazole; total colectomy + ileostomy

Question 14

Is PO vanc okay in pregnancy?

Answer 14

Yes it doesn’t get absorbed systemically

Question 15

Abscess

Answer 15

90% of abd abscesses have anaerobes

80% of abd abscesses have anaerobes/aerobes

Question 16

Abscess Tx

Answer 16

Drainage!!!!

Question 17

When to give abx for an abscess

Answer 17

1) DM
2) Cellulitis
3) Signs of sepsis
4) Fever
5) Prosthetic hardware
Often give a max of 4 additional days of abx status post drain placement or control after perforated viscous

Question 18

Single glove leak rate for 2 hr case?

Answer 18

50%

Question 19

Double glove leak rate for 2 hr case?

Answer 19

10%

Question 20

SSI risk for wound classification:

1) Clean
2) Clean contaminated
3) Contaminated
4) Grossly contaminated

Answer 20

1) 2% (hernia)
2) 3-5% (elective SBR, colon resection)
3) 5-10% (Gunshot wound to colon)
4) 30% (abscess or feculent peritonitis)

Question 21

CDC risk factors for SSI

Answer 21

1) ASA 3-5
2) Length of case > 75% of expected time of case
3) Grossly contaminated

Question 22

SSI ppx:

1) How long before surgery do we give abx?
2) When do we stop abx after surgery?

Answer 22

1) 1 hour

2) Within 24 hours if gangrenous viscous; 48 hours of cardiac case; otherwise stop immediately.

Question 23

What abx to give pre-op?

Answer 23

Clean contaminated cases -> cephalosporin

GI: Cefoxitin (Mefoxin), cefotetan (Cefotan), ampicillin/sulbactam (Unasyn), or cefazolin plus metronidazole

Question 24

Definition of SSI?

Answer 24

Infection in the area of surgery or incision within 30 days of surgery or 1 year if there is a prosthesis

Question 25

MC organism in SSI

Answer 25

S. auerus

Question 26

MC anerobe in SSI

Answer 26

B. fragilis

Question 27

MC GNR in SSI

Answer 27

E. coli

Question 28

What is Exoslime?

Answer 28

Substance released by staph that is an exopolysaccharide matrix -> helps form biofilmsq

Question 29

Amount of bacterial isolates required for infection?

Answer 29

10^5; fewer for foreign bodies or immunocompromised

Question 30

Other risk factors for SSI

Answer 30

``` Increased length of operartion Hematoma/Seroma Increased age Chronic disease (COPD, CRF, Liver Failure, DM) Malnutrition Immunosuppression ```

Question 31

MC infection in surgical patient

Answer 31

UTI -> TAKE OUT CATHETERS!!! | MC organism -> E. coli

Question 32

MC infectious cause of death in SSI

Answer 32

Nosocomial pneumonia Directly related to length of ventilation MC organism: S. aureus, Pseudomonas, E. coli MC ICU pneumonia: GNR

Question 33

#1 thing to decrease line infections

Answer 33

Stopping procedure if sterile technique is broken

Question 34

MC organisms in line infections

Answer 34

1) S. epidermidis 2) S. aureus 3) Yeast

Question 35

Tx of line infection

Answer 35

Removal of line -> then 0-3 days of antibiotics

Question 36

Tx of line infection in septic, DM, immunocompromised

Answer 36

10-14 days after removal of line

Question 37

If cannot remove line what is the salvage rae with 2 wks of abx?

Answer 37

50%

Question 38

MC organism necrotizing soft tissue infections

Answer 38

Group A (B-hemolytic) Strep Clostridium perfringens Multiorganism

Question 39

RFs for necrotizing infection

Answer 39

Obesity DM (immunocompromised) Poor blood supply patients

Question 40

S/S of necrotizing infection

Answer 40

Fast onset presentation Pain out of proportion to exam (May not show superficial signs because spreads along deep tissues) WBC > 20 Thin gray discharge, foul smelling AMS Skin blistering, necrosis, induration, edema Gas on scan

Question 41

LRINEC score

Answer 41

CR,azy W,H,ite N,oob Cr,apped Glucose 1) CRP (<15 or > 15) 2) WBC (<15, 15-25, >25) 3) Hgb (>13.5, 11-13.5, < 11) 4) Na (>= 135, < 135) 5) Cr (<1.6, >= 1.6) 6) Glucose (<180, >= 180

Question 42

Tx of necrotizing infection

Answer 42

Early debridement, high dose penicillin vs broad spectrum abx for Nec Fasc (Group A strep, MRSA) Early debridement, high dose penicillin (Clostridium) Early debridement, try to save the TESTICLES, abx (Fournier's)

Question 43

Fungus: Actinomyces

Answer 43

Pulmonary sxs, yellow sulfur granules on gram stain | Tx: Drainage/Penicillin G

Question 44

Fungus: Nocardia

Answer 44

Pulmonary/CNS sxs | Tx: Drainage/Sulfonamides = Bactrim

Question 45

Fungus: Aspergillosis

Answer 45

Tx: VORICONAZOLE

Question 46

Fungus: Histoplasmosis

Answer 46

Pulmonary sxs; Mississippi/Ohio river valleys | Tx: Liposomal amphotericin