Therapeutics - Nosocomial/Surgical prophylaxis 1

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Therapeutics - Nosocomial/Surgical prophylaxis 1
2014-10-25 18:10:44
Therapeutics Nosocomial Surgical prophylaxis
Therapeutics - Nosocomial/Surgical prophylaxis
Therapeutics - Nosocomial/Surgical prophylaxis
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  1. What is a nosocomial infection?
    • Infection which manifests after a minimum stay in health care facility of 48 hours.
    • Risk may persist for up to 6 months
  2. What are the risk factors for Nosocomial infections?
    • Advanced age
    • Female>males
    • Immunosuppressive therapy/disease
    • Extended length of stay
    • Previous infection
    • Obesity
    • Uncontrolled blood sugar
    • Duration and type of surgery
    • Catheter placement
    • Mechanical ventilation
  3. What are the risk factors for mortality from HAI?
    • Inadequate antibiotic treatment
    • Lack of blood pressure support medications
    • Severity of illness
    • Advanced age
  4. What is the most common site for a nosocomial infection to occur?
  5. What is the second most common site for a nosocomial infection?
    Site of surgery
  6. Which site of nosocomial infections has the highest rate of mortality?
  7. What are the risk factors for a nosocomial lung infection?
    • mechanical ventilation (VAP)
    • H2-antagonist/PPI therapy (reduces acid defense)
    • antibiotic exposure
    • pre-existing chronic lung disease
  8. What is the most common pathogen in surgical site nosocomial infections?
  9. What are the risk factors for a surgical site nosocomial infection?
    • site, i.e. GI or GU tract etc.
    • integrity of tissue
    • duration of surgery
    • pre-surgical antibiotic exposure
  10. What is the most common pathogen associated with nosocomial infections of the lungs?
    Staph aureus
  11. What are the preventative measures available for nosocomial lung infections?
    • Incentive spirometry
    • Chlorhexadine
  12. What is the most common HAP pathogen?
    Gram negative bacilli
  13. What is the second most common HAP pathogen?
    Staph aureus
  14. What is the third most common HAP organism?
  15. What is the 4th most common HAP organism
    H flu
  16. Why is Cipro usually used instead of Levo in the treatment of HAP or VAP?
    Cipro has better G- coverage and treats Pseudomonas slightly better than Levo
  17. How would you treat a non-ESBL producing E. coli nosocomial infection?
    • 3rd generation cephalosporin (Ceftriaxone, Cefepime is OK too)
    • Antipseudomonal PCN
    • Ampicillin +/- aminoglycoside
  18. How would you treat an ESBL producing nosocomial E. coli infection?
    • Meropenem
    • Ertapenem
    • Imipenem/Cilastin
  19. How would you treat a non-MRSA Staphylococcus aureus nosocomial infection?
    • Oxacillin or Nafcillin
    • Or
    • 1st gen cephalosporin
  20. How would you treat a MRSA Staphylococcus aureus nosocomial infection?
    • Vano
    • +/-
    • Gentamicin
    • +/-
    • Rifampin
    • (Alternatives
  21. What are the alternative treatments for MRSA Nosocomial infections?
    • Linezolid (Zyvox)
    • Daptomycin (Cubicin)
  22. How would you treat an Nosocomial Enterococci infection?
    • Ampicillin + Gentimicin
    • Vancomycin + gentimicin
    • Linizolid
  23. What cephalosporin has activity against Enterococci?
  24. What is the desired peak of Gentamicin when using it to treat Enterococci and why?
    • 4
    • Only being used for synergy
  25. What would you use to treat a nosocomial UTI with pseudomonas aerugenosa as the causative agent?
    • Flouroquinolone or Aminoglycoside (Consider a flouroquinolone first)
    • Aztreonam can also be used
    • Alternative:
    • Antipseudomonal penicillin + aminoglycoside
    • Or
    • Ceftazadime
    • Or
    • Cefepime + aminoglycoside
  26. How would you treat a non-MRSA nosocomial Staphylococcus epidermidis infection?
    Pen G
  27. How would you treat a MRSA nosocomial Staphylococcus epidermidis infection?
    Vancomycin or Daptomycin
  28. What are the common causative agents for catheter related nosocomial infections?
    • Saph aureus (MRSA)
    • Staph epidermidis
    • Klebsiella spp.
    • Serratia
    • Candida albicans
    • Pseudomonas aeruginoasa
  29. What factors indicate a catheter related cause of infection?
    • Local phlebitis or inflammation at infusion site
    • Lack of other cause
    • Local embolic disease
    • Hematogenous Candida endophalmitis
    • >= 15 colonies of bacteria on semiquantitative culture of catheter tip
    • unresolving infection despite “appropriate” antibiotics
    • resolution of symptoms with catheter removal
  30. How should you treat a catheter related infection?
    • Remove/replace
    • Culture tip
    • Antibiotics
    • Preventative measures (aseptic technique)