2 new classes of antibiotics have been developed in the past 40 years. True or false?
What are the surgical infection prevention guidelines? (7)
give antibiotics within 1 hour of incision
stop prophylactic antibiotics at 24 hours (48 for cardiac)
increase dose for larger pts
administer antibiotics appropriate for local resistance patterns
follow American Heart Association guidelines for pts at risk of infective endocarditis
adhere to procedure-specific recommendations
What antibiotic has a broad antimicrobial spectrum, low toxicity, incidence of allergic reaction, and has rare cross-sensitivity to PCN?
What do you need to infuse slowly to avoid "Red Man Syndrome"?
What causes the "Red Man Syndrome" from giving vancomycin too rapidly?
histamine release resulting in HYPOtension
Note: True allergy can cause CV collapse.
For what surgery does increased FiO2 intraop reduce the incidence of surgical site infections?
Hyperthermia increases the incidence of SSI. True or false?
Increased anesthesia for the treatment of pain decreases the incidence of SSI. True or false?
Hypocapnea causes vasoconstriction which can impair perfusion to vital organs. True or false?
Low glucose inhibits leukocyte function thereby increasing risk of SSI. True or false?
How many cases per year are due to CVC blood stream infections?
What are the signs of a BS infection? (3)
non-specific signs of infection with no obvious source
indwelling catheter is present
change in mental status, hemodynamic instability, altered tolerance for nutrition, and malaise
What is the definition of a sepsis?
infection plus systemic inflammatory response
What characteristics describe a severe sepsis?
What characteristics describe septic shock?
Severe sepsis plus
HYPOtension (systolic BP 90mmHg) despite adequate fluid resuscitation
What is the estimated mortality for septic shock?
Patients that have sepsis may also have hyperglycemia. True or false?
How do you manage treatment regarding surgery for a patient with sepsis? (5)
postpone surgery if possible
MAP > 65mmHg
CVP 8-12 mmHg
adequate urine output, normal pH
O2 sat > 70%
Indications of pulmonary sepsis organ failure:
____ minute ventilation
______ airway resistance
_____ skeletal muscle efficiency
< muscle efficiency
Indications of cardiovascular organ failure due to sepsis:
SBP < _____
______ cardiac filling pressures
______ cardiac output
SBP < 90
lower cardiac filling pressures
lower cardiac output
What are gastrointestinal signs of sepsis organ failure? (2)
“Shock liver” (like heart attack of the liver)
Ileus (bowel obstruction)
What are causes of coagulation issues with sepsis related organ failure? (4)
Vit K deficiency
Effects of Factors II, VII, IX, & X
Thrombocytopenia (due to increased destruction)
What is an anaerobic, gram positive spore forming organism causing antibiotic diarrhea and pseudomembranous colitis?
Clostridium difficile infection
What are risk factors of Clostridium difficile? (9)
severe underlying disease
presence of NG tube
ICU long hospital stay
depressed immune system
What are signs of Clostridium difficile infection?
diarrhea & abdominal pain
How do we diagnose clostridium difficile infection?
enzyme linked immunoassay for C.diff toxin
What is the treatment for Clostridium difficile infection? (3)
fluid & electrolyte replacement
discontinue offending agent
c diff antibiotic therapy (Flagyl & Vanco)
What infection is this image of?
Clostridium difficile Colitis
What is caused by mycobacterium and survives in tissues with high oxygen concentration?
What infection is most likely to occur in racial & ethnic minorities (Asia), IV drug abusers, AIDS?
90% of patients infected never become symptomatic with tuberculosis. True or false?
What are clinical signs of TB? (4)
Tuberculin test (PPD)
Read in ____- _____hours
Positive result > ____mm induration (> ___ mm AIDS)
What will appear in CXRs for people with TB?
Apical infiltrates or upper lobe infiltrates with cavitation
Sputum smears are able to detect active TB in 90% of patients. True or false?
Patients with positive PPD should be treated with _____.
Considered non-infectious if patient has received treatment, is improving clinically, and has ___ negative sputum smears.
If TB patient, HEPA filter placed on circuit (between Y connector & mask/LMA/ETT). True or false?
What is an acute febrile illness associated with myalgias, malaise, and headache?
What herpes viruses route of transmission is oral?
What virus does this describe?
- Disseminated disease in immunocompromised hosts
- Transmitted by infected secretions or leukocyte containing blood products
- Parturient to fetal transmission-->CNS damage
What virus is an infectious mononucleosis associated with fever, LAD (lymphadenopathy), splenomegaly?
Zidovudine (AZT) greatly reduces risk of transmission of what disease?
Having what 2 forms of hepatitis at the same time can be very dangerous?
Hep B and D
What types of hepatitis can often cause the most liver damage?
B, C, D
What types of hepatitis are transmitted via the fecal-oral route? (2)
Hep A and E
What are the symptoms of hepatitis?
Dark urine, fatigue, anorexia, nausea, low grade fever, abdominal discomfort, myalgias, arthralgias, jaundice, hepatomegaly, and splenomegaly.
What is the treatment for hepatitis?
Abstinence from alcohol
HCV: interferon & ribaviron
What is a microbial infection that implants on heart valves?
Streptococcal organisms account for 50% of cases for those infected with endocarditis. True or false?
What are predisposing factors for those with infective endocarditis? (4)
Operative procedures associated with transient bacteremia (dental, upper airway, gall bladder, lower GI tract, & GU tract)
IV drug abusers
*Patients with prosthetic heart valves*
Patients with congenital heart defects/valvular disease
What are the signs of infective endocarditis? (2)
indicated by heart murmur, anemia, fever with a history of cardiac disease and recent surgical procedure
evidence of cerebrovascular occlusion & hematuria
Name 3 CNS infections.
What is meningitis characterized by?
Fever, headache, vomiting, nuchal rigidity, obtundation
CSF findings: > neutrophils, glucose concentration < 50% of blood glucose conc., > protein conc.
What is a brain abscess a result of?
Result of direct extension of contiguous infections (sinusitis, otitis media, lung abscess)
What diagnosing test do we perform to find a brain abscess?
An epidural abscess is usually present ___-___ hours after performance of epidural with severe backache, local tenderness, paraspinal muscle spasm, fever, and leukocytosis.
What infection is caused by inhalation of oropharyngeal secretions containing pneumococci and streptococci?
For those with pneumonia, OP secretions inhaled during sleep is less common in healthy patients and more common in alcoholics, drug addicted, and patients with neurologic disorders. True or false?
What infection does this describe?
- Complication of bacterial pneumonia
- Common in alcoholics & poor dental hygiene
What infection does this describe?
- Suspected in patients who have undergone abdominal surgery who have unexplained fever
- Diagnosis: wide separation between gastric bubble and diaphragm on CXR.
- Treatment: surgical drainage and antibiotics
Most common of all bacterial infections affecting humans
> in females < 50 yrs of age is the contraction of _____.
Urinary Tract Infection
What is the most common organism causing UTI?
What infection does this describe?
- Progressive inflammatory destruction of bone
- Staphylococcus aureus adheres to bone and expresses receptors for bone matrix
- Surgical sample, CT & MRI
After contact with C. diff patient, immediately use hand foam. True or false?
false, FOAM will not work