Term
| What are the 3 most common nosocomial infections? |
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Definition
1) Bloodstream (IV)
2) UTI (urinary catheter)
3) Pneumonia (mechanical ventilation)- MOST COMMON |
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Term
| Why is C. dif such a problem in hospital settings? |
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Definition
Anaerobic, spore-forming toxin-producing gram (+) rod
1) Colonizes inanimate environmental sources/Long-lasting spores
2) Develops in presence of antibiotics. |
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Term
| What is the basic pathogenesis of C. dif? |
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Definition
1) Antibiotics alter gut flora
2) Ingestion of C. dif (spores) establishes colonization
3) Toxin leads to diarrhea |
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Term
| What are the main toxins of C. dif? |
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Definition
1) Toxin A- enterotoxin that affects actin cytoskeleton and makes intestinal epithelia leaky, attracting PMNs and TNF and causing inflammation
2) Toxin B- Same effects as A, but also causes cytopathic effect in tissue culture- enabling diagnosis
3) Binary toxin- Actin-specific, ADP-ribosylating agent found in some severe isolates |
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Term
| How do you detect a C. dif infection? |
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Definition
1) Microscopy of stool to find leukocytes (toxin A and B inflammation)- NONSPECIFIC
2) Sigmoidoscopy to see pseudomembranes
3) ***Gold standard is A/B Toxin detection by ELISA or cell culture cytotoxicity**** |
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Term
True or False.
You can treat C. dif with IV Vancomycin |
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Definition
False!
IV/oral metranidazole or oral Vancomycin |
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Term
| Why is Enterococcus faecium infections such a problem in hospital settings? |
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Definition
Facultative anaerobic, gram-positive cocci (singly/pairs/chains) found in lower GI tract
1) Produce bloodstream infection (sometimes with endocarditis) and UTI
2) Colonization>Infection (big carrier population so be careful when you see patients!)
3) Cell wall alterations make treatment difficult |
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Term
| Why problems are associated with HA Staph? |
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Definition
Coagulase+, Gram (+) cocci in clusters carried in nose and groin.
1) common in wound infections, abscess and bloodstream infections
2) >50% are MRSA (empiric treatment with Vancomycin suggested)
** Coagulase (-) Staph epidermidis only causes nosocomial infections with IV lines or implanted foreign materials** |
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Term
| What problems are associated with HA Klebsiella infections? |
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Definition
Gram (-) bacillus, facultative anaerobe, without spores (enterobacteriaceae)
- Ascending infections from anus to aspiration.
1) Transient hand-colonization passes from patient to patient in ICU
2) Mucoid nature makes resistant to phagocytosis
3) Cause bloodstream infection, nosocomial pneumonia and UTI
4) Treatments depend on presence of ESBLs |
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Term
| What problems are associated with HA Acinetobacter infections? |
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Definition
Gram (-), aerobic bacteria with plastic genome (antibiotic resistance)
Not too virulent, but a pain in the but!
1) A. baumannii survies on dry surfaces for days-weeks, and easily colonizes hands (ICU transmission)
2) Produces endotoxin that leads to bloodstream infections, nosocomial pneumonia and wound infection.
3) Treat with ampicillin/subactam or carbapenem |
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Term
| What are the 4 Universal Healthcare Precautions? |
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Definition
1) Gloves worn to touch body fluids, secretions (not sweat), non-intact skin and mucous membranes (ALWAYS WEAR GLOVES).
2) Hands washed immediately after gloves removed and between patients.
3) Wear mask for splashes
4) Don't re-cap, bend or break needles. |
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Term
| What are the 3 "Transmission-based Precautions"? |
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Definition
1) Airborne- private room with neg. pressure and N-95 for visitors (measles, varicella and TB)
2) Droplet- Private room and masks for Large-particle aerosoles (Meningococcus, influenza, pertussis, mumps, rubella)
3) Contact- Private room and gloves/gowns to prevent Direct or Indirect passage of MRSA, VRE, C. dif, enteritis, rotavirus, HPA, RSV, lice and scabies. |
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Term
| What are the clinical symptoms of a C. dif infection? |
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Definition
Distended colon without bowel sounds. Patient will likely be guarding their stomach. Relapase is common.
20% of HA diarrhea (other is Norovirus) |
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Term
True or False:
It is best to wash with alcohol before and after seeing a patient with C. dif |
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Definition
False!
This is not bad, but you need SOAP AND WATER for mechanical disruption of spores. |
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Term
| What can you treat CA-MRSA with that will most likely be ineffective against HA-MRSA? |
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Definition
TM/SMX (Bactrim).
Probably need metranidazole/vancomycin for HA-MRSA |
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Term
| How can you distinguish between S. aureus and S. epidermidis |
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Definition
Both are gram positive, cocci that appear in clusters on gram stain.
S. aureus is coagulase +, while S. epidermidis is coagulase - |
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Term
| How do you treat Klebsiella infections? |
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Definition
Depends on ESBLs
If there are ESBLs, you may not be able to use Carbapenems, and should try Aminoglycosides and FQ, or Colistin as a last resort. |
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Term
| When is the use of a Positive-pressure isolation room warranted? |
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Definition
| Neutropenic precautions- transplant patient on immunosuppreseents, or someone who is severely compromised. |
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