PBL: Case 1 Part 1

Question 1

Presence of bacteria in the blood

Answer 1

bacteremia

Question 2

Bacteria passing through (dental, colonoscopy)

Answer 2

transient bacteremia

Question 3

bacteria seeding from the infected site to another area intermittently (seeding blood) (same organism off and on)

Answer 3

intermittent bacteremia

Question 4

• Bacteria coming from an intravascular source all of the time (Endocarditis)

Answer 4

continous bacteremia

Question 5

sepsis goin on inside a site such as an iv catheter, endocarditis

Answer 5

primary sepsis

Question 6

sepsis going on in an external site such as strep from lungs, UTI, dental surgery, tooth accesses.

Answer 6

secondary sepsis

Question 7

a contaminant in the blood

Answer 7

pseudobacteremia

Question 8

bacteremia with organisms multiplying in blood and symptoms showing

Answer 8

septicemia

Question 9

molds and yeast in the blood

Answer 9

fungemia

Question 10

viruses in the blood

Answer 10

viremia

Question 11

*Systemic inflammatory response syndrome (things must fall in a category?)

Answer 11

SIRS

Question 12

inflammation of the cardiac lining

Answer 12

endocarditis

Question 13

Sepsis with hypotension

Answer 13

septic shock

Question 14

when the proteins that control blood clotting become over active and you get massive bleeding out

Answer 14

disseminated Intravascular coagulation (DIC)

Question 15

blood culture system where the instrument checks for positive cultures 24-7

Answer 15

continuous monitoring blood culture systems

Question 16

bacteria secreting _______ are notorious for septic shock

Answer 16

endotoxins

Question 17

common symptoms and abnormal lab tests that would be associated with possible sepsis

Answer 17

• fever (i or d)
• shaking
• chills
• tachypnea
• prostration (laying down)
• blood pressure (i or d)
• DIC
• WBC count (i or d)
• lactic acidosis
• C-RP (i)
• procalcitonin (indicator of inflammation on high levels indicative of septicemia)

Question 18

Proper method of collecting a blood specimen for bacteriologic culture (5 steps)

Answer 18

1. alcohol
2. iodine based
3. make circles going out
4. draw opposite arm that has iv
5. draw below iv if have to draw from arm with iv

Question 19

correlate the number, timing and volume of specimens with optimal recovery of organisms for meaningful clinical use

Answer 19

Number: one set = one aerobic bottle and one anaerobic bottle; no more then 3 sets in 24 hours
Volume: 8-10 for adults and 1-3 for babies;
Timing: take blood before antibiotics or any therapy and right before a fever

Question 20

blood to medium ratio when collecting a blood

Answer 20

1:5- 1:10

Question 21

IV catheter related

Answer 21

Skin flora:

• alpha/gama strep
• CoNS
• Propionibacterium ances
• staphylococcus sacchrolyticus
• Corynebacterium spp.

Question 22

UTI

Answer 22

• E. coli (coming from GI)

Question 23

Subacute endocarditis

Answer 23

• CoNS
• Veridans strep
• (s. aureus)

Question 24

acute endocarditis

Answer 24

• staph aureus
• enterococcus
• strep pneumo

Question 25

Gunshot to the abdomen

Answer 25

GI flora: - E. coli - Other enterobacteriaceae - Enterococcus - anaerobes (B. frag, Clostridium, Bifidobacterium, anaerobic coccci, Fusobacterium)

Question 26

Oral surgery

Answer 26

Mouth Flora: - alpha and gamma streptococci - Corynebacterium - CoNS - non-pathogenic Neisseria app. - Prevotella melaninogenica - Porphyromonas spp. - Prevotella spp.

Question 27

Most common contaminants found in the blood

Answer 27

Skin flora: - alpha/gama strep - CoNS - Propionibacterium ances - staphylococcus sacchrolyticus - Corynebacterium spp.

Question 28

Immunocomporomised

Answer 28

anything really; fungi

Question 29

Preexisting pneumonia is the most common cause of septicemia. This pneumonia is caused by....

Answer 29

S. pneumo | Klebs. pneumo

Question 30

BACTEC system

Answer 30

measuring CO2 by fluorescences

Question 31

BacT/Allert system

Answer 31

measuring CO2 by pH change

Question 32

SeptiCheck

Answer 32

agar paddle and you inoculate it

Question 33

Lysis Centrifugation

Answer 33

(saphonin lysis white blood cells) this is for: intracellular pathogens and fungi, yeasts and molds

Question 34

What is the purpose of sodium polyanetholsulfonate (SPS)

Answer 34

anticoagulant

Question 35

What is the purpose of resins (ARD antimicrobial removal devices) in blood culture systems

Answer 35

neutralizes antibiotics

Question 36

Blood culture procedure for possible brucellosis

Answer 36

Castanata bottle/biphasic bottle: used when takes a long time to grow brucellosis (4 weeks)

Question 37

What approaches could be used to determine whether an isolate is a skin contaminant or a pathogen

Answer 37

Collect multiple specimens (3 sets a day max); Skin contaminant: 1 out of all the bottles positive Pathogen: all positive more likely to be a pathogen

Question 38

What one gram POSITIVE organism may be observed on a gram stained smear from a blood culture bottle but would NOT grow on SBA and, with some organisms, not on CHCO

Answer 38

- Anaerobes | - Streptococcus abiotrophia (nutrient varient)

Question 39

What one gram NEGATIVE organism may be observed on a gram stained smear from a blood culture bottle but would NOT grow on SBA and, with some organisms, not on CHCO

Answer 39

- Haemophilus (only grows on chocolate) - Campylobacter (charcoal containing media, not blood OR chocolate) - anaerobes

Question 40

What media should be set up on a positive blood culture, based on results of a positive smear

Answer 40

- blood - choc - anaerobe blood - do preliminatry susceptibilites, - - GLC for anaerobes

Question 41

What test should you set up if you think you have a strep? | - of these which can you set up directly from the blood?

Answer 41

1. Catalase 2. NaCl 3. PYR 4. Bile Esculin 5. CAMP 6. Optochin (bile solubility) 7. Bacitracin Set up from blood: Bile Esculin and optochin

Question 42

If you have a gram positive cocci what should you do first?

Answer 42

Gram stain, plate it out, and do optochin right away!

Question 43

What would you do if your gram stain was clumped (staph)

Answer 43

Do a coag right away (in 4 hours) FROM BLOOD

Question 44

What would you do if your gram stain was a GNR

Answer 44

Vitek or KIA FROM BLOOD

Question 45

We keep blood bottles for how many days?

Answer 45

5 days

Question 46

What is the significance if positive on the first day v.s. the fifth day?

Answer 46

First day: more likely to be significant | Fifth day: more likely to be a contaminant

Question 47

What is the best way to do a gram stain on a blood?

Answer 47

Methanol Fixation because it preserves red cells the best