Term
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Definition
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Term
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Definition
| WBC < 4,000 cells/ml (worse) |
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Term
| Bandemia (AKA left shift) |
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Definition
| Bands (AKA "stabs") > 10%- potential infection |
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Term
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Definition
| Presence of bacteria in blood culture |
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Term
| Fungemia- canadis species most common |
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Definition
| presence of fungus in blood culture |
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Term
| Fever in Critically ill patients |
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Definition
| single temp > 38.3; >38 for > 1 hr |
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Term
| Infections WITHOUT fevers |
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Definition
| elderly, open abdominal wounds, large burns, antipyretic or anti-inflammatory drugs, immune suppressed |
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Term
| Noninfectious causes: Central fevers |
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Definition
| stroke, intracranial bleed, severe head trauma- fever goes away as trauma heals |
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Term
| Noninfectious causes: Drug induced fevers- need to go through drug profile |
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Definition
| malignant hyperthermia, neuroleptic malignant syndrome, immune/inflammatory reactions- antibiotic induced fever |
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Term
| Noninfectious causes: drug related fevers |
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Definition
| antimicrobials- more common mostly because used more often (beta-lactams, sulfonamides, abacavir, amphotericin B); anti-epileptics (phenytoin); antiarrhythmics (quinidine, procainamide) |
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Term
| Infectious Causes of Fever |
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Definition
| surgical site infections; central nervous system infections; urinary catheter related infection; clostridium difficile infection; intravascular line infections; ventilator associated pneumonia |
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Term
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Definition
| temporary: peripheral venous catheter; midline catheter |
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Term
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Definition
| Non-tunneled lines; Peripherally inserted central catheter (PICC); Tunneled line; Totally implanted lines |
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Term
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Definition
| subclavian (Try not to use these); jugular; femoral |
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Term
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Definition
| don't need surgery just x-ray to see if placed correctly |
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Term
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Definition
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Term
|
Definition
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Term
|
Definition
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Term
| Local Catheter Infections |
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Definition
| Localized infections, exit-site infections, tunnel infections, pocket infections |
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Term
| Localized catheter infections |
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Definition
| easiest to treat. doesn't infect the line just the area. |
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Term
|
Definition
| within 2 cm of catheter exit site |
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Term
| Tunnel Infections- ruin catheter need to replace it |
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Definition
| Along the subcutaneous tract |
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Term
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Definition
| hard to treat can't salvage catheters; subcutaneous pocket of an implanted device |
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Term
| Systemic line infections- need blood cultures before we treat |
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Definition
| CVC with bacteremia or fungemia; symptoms of systemic infection present; with or without local infection; EX: WITH: Bacteremia + pocket infection, WITHOUT: luminal infection (bacteria in the line inself) |
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Term
| Infusate-Related (line infections) |
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Definition
| Uncommon: pharmacy specific problem; Contamination at compounding; contaminated stock solution; pathogen: infusate and blood cultures; sudden onset of symptoms soon after the start of an infusion |
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Term
| Sign and symptoms of line infections in critcal care |
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Definition
| clinical fever (recurrent or sustained); bacteremia or fungemia- key; leukocytosis or bandemia; no reasonable other source of infection |
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Term
| Pseudobacteremia (line infections) |
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Definition
| blood culture contamination- seen often; low ratio of positive/negative blood cultures (increased number of cultures = increased chance of contamination); bacteria species (coagulase negative staph, bacillus sp, diptheroids (corynebacteria); neutropenic patients (possible infection) |
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Term
| "Plate Roll" (line infections) |
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Definition
| Sensitivity 60%; > 15 colony forming units (CFU) |
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Term
| Flushing, vortexing, or sonicating in broth (line infections) |
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Definition
| > 100 CFU; sensitivity 80% (sonication) |
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Term
| Blood cultures (for line infections) |
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Definition
| do different kinds, need to have 2 diff. sets at same time so you can compare results, if line infected it is a source infection. 1 set venopuncture, 1 set from line |
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Term
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Definition
| complicated vs. uncomplicated line infection; type of line; patient specific issues (ease of IV access, goal of primary therapy, immune status, abx history); severity of disease; pathogen isolated--- need to know |
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Term
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Definition
| most common. staph aureus, coagulase-negative staph |
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Term
|
Definition
| pseudomonas sp, enterobacter sp |
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Term
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Definition
| rare but more common w/ TPN use; Candida albicans; rate of non albicans sp increases |
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Term
| Line infection: empiric treatment |
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Definition
| DOC: vancomycin; alternatives: daptomycin (intercarditis it is good) or linezolid-- MRSA, coag negative staph, choice depends on complications; nafcillin or alternatively cefazoline-- local rate of MRSA low |
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Term
| Gram negative infection suspected |
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Definition
| antipseudomonal beta-lactam (ceftazidime, piperacillin-tazobactam, cefipime); antipseudomonal carbapenem (imipenem- no pseudomonal activity even tho its carbapenem, meropenem, doripenem); may add aminoglycoside (Gentamicin, tobramycin, amikacin) |
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Term
|
Definition
