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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
What are the risk factors for Nosocomial infections?
- Advanced age
- Immunosuppressive therapy/disease
- Extended length of stay
- Previous infection
- Uncontrolled blood sugar
- Duration and type of surgery
- Catheter placement
- Mechanical ventilation
What are the risk factors for mortality from HAI?
- Inadequate antibiotic treatment
- Lack of blood pressure support medications
- Severity of illness
- Advanced age
What is the most common site for a nosocomial infection to occur?
What is the second most common site for a nosocomial infection?
Site of surgery
Which site of nosocomial infections has the highest rate of mortality?
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
What is the most common pathogen in surgical site nosocomial infections?
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
What is the most common pathogen associated with nosocomial infections of the lungs?
What are the preventative measures available for nosocomial lung infections?
- Incentive spirometry
What is the most common HAP pathogen?
Gram negative bacilli
What is the second most common HAP pathogen?
What is the third most common HAP organism?
What is the 4th most common HAP organism
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
How would you treat a non-ESBL producing E. coli nosocomial infection?
- 3rd generation cephalosporin (Ceftriaxone, Cefepime is OK too)
- Antipseudomonal PCN
- Ampicillin +/- aminoglycoside
How would you treat an ESBL producing nosocomial E. coli infection?
How would you treat a non-MRSA Staphylococcus aureus nosocomial infection?
- Oxacillin or Nafcillin
- 1st gen cephalosporin
How would you treat a MRSA Staphylococcus aureus nosocomial infection?
What are the alternative treatments for MRSA Nosocomial infections?
- Linezolid (Zyvox)
- Daptomycin (Cubicin)
How would you treat an Nosocomial Enterococci infection?
- Ampicillin + Gentimicin
- Vancomycin + gentimicin
What cephalosporin has activity against Enterococci?
What is the desired peak of Gentamicin when using it to treat Enterococci and why?
- Only being used for synergy
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
- Antipseudomonal penicillin + aminoglycoside
- Cefepime + aminoglycoside
How would you treat a non-MRSA nosocomial Staphylococcus epidermidis infection?
How would you treat a MRSA nosocomial Staphylococcus epidermidis infection?
Vancomycin or Daptomycin
What are the common causative agents for catheter related nosocomial infections?
- Saph aureus (MRSA)
- Staph epidermidis
- Klebsiella spp.
- Candida albicans
- Pseudomonas aeruginoasa
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
How should you treat a catheter related infection?
- Culture tip
- Preventative measures (aseptic technique)