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Surgical Recall > SR 27 - Surgical Infection > Flashcards

SR 27 - Surgical Infection Flashcards

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1
Q

Define cellulitus

A

Blanching erythema from superficial dermal/epidermal infection

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2
Q

Define a superinfection

A

New infection arising while a patient is receiving antibiotics for teh original infection at a different site

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3
Q

What is the most common nosocomial infection?

A

UTI

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4
Q

What is the most common nosocomial infection leading to death?

A

Respiratory tract infection (pneumonia)

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5
Q

What constitutes a positive urine analysis?

A

Positive nitrite
Positive leukocyte esterase
>10 WBC/HPF
Presence of bacteria (supportive)

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6
Q

What number of CFU confirms the diagnosis of UTI?

A

100,000 (10^5) CFU

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7
Q

What are the common organisms for UTI?

A

E. coli, klebsiella, proteus

Enterococcus, staphylococcus aureus

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8
Q

What is the treatment for UTIs?

A

Antibiotics with gram-negative spectrum (i.e. Bactrim, gentamicin, ciprofloxacin, aztreonam)
Check culture and sensitivity - adjust meds from there

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9
Q

What is the treatment for bladder candidiasis?

A

Remove or change foley catheter

Administer systemic fluconazole or give amphotericin bladder washings

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10
Q

What are the signs of a central line infection?

A

Unexplained hyperglycemia
Fever, mental status change, hypotension, tachycardia
Shock
Pus and erythema at central line site

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11
Q

What is the most common cause of ‘catheter-related bloodstream infections’?

A

Coagulase-negative staphylococcus (33%)

Enterococci, Staphylococcus aureus, gram-negative rods

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12
Q

When should central lines be changed?

A

When they are infected

There is NO advantage to changing them ever 7 days

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13
Q

What central line infusion increases the risk of infection?

A

Hyperal (TPN)

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14
Q

What is the treatmetn for central line infection?

A

Remove central line, send for culture
+/- IV antibiotics
Place new central line in a different place

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15
Q

When should peripheral IV short angiocatheters be changed?

A

Every 72-96 hours

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16
Q

What is a surgical site infection?

When do they arise?

A

Infection in an operative wound

POD 5-7

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17
Q

Signs and symptoms of surgical site infections?

A

Pain at incision site, erythema, drainage, induration, warm skin, fever

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18
Q

What is the treatment for surgical site infections?

A 
Remove skin sutures/staples
Rule out fascial dehiscence
Pack wound open
Send wound culture
Administer antibiotics
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19
Q

What are the most common bacteria found in post-op wound infections?

A

Staph aureus (20%)
E. coli (10%)
Enterococcus (10%)
Others - staph epidermidids, pseudomonas, anaerobes, gram -, streptococcus

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20
Q

Which bacteria cause fever and wound infection in the first 24 hours after surgery?

A

Streptococcus

Clostridium (bronze-brown weeping tender wound)

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21
Q

What is the definition of a ‘clean’ wound? Infection rate?

A

Elective, nontraumatic wound without acute inflammation

usually closes primarily without the use of drains

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22
Q

What is the definition of a ‘clean-contaminated’ wound? Infection rate?

A

Operation on GIT or RT withou unusual contamination or entry into the biliary or urinary tract

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23
Q

What is the definition of a ‘contaminated’ wound? Infection rate?

A

Acute inflammation, traumatic wound, GIT spillage, or a major break in sterile technique
5% infection rate

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24
Q

What is the definition of a ‘dirty’ wound? Infection rate?

