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ICM - Infectious Disease > Staph: bacteremia, sepsis, and MRSA > Flashcards

Staph: bacteremia, sepsis, and MRSA Flashcards

(73 cards)

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1
Q

What type of colonies does Staph form on blood agar

A

Coag + = Golden B-hemolytic

Coag - = Small, White non-hemolytic

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2
Q

Coagulase negative infections as important causes of infections with…

A

Prosthetic Devices

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3
Q

Most virulent of staph aureus species?

A

Staph aureus

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4
Q

Is S. Aureus an exogenous bacteria?

A

Normal human flora

25-50% of healthy persons

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5
Q

Heavier S. Aureus colonization happens among…

A

Insulin-dependent Diabetics
HIV patients
Hemodialysis patients
Skin Damaged Patients

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6
Q

Sites of human colonization

A 
Anterior nares
Skin
Vagina
Axilla
Perineum
Oropharynx
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7
Q

Diseases assocaited with increased S. Aureus risk?

A

Diabetes
PMN defects (chronic gran. disease, neutropenic, Job’s or Chediak-Higashi syndrome)
Skin Abnormalities
Prosthetics

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8
Q

How does MRSA tend to present?

A

Mostly infections of skin, tissue

approx 5-10% invasive

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9
Q

Pathogenesis of S. Aureus?

A

Pyogenic organism causes abscess at primary/distant sites
Inflammatory Response -> Initial PMNS -> Mac and Fibro infiltration
Contained or spreads to adjacent tissues/bloodstream

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10
Q

Whay give Bactrim?

A

A kind of shitty option for MRSA
Hyperkalemia, Nausea
Not a good Strep drug

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11
Q

Why give Kephlex?

A

Strep and Methycillin sensitive

Not MRSA

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12
Q

Toxin mediated S. Aureus disease

A

Cytotoxins at site
Pyogenic toxin superantigens (food bourne, TSS)
Exfoliative toxin (Staphylococcal scalded skin syndrome)

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13
Q

TSS treatment

A

Clindamycin

Stops bacterial protein synthesis to stop toxin production

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14
Q

Vaccination for S. Aureus?

A

Anti-S. Aureus antibodies have only been shown to be protective in vitro, but never in clinical trials

No. No Vaccine for you. Go away now.

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15
Q

Skin and soft tissue manifestations of S. Aureus

A

Impetigo (Epidemal Infection)
Folliculitis (Infections of superficial dermis)
Fununcles, Carbuncles, and Abscesses
Hidradenitis suppurativa (follicular inflam of intertriginous areas)
Cellulitis, Erysipelas, and fascitis (Infection of SubQ)
Pyomytosis (Infection of skeletal muscle)

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16
Q

CV manifestations of S. Aureus

A

Infective Endocarditis
Cardiac Device Infection
Intravascular catheter infection
Septic thrombophlebitis

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17
Q

Bone, Joint Infection

A

Osteomyelitis
Prosthetic Joint Infection
Septic Arthritis/Bursitis

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18
Q

S. Aureus manifestations (not including Skin, CV, or Bones)

A 
Bacteremia, Sepsis/TSS
Splenic Abscess
Pulm Infection
Meningitis (usually head trauma, neuratrauma)
Bacteriuria (indwelling catheter)
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19
Q

Is strep viridins in the blood bad

A

Real bad…endocarditis and such

Also…don’t ignore yeast in the blood

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20
Q

How many blood cultures to you order

A

Two or more

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21
Q

S. Aureus sepsis is usually preceded by..

A

Bacteremia

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22
Q

Leading cause of community and healthcare acquired bacteremia

A

S. Aureus

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23
Q

What is bacteremia

A

presence of viable bacteria in the blood

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24
Q

Three categories of S. Aureus

A

Healthcare-associated hospital onset
Community Acquired
Healthcare acquired community onset (long term care)

