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DVG surgical infections
Surgical infection questions from de Virgilio
30
Medical
Professional
11/19/2013

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Term
Risk factors for SSIs
Definition
# National Nosocomial InfectionSurveillance risk index: 1. ASA > 2; 2. Class III or IV wounds; 3. duration of operation greater than the 75 percentile for that particular procedure
# Body temp
# Blood sugar
Term
Wound classification
Definition
# Class I (Clean): hernia repair or breast bx
# Class II (Clean/Contaminated): elective GI surgery
# Class III (Contaminated): bowel injury from trauma or inadvertent enterotomy
# Class IV (Dirty): perforated viscus or necrotizing soft-tissue infx (NSTIs)
Term
Use of abx in clean cases
Definition
# anytime you are inserting a prosthetic device;
# should be done an hour prior to incision to ensure optimal tissue levels
Term
Types of cases in which prophylactic abx are indicated
Definition
Any non-"Clean" case; when prosthetic is inserted.
Term
Fever, diarrhea, vomiting, diffuse redness of the skin and hypotension less than 48 hrs after an operation followed by desquamation a day or two later
Definition
Toxic shock syndrome
Term
Toxic shock syndrome:
# offending agent
# sx
# physical exam
# treatment
Definition
# S.aureus that express toxic shock syndrome toxin-1, enterotoxin B or enterotoxin C
# Fever, diarrhea, vomiting, diffuse erythema, hypotension less than 48 hrs from surgery
# exam of surgical site is unremarkable
# I&D and Abx (*** Clindamycin has anti-toxin effects/inhibits production)
Term
Malignancies a/w Clostridium Septicum
Definition
Colon and hematological
Term
# Bipolar safety pein-shaped, gram neg organism
# post-exposure ppx
Definition
# Yersinia pestis (AKA plague)
# doxy
Term
Leading cause of empyema
Definition
Bronchopulmonary infection
Term
Abx that exhibit synergism with gentamicin against enterococci
Definition
PCN or vancomycin
Term
Special toxicities of gentamicin
Definition
8th CN and nephrotoxicity
Term
Morphology and examples of bacteria susceptible to gentamicin
Definition
GNR, enterococcus and serratia
Term
Special toxicity of prolonged use of Flagyl
Definition
Peripheral neuropathy
Term
Tx of VRE
Definition
Linezolid or Synercid
Term
Sx of tetanus infxn
Definition
Generalized rigidity and convulsive spasms of skeletal muscles, esp jaw and neck; intense facial spasms, AKA risus sardonicus
Term
Tetanus:
# Causative organism
# Causative agent and MOA
# Method of dx
# Treatment
Definition
# Gram pos, anaerobic rod- Clostridium tetani
# Exotoxin- tetanospasmin, interferes with neurotransmitter release at peripheral motor endplates, spinal cord, brain and Sympathetic NS blocking inhibitory impulses leading to unopposed muscle spasm
# diagnosed clinically
# Supportive: human tetanus Ig, airwayprotection (trach), IV Mg and benzos for muscle spasms, high calorie nutrition
Term
Bacteremia a/w colon cancer
Definition
Strep Bovis (16-32%)
Term
Abx useful in treating MRSA
Definition
Linezolid, Synercid, vancomycin, rifampin
Term
Exotoxin produced by S. pyogenes
Definition
streptokinase (fibrinolytic)
Term
Exotoxin produced by S. aureus
Definition
hemolysin and leukocidin which damage plasma membranes and exfoliatin
Term
Exotoxin produced by C.perfringens
Definition
heat-labile enterotoxin that causes watery diarrhea
Term
Chloramphenicol:
# MOA
# special toxicity
Definition
# inhibits protein synthesis
# aplastic anemia
Term
Leading cause of death from liver dz in US
Definition
Hep C
Term
Rates of chronic carrier states and chronic liver dz in pts with Hep C
Definition
75-80% and 75% of those, respectively
Term
Treatment for Hep C
Definition
Peginterferon alfa-2b plus ribavirin
Term
Rates of chronic carrier state in Hep B
Definition
0.1-2%
Term
Post-exposure PPX and tx of anthrax
Definition
Cipro and Cipro/rifampin (penetrates CNS and intracellular locations)/clinda (blocks toxin production)
Term
Natural hx of antrax infection
Definition
malaise, myalgia and fever after 1-6 day incubation period leading to chest pain, diaphoresis and respiratory distress
Term
Hard signs of NSTI
Definition
bullae, skin necrosis, gas on xray, crepitus
Term
Tx of NSTIs
Definition
Aggressive hydration, broad spectrum abx, and surgical debridement and a second look debridement 12-24 hrs later +/- HBO
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