A

Pus present, perforated viscus or dirty traumatic would

33% infection rate

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25
What are the possible complications of wound infections?
Fistula, sinus tracts, sepsis, abscess, suppressed wound healing, superinfection, hernia
26
What factors influence the development of infections?
Foreign body (i.e. suture, drains, grafts) Decreased blood flow (poor delivery of PMNs and antibiotics) Strangulation of tissues with excessively tight sutures Necrotic tissue or excessive local tissue destruction Long operation (>2 hrs) Hypothermia in OR Hematomas or seromas Dead space that prevvents the delivery of phagocytic cells to bacterial foci Poor approximation of tissues
27
What patient factors influence the development of infections?
``` Uremia Hypovolemic shock Vascular occlusive states Advanced age Distant area of infection ```
28
What are examples of an immunosuppressed state?
``` Immunosuppressant treatment Chemotherapy Systemic malignancy Trauma or burn injury Diabetes mellitus Obesity Malnutrition AIDS Uremia ```
29
What lab tests are indicated with a surgical wound infections?
CBC - leukocytosis or leukopenia (an abscess may act as a WBC sink) Blood cultures Imaging studies (i.e. CT scan to locate an abscess)
30
What is the treatment for surgical wound infections?
Incision and drainage - an abscess must be drained | Antibiotics for deep abscesses
31
What are the indications for antibiotic after drainage of a subcutaneous abscess?
DM, surrounding cellulitis, prosthetic heart valve or immunocompromised state (flucuation is a sign of a subcutaneous abscess)
32
What are the causes of a peritoneal abscess?
Postoperative status after a laparotomy, ruptured appendix, peritonitis, any inflammatory intraperitoneal process, anastomotic leak
33
What are the common sites for peritoneal abscesses?
``` Pelvis Morison's pouch Subprenic Paracolic gutters Periappendiceal lesser sac ```
34
What are the signs/symptoms of a peritoneal abscess?
Fever (classifcally spiking) Abdominal pain Mass
35
How is the diagnosis of peritoneal abscess made? When should you look?
Abdominal CT scan or ultrasound | POD 7
36
What CT scan findings are associated with abscesses?
Fluid collection with fibrous rind | Gas in fluid collection
37
What is the treatment for a peritoneal abscess?
Percutaneous CT-guided drainage | For pelvic abscess - transrectal/transvaginal drainage
38
All abscesses must be drained except which type?
Amebiasis | Pre-treatment with surgical removal
39
Define necrotizing fasciitis
Bacterial infection of underlying fascia | Spreads rapidly along fascial planes
40
What are the causative agents for necrotizing fasciitis?
GAS (S. pyogenes) | But often polymicrobial with anaerobes/G- organisms
41
What are the signs and symptoms of necrotizing fasciitis?
Fever, pain, crepitus, cellulitis, skin discoloration, blood blister, weeping skin, increased WBCs Subcutaneous air on X-ray Septic shock
42
What is the treatment for necrotizing fasciitis?
``` IVF IV antibioitics Aggressive early, extensive surgical debridement Cultures Tetanus prophylaxis ```
43
What is clostridial myositis?
Clostridial muscle infection AKA Gas gangrene Due to Clostridium perfringens
44
What are the signs and symptoms of clostridial myositis?
Pain, fever, shock, creptius Foul-smelling brown fluid Subcutaneous air on X-ray
45
What is the treamtent of clostridial myositis?
IV antibiotics Aggressive surgical debridement of involved muscle Tetanus prophylaxis
46
What is suppurative hidradenitis? Where do they occur?
Infection/abscess formation in apocrine sweat glands | Perineum/buttock, inguinal area, axillae (sites of aprocrine glands)
47
What is the causative organisms in suppurative hidradenitis?
S. aureus
48
What is the treatment for suppurative hidradenitis?
Antibiotics | Incision and drainage (excision of skin with glands for chronic infections)
49
What is pseudomembranous colitis?
Antibiotic-induced colonic overgrowth of C. difficile, secondary to loss of competitive nonpathogenic bacteria that comprise the normal colonic flora (Esp. penicillins, cephalosporins, clindamycin) Caused by exoctoxin release by C. difficile