| Amphoteracin B (highly active, liposomal costly but conventional higher toxicity); Advanced azole (fluconazole-- fine as long as pt isn't trying to die; voriconazole)- some cross resistance |
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Term
|
Definition
| caspofungin; micafungin; anidulafungin-- highly active against candida sp, DOC: areas of increased azole resistance; clinically stable- Fluconazole; Not stable/increased resistance: echinocandin |
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Term
| Antibiotic lock therapy (ALT) |
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Definition
| Biofilm; Mixed with normal saline or heparin; Agent selection factors; Antibiotic examples |
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Term
| Antibiotic locks (vanco, gent/amikacin, cipro) |
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Definition
| improve chances of line salvage; only effective in lumenal infections; not usually effective for candida spp; best outcomes: coag neg staph spp.; 10-14 days in addition to systemic abx |
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Term
| complications of line infection |
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Definition
| persistent bacteremia; metastatic infections (Endocarditis, septic arthritis, acute osteomylitis, septic thrombosis); systemic + local infection |
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Term
| Coagulase-negative Staph Spp. Uncomplicated Cases: IV line retained |
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Definition
| systemic abx + ALT for 10-14 days |
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Term
| Coagulase-negative Staph Spp. Uncomplicated Cases: IV line not retained |
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Definition
| systemic abx for 5-7 days |
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Term
| Coagulase-negative Staph Spp. Complicated cases: |
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Definition
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Term
| Staph aureus- harder to treat. |
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Definition
| Shorter duration (>/= 14 days): infected catheter removed, resolution of infection w/in 72 hours, no prosthetic intravascular device, no metastatic infection, not diabetic, not immunosuppressed; otherwise 4-6 wks, line salvage not recommended |
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Term
| Gram-negative bacilli (E. coli, Klebsiella, etc) |
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Definition
| Recommended to remove line (systemic abx for 7-14 days); Line salvage (depends on pathogen)-- systemic abx - ALT for 10-14; if no clinical response or deterioration- remove line; complicated: treat as per diagnosis |
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Term
|
Definition
| more common wiht TPN; Remove line (treat for 14 days after first negative blood culture)- line salvage= not usually salvageable |
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Term
|
Definition
| pneumonia > 48-72 hours after intubation; occurs in 9-27% of all intubated pts |
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Term
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Definition
| chest radiograph (xray or CT): new or progressive infiltrate; at least 2 of the following: fever, leukocytosis or leukopenia, purulent secretions |
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Term
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Definition
| < 4 days of hospitalization, better prognosis- haven't had a chance to pick up new/nastier bugs, abx sensitive pathogens more likely BUT if at risk for multi-drug resistant pathogens (MDRP) = treat like late onset VAP |
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Term
| VAP Pathogens- Early onset |
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Definition
| Streptococcus pneumoniae, Haemophilus influenza, Staph aureus (methicillin sensitive), enteric gram-negative bacilli |
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Term
| VAP: early onset and NO MDRP risk factors |
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Definition
| Ceftriaxone, or Cefotaxime OR Levofloxacin, or Moxifloxacin OR Amp-sulb (check local E. coli sensitivities) OR ertapenem (usually restricted/non-formulary |
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Term
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Definition
| >/= 5 days of hospitalization- increase risk of getting resistant bugs, increased morbidity and mortality, increased rate of multi drug resistant pathogens |
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Term
| Multi-drug resistant pathogens risk factors |
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Definition
| one of the following: antimicrobidal therapy in past 90 days- any therapy, current hospitalization of >5 days; high frequency of local abx resistance; immune suppressed; has risk factors for HCAP |
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Term
|
Definition
| prior hospitalization (> 2 days), within 90 days of current admit; nursing home or extended care facility; home infusion; dialysis; long term wound care; close contact with MDR pathogen |
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Term
| Pathogens- Late Onset VAP |
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Definition
| aerobic gram-negative bacteria, Gram-positive cocci, Legionella pneumophila (bilateral atypical) |
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Term
| Late Onset or MDRP risk factors txt for VAP |
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Definition
| pip-taxo, or Cefepime, or ceftazidime OR imipenem or meropenem or doripenem AND gentamicin or tobramycin or amikcain +/- Azithromycin OR ciprofloxacin or levofloxacin |
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Term
| VAP: Dose Does Matter! Decreased penetration: |
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Definition
| vancomycin (target troughs 15-20 mg/dL)- pulmonary gets 1/6 dose of blood, Aminoglycosides (higher peaks)- decrease penetration in pulmonary |
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Term
| VAP: Dose Does Matter! High bacterial load. Examples |
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Definition
| pip/tazo, cefepime, levofloxacin |
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Term
|
Definition
| epithelial cells vs WBCs, non-invasive (expectorated sputum, endotracheal aspirate, colonization vs. pathogen), invasive- used more in ICU (bronchoalveolar lavage (BAL)-- hypoxemia vs. improved sample |
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Term
| Acute respiratory distress syndrome (ARDS) |
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Definition
| antibiotics won't help stop them; most common cause-> sepsis; bilateral infiltrates: pulmonary edema |
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Term
| Systemic Inflammatory response syndrome (SIRS) |
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Definition
| systemic activation of immune response; regardless of cause (generalized infection, trauma, thermal injury sterile inflammatory process) |
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Term
|
Definition
|
|
Term
|
Definition
| w/ organ dysfunction; hypoprofusion = low blood pressure |
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|
Term
| septic shock - ICU patients |
|
Definition
| refractory to IV fluids- push IV fluids in; Requires vasopressers |
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Term
|
Definition
| Fluid resuscitation: crystalloid = bag of NS, LR colloids (albumin, dextran, hydroxyethyl starch); Vasopressors: norepinephrine or dopamine; Corticosteroids: consider if fluid and vasopressors not effective |
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Term
|
Definition
| within 1 hr of sepsis diagnosis, suspected infectious etiology, bacterial sensitivities |
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Term
| Sepsis Antibiotic Management |
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Definition
| Reassess daily (reduce toxicity costs, prevent resistance); combination therapy (think resistant gram negatives, known or suspected pseudomonas, neutropenic patients, at most 3-5 days; total duration 7-10 days; slow improvement --> longer courses) |
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