Surgical Site Infections
This surgical site infection type involves skin or subcutaneous tissue of the incision
What is superficial incisional
A 29-year-old man is admitted to the hospital with multiple fractures after being involved in an automobile crash. Postoperatively he required multiple transfusions and vasopressors. On postoperative day 7, he develops fever, leukocytosis, and hypotension. His chest x-ray, urinalysis, and surgical sites are clear. He has slight erythema around the right internal jugular central line. Of the following this organisms most commonly causes line infections
A. pseudomonas
B. Klebsiella
C. Staphylococcus epidermidis
D.Staphylococcus aureus
E. streptococcus pneumonea
What is C. Staphylococcus epidermidis
This is the duration in which antibiotics should be stopped in a patient with perforated diverticulitis after source control according to the STOP-IT Trial
What is 4 days?
This antibiotic works by inhibiting the 50s ribosome subunit and can be used to cover MRSA in patients with AKI
what is linezolid
This is the wound classification and incidence as surgical site infection in a 45yo M who underwent a lipoma excsion with no complications
what is clean 1-3%
Most common causative pathogen in SSIs
What is S. aureus?
These are methods to reduce ventilator associated pneumonias (VAP)
what is elevation of the head of the bed, sedation vacation with daily weaning assessment, chlorhexidine mouth care, subglottic drainage
This is the SCIP guideline for timing prophylactic surgical antibiotics should be given
What is 1hr of surgical incision with discontinuation 24hrs post-op or 48hrs for cardiothoracic
This antibiotic binds to the acyl-D-ala-D-ala portion of the growing cell wall and is renally excreated which can have nephrotoxicity
Vancomycin
These are the causes of post-op fever. (Ws)
Wind
Water
Wound
Walking
Wonder-drugs
This surgical site infection type involves soft tissues deep to the subcutaneous tissues, including and muscles and fascial planes
What are deep incisional infections?
This is the number of colony forming units on culture that would indicate a CLABSI
what is 100,000 CFU/mL
These are the antibiotic indicated pre-opperative antibiotics for an elective hernia repair in patients with and without penicillin allergies
cefazolin (ancef), Clindamycin (tecnically due to low cross reactivity of cephlosporins also ancef)
This is the mechanism and gene responsible for MRSA resistance to penicillins
what is MecA gene beta-lactamase resistance through horizontal gene transfer
This is the most likely diagnosis and associated organism in A 12-year-old boy underwent successful small bowel transplantation 9 months ago. He has suffered no signs of rejection but recently has developed fever and cervical lymphadenopathy. Abdominal imaging reveals numerous enlarged mesenteric lymph nodes.
What is posttransplant lymphoproliferative disorder (PTLD) from EBV
This surgical site infection type involves any body cavity that was opened or manipulated during surgery
what is organ space infection
This is the diagnosis and treatment for a patient who is reporting multiple episodes of fowl smelling diarrhea after being treated for a urinary tract infection.
c diff, stop current antibiotic, oral vancomycin
Abx routinely added to broad-spectrum regimens for NSTIs
What is clindamycin?
d/t toxin neutralization
This antibiotic class works through inhibition of DNA gyrase (topoisomerase)
What are fluoroquinolones?
This is how you can salvage a central line a 2 year old with short bowel syndrome who presents with a fever and was started on antibiotics whose repeat cultures continue to grow gram positive bacteria
what is ethanol lock
Time frame to be considered SSI per CDC (w/ and w/o implant left in place)
What is 30 days? (no implant)
What is 1 year? (w/ implant)
Best abx treatment for a 68 y/o M POD3 from ex lap and Hartmann procedure complaining of burning and pain on urination. He had a urinary catheter placed at the time of surgery that was removed yesterday. UA shows a specific gravity of 1.030 with positive LE and nitrites.
A. TMP-SMX for 14d
B. Ciprofloxacin for 14 days
C. Nitrofurantoin for 5 days
D. Carbapenem for 14 days
E. Amoxicillin for 10 days
What is nitrofurantoin for 5 days?
(uncomplicated cystitis)
This abx is NOT used in pulmonary infections due to inhibition by surfactant
What is daptomycin?
This abx breaks up DNA through production of oxygen free radicals
Bonus! Does this abx have coverage against bacterial anaerobes or aerobes?
What is metronidazole (flagyl)?
What are anaerobes?
Diagnostic exam that should be performed in pt with Clostridium septicum or Strep gallolyticus infection
Colonoscopy
Strong association with colon cancer