50
What are the signs and symptoms of pseudomembranous colitis?
Diarrhea (10% bloody) | +/- fever, increased WBCs, abdominal cramps, abdominal distention
51
How do you diagnose pseudomembranous colitis?
Stool assy for exotoxin titer +/- fecal leukocytes On colonoscopy, you see a membranous exudate
52
What is the treatment of pseudomembranous colitis?
PO metronidazole or PO vancomycin Discontinuation fo causative agents NEVER give antiperistaltics
53
What are hte indications for prophylactic IV antibiotics?
Accidental wounds with heavy contamination and tissue damage Accidental wounds requring surgical therapy that has had to be delayed Prosthetic heart valve or valve disease Penetrating injuries of hollow intra-abdominal organs Large bowel resections and anastomosis Cardiovascular surgery with the use of a prosthesis/vascular procedures Patients with open fractures (start in ER) Traumatic woudns occuring >8 hours prior to medical ttention
54
What must a prophylactic antibotic cover for procedures on teh large bowel/abdominal trauma/appendicitis?
Anaerobes
55
What commonly used antibiotics offer anaerobic coverage?
``` Cefoxitin (Mefoxin) Clindamycin Metronidazole (Flagyl) Cefotetan Ampicillin-sulbactum (Unasyn) Zosyn Timentin Imipenem ```
56
What antibiotic is used prophylactically for vascular surgery?
Ancef | significant PCN allergy - erythromycin or clindamycin
57
When is the appropriate time to administer prophylactic antibiotics?
Adequate blood levels prior to surgical incision
58
What is parotitis? Bug?
Infection of the parotid gland | Staphylococcus
59
Factors associated with increased risk for parotitis?
``` >65yo Malnutrition Poor oral hygiene Presence of NG tube NPO dehydration ```
60
When does parotitis most commonly occur?
2 weeks postoperatively
61
Signs of parotitis?
Hot, red, tender parotid gland | Increased WBCs
62
What is the treatment of parotitis?
Antibiotics | Operative drainage, as necessary
63
What is a 'stitch' abscess?
Subcutaneous abcess centered around a subcutaneous stitch, which is a foreign body Treat with drainage and stitch removal
64
What bacteria to be found in the colon?
Anaerobic - bacteroides fragilis | Aerobic - E. coli
65
Which bacteria are found in infections from human bites?
Strep viridans, S. aureus, Peptococcus, Eikenella | Treat with Augmentin
66
What is the most common ICU pneumonia bacteria?
Gram-negative organisms
67
What is Fournier's gangrene?
Perineal infection starting classifcally in the scrotum in patients with diabetes Treat with triple antibiotics adn wide debridement - surgical emergency
68
Does adding antibiotics to peritoneal lavage solution lower the risk of abscess formation?
No
69
What are the classic antibiotics for 'triple' antibiotics?
Ampicillin, gentamycin, metronidazole (Flagyl)
70
What antibiotic is used to treat amoeba infection?
Metronidazole (Flagyl)
71
What bacteria commonly infect prosthetic material and central lines?
Staphylococcus epidermis
72
What is the antibiotic of choice for Actinomyces?
Penicillin G
73
What is a furnucle?
Staph abscess that forms in a hair follicle
74
What is a carbuncle
Subcutaneous staph abscess, suusally an extension of a furuncle Most commonly seen in patients with diabetes
75
what is a felon
Infection of the finger pad
76
What are the signs of tetanus?
Lockjaw, muscle spasm, laryngospasm, convulsions, respiratory failure
77
What are the appropriate prophylactic steps in tetanus-prone injury in patients who have three previous immunizations
None | Tetanus toxid only if >5 years since last toxoid
78
What are the appropriate prophylactic steps in tetanus-prone injury in patients who have two previous immunizations?
Tetanus toxoid
79
What are the appropriate prophylactic steps in tetanus-prone injury in patients who have one previous immunization?
Tetanus immunoglobulin IM and tetanus toxoid IM (different sites)
80
What are the appropriate prophylactic steps in tetanus-prone injury in patients who have no previous immunizations?
Tetanus immunoglobulin IM and tetanus toxoid IM (different sites)

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