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25
Risk factors for S. Aureus sepsis
IV Catheters MRSA colonization Implanted prosthetic devices Injection drug use
26
Typical S. Aureus infection history
``` Recent skin, soft tissue infection Presence of indwelling prosthetic devices Injection Drug Use Recent Hospital Exposure IV catheter ```
27
Symtoms of metastatic S. Aureus bacteremia
``` Bone/Joint Pain Protracted fever/Sweats Abdominal Pain (Splenic Infarction) CVA tenderness (renal infarction, psoas abscess) Headache (Septic Emboli) ```
28
Physical exam findings in S. Aureus bacteremia?
Careful cardiac exam for new murmurs, evidence of HF Stigmata of endocarditis Neurological exam
29
Diagnostic Evaluation of S. Aureus bacteremia
Blood Cultures Echocardiography Other imaging may be necessary based on symptoms
30
Treatment of S. Aureus bacteremia
Control source of infection Empiric ABs pending Sensitivity -- Vanco Tailored therapy once sensitivities apparent Blood Cultures 48-72 hours after clearancy Treat for 14 days of IV therapy is no complications
31
Typical treatment for MSSA?
Nafcillin/Oxacillin, Cafasolin | Nafs the best, but has to be infused every 4 hours and causes phlebitis
32
Special management problems with central catheter related infections?
If you have a CL + a Fever --> Blood Cultures + ABs No source for fever --> switch line over wire (the half assed answer) This is probably actually bullshit
33
Definition for sepsis
Clinical syndrome complicating severe infection | Signs occur in tissues remote from infection site
34
What is SIRS?
Systemic Inflammatory Response Syndrome Clinical syndrome complicating a noninfectious insult (ex. pancreatitis, pulmonary contusion)
35
Diagnostic Criteria for SIRS
``` Temp above 38 (100.4) or below 36 (96.8) HR over 90 RR abover 20 PaCO2 below 32 mmHg WBC above 12K 10% immature forms (bands) SBP under 90 mmHg ```
36
Perks of Daptomycin for S. Aureus?
Bloodstream infection | Doesn't get into lungs very well
37
Four steps of sepsis
SIRS Sepsis Severe Sepsis Septic Shock
38
On the sepsis steps, definition for sepsis?
2 SIRS + COnfirmed or Suspected Infection
39
On the sepsis steps, definition for Severe Sepsis
Sepsis End Organ Damage Hypotension (below 90) Lactate above 4 mmol
40
Enterococci don't kill
He said something like this? | Give entero Pen
41
On the sepsis steps, definition for Septic SHock
Severe Sepsis | Persistent Hypotension, End organ damage, and lactate below 4
42
Septic Shock =
Sepsis-induced hypotension persisting despite adequate fluid resuscitation
43
Sepsis according to Meyer
When a person is really sick Doesn't need bacteremia ?
44
Risk Factors for sepsis
``` ICU patient with nosocomial infection Bacteremia Age over 65 Diabetes Cancer Comm. acquired pneumonia ```
45
The patient most likely to get epsis
An African, American male over 65 in winter
46
Pathogens most likely to cause sepsis
1. G+ 2. G- 3. Fungal
47
Important clinical evaluation of the septic patient
Determine source of infection (H&P) Assess respiratory status (O sat, resp. effort) Assess perfusion (BP, Capillary refill, pulses) Assess end-organ effects (lactate level, renal and hepatic function, mental status)
48
Are eyes important
Yes | Eyes are important, as they say
49
Early management of sepsis?
``` Control of Airway (supp ox, intubation) Establish venous access Maintain perfusion (IV fluids, vasopressors) ```
50
Control of Septic focus?
``` Early ABs (empiric, then tailored) Possible debridement/surgical intervention ```
51
Vasoactive agents used in septic shock?
``` Dobutamine Dopamine E NE Phenylephrine Amrinone ```
52
How are Dobutamine and Amrinone different from other septic shock vasoactive agents?
Arterial dialation, rather than constriction
53
Is getting dead crap out a good thing?
yes. | yes, it is.
54
More sick = more mortality. | T or F
T | SIRS (7%) to Septic Shock (46%)
55
Should you save a 95 yo Dr. Meyer in Septic Shock.
No | He requested to be let go.
56
Methicillin resistance medicated by...
PBP-2 (penicillin binding protein protein encoded by mecA gene_
57
Viewpoint on Kevorkian?
a few bad things happened? Death with dignity should be your practice? Is this presentation still about S. Aureus?
58
Where is the MecA gene located
Mobile genetic element (SCCmec)
59
name the Healthcare assocaited MRSAs
USA 100, USA 200 pulse field electrophoresis pattern
60
Name the community associated MRSAs
USA 300, USE 400
61
Where did MRSA come from?
Antibiotic Selective Pressure
62
Healthcare providers are...
Pigs. | Learn to wash your god damn hands
63
Use of which antibiotics are assocaited with MRSA risk
Cephalosporin | Fluoroquinoline
64
Timeline that counts as HA-MRSA
Within 48 hours of hospitalization | Within 12 months of healthcare exposure
65
Is MRSA becoming more common?
Yes
66
CA or MRSA -- who kills more now?
MRSA
67
Key interventions to prevent the spread of MRSA
Hand Hygiene Decontamination of Environment and Equipment Contact Precautions for infected+colonized patients Active Surveillance Cultures
68
The sequel?
VRSA | Vanco Resistant
69
Things that pre-dispose you to VRSA?
Prior MRSA Underlying Conditions(diabetes, chronic ulcers) Previous Vanco Exposure) Still super rare
70
Measurements of MRSA that could be valuable?
Prevalence Survey Active Surveillance MRSA infections Compliance with Hand Hygienes
71
What does Dr. Meyer do to people at Arnett that don't follwo precautions
Chew their asses out in a polite, but professional way
72
If you want to know how to fix problems, who should you ask
People who deal with them
73
Don't forget an important side effect of Vanco...what is it
Hearing loss

ICM - Infectious Disease (11 decks)

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