Infectious Disorders Flashcards
(36 cards)
Antibiotic Resistance
When germs (bacteria & fungi) develop the ability to defeat the drugs designed to kill them Bacteria have become resistant to the antibiotics designed to kill them Multidrug-resistant (MDR) organisms are responsible ↑number hospital-acquired infections
Penicillin
β-lactam antibiotic Penicillin G (IV) destroyed by stomach acid Penicillin V (PO) semi-synthetic True PCN allergy IgE <1% 10% crossover b/w PCNs & cephalosporins
Surgical Site Infections (SSIs)
20% intra-abdominal
15% nosocomial (hospital-acquired infections)
2-5% extra-abdominal surgeries
*Occurs w/in 30days surgery or w/in 1yr prosthetic implant or organ
SSI Prevention
Preoperative antibiotics Glycemic control <500mg/dL Maintain normothermia Optimize oxygenation Antimicrobial soap bath prior to surgery Intraop skin prep w/ an alcohol-based antiseptic agent
Bloodstream Infections
Nosocomial bloodstream infections r/t central venous catheters
Catheter-associated bloodstream infection defined as bacteremia or fungemia in patient w/ IV catheter & at least one positive blood culture obtained from peripheral vein
Internal Jugular Vein
R 15cm
L 18cm
Subclavian Vein
R 14cm
L 17cm
Clostridium Difficile
C Diff
Spore-forming bacteria
Antibiotic-associated diarrhea & pseudomembranous colitis d/t toxin A & B production
Megacolon → colectomy & ileostomy
Treatment: remove causative antibiotic & oral antibiotics
Hemodynamic instability
Contact & isolation precautions
Handwashing to remove spores
Bleach germicidal wipes on equipment/room
Necrotizing Soft Tissue Infection
Mortality up to 75%
- Gas gangrene, toxic shock syndrome, Fournier’s gangrene, severe cellulitis, flesh-eating infection
- General infection, atypical measles syndrome, pain
- Infection begins in deep tissue
Necrotizing Anesthesia Management
Resuscitation
Septic & fluid shifts
Do not delay surgical treatment
Hemodynamic instability d/t cytokines release
Ensure adequate IV access, A-line, central venous catheter, blood products available
Multi-organ failure risk → ICU
Tetanus
Neurotoxin tetanospasmin from clostridium tetani organisms
Suppresses inhibitory spinal cord neurons → generalized skeletal muscle contractions
Treatment includes benzodiazepines & muscle relaxants to control skeletal muscle spasm
- Neutralize exotoxin (human anti-tetanus immunoglobulin)
- Penicillin
Pneumonia
Community-acquired
Aspiration (anesthesia related)
Postoperative
Ventilator-assisted
Pneumonia S/S
Fever, chest pain, dyspnea, fatigue, rigors, cough, sputum production
Patient history - travel, cave exploration, diving contact w/ birds/sheep, immunocompromised
Chest radiograph
+ cultures
↑WBCs
Pneumonia Prevention
CDC recommends PPSV23 vaccine all adults >65yo
Pneumonia Anesthesia Management
Delay surgery during acute pneumonia Avoid fluid overload LPV often PEEP dependent Consider same ventilator settings as ICU Lowest inspired oxygen possible Suctioning Maintain antibiotic/antiviral/antifungal schedule
Severe Acute Respiratory Viral Illness
Highly virulent w/ high mortality
H5N1 influenza A “bird flu”
Coronavirus strains (MERS, SARS-CoV, COVID-19)
Non-specific S/S fever, headache, diarrhea, respiratory distress, hemoptysis
Precautions: airborne, droplet, or contact
Viral Infections Treatment
Prevent spread
Vaccines when available
Neuraminidase inhibitors (Tamiflu) - only given w/in first 48hrs S/S
1° supportive care
Anesthesia Management
LPV & symptom management Barrier precautions Filters place on breathing circuit Clean room w/ alcohol Wait 48hr until another case
Operating Rooms
All ORs are positive pressure rooms
Negative Pressure
Minimum recommendation total 15 air exchanges per hour w/ minimum 3 air changes outdoor air per hour
Isolation rooms need an anteroom
Ultraviolet Germicidal Irradiation
Different wavelength types UV-C (germicidal UV) Installed into HVAC systems Needs direct light to the surface Burns possible
HEPA Filters
High-efficiency particulate air filters
Theoretically remove at least 99.97% dust, pollen, mold, bacteria, & any airborne particles w/ size 0.3 microns
Inspiratory & expiratory on AGM breathing circuits
HMEF
Heat & moisture exchange medium together w/ electrostatic filter
Tuberculosis
Mycobacterium tuberculosis - aerobe
Survives most successfully in tissues w/ high oxygen concentrations (pulmonary & extrapulmonary)
