Fiser Chapter 5 INFECTION Flashcards Preview

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Flashcards in Fiser Chapter 5 INFECTION Deck (65)
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1

Stomach microflora

Virtually sterile, some GPCs and yeast

2

Proximal small bowel microflora

10^5 bacteria, mostly GPCs

3

Distal small bowel microflora

10^7 bacteria, GPCs, GPRs, GNRs

4

Colon microflora

10^11 bacteria, almost all anaerobes, some GNRs, GPCs

5

Most common bacteria in GI tract

Bacteroides fragilis (anaerobe)

Most common aerobe: E coli

6

Postop fever and infection

Hours: NSTI
2 days: atelectasis
2-5 days: UTI (most common postop infection)
>5 days: wound infection
If within 2 days, its because of injury to bowel or invasive STI (C perfringens or beta-hemolytic strep)
7-10 days abscess

7

GN sepsis

E coli -> endotoxin (LPS lipid A) -> TNF-alpha release from macrophages -> complement activation -> coagulation cascade

8

Infection and blood glucose

Hyperglycemia often just before clinical sepsis

Early GN sepsis: decreased insulin, increased glucose
Late GN sepsis: increased insulin and glucose

9

Optimal blood glucose in sepsis

100-120 mg/dL

10

C diff colitis treatment

Oral vanc or flagyl
IV flagyl
Lactobacillus can also help
Stop or change other abx

11

Abscess bacteria

90% anaerobes
80% both anaerobes and aerobes

12

Abscess tx

I&D
Antibiotics if DM, cellulitis, clinical sepsis, fever, leukocytosis, or bioprosthetic hardware (valve, hip)

13

Expected wound infection rates

Clean: 2%
Clean contaminated 3-5%
Contaminated 5-10%
Gross contamination 30%

14

Prophylactic abx timing

24hr after OR
48hr after OR for cardiac cases

15

SSI bacteria

-Definition >/= 10^5 bacteria. Less if foreign body present.
-Most common organism S aureus (coagulase positive)

16

COPS

S aureus

17

CONS

S epidermidis

18

Exoslime

Exopolysaccharide matrix released by Staph species

19

B frag in SSI

indicates necrosis or abscess (only grows in low redox state) and/or translocation from gut

20

Risk factors for SSI

Long operation
Hematoma or seroma
Old
Chronic disease (COPD, RF, LF, DM)
Malnutrition (most common immunodeficiency)
Immunosuppression

21

Leading cause of infectious death after surgery

nosocomial PNA

22

Nosocomial PNA bacteria

1. Staph aureus
2. Pseudomonas
But GNRs #1 class of organisms in ICU PNA?

23

Line infection bacteria

1. Staph epidermidis
2. Staph aureus
3. Yeast

24

Central line cx indicative of line infection

>15 colony forming units

25

Central line infection dx and tx

Dx: >15 CFU or site looks bad
Tx: move to new site, or just PIV if possible

26

NSTI organisms

Beta-hemolytic GAS (exotoxin)
C perfringens
Mixed

27

NSTI clinical findings

Pain out of proportion
WBC >20
Thin gray drainage
Skin blistering/necrosis
Induration and edema
Crepitus or ST gas on XR
Sepsis +/-

28

Overlying skin pale red, progressing to purple with blister or bullae

NSTI

29

NSTI tx

Early debridement
High dose PCN
Broad spectrum abx if poly-organismal

30

Necrotic tissue, pain out of proportion, gram stain shows GPRs without WBCs --> myonecrosis and gas gangrene

C perfringens NSTI
Farming injury -> necrotic tissue decreases redox -> good environment for C perfringens -> alpha toxin -> myonecrosis and gas gangrene