Podcast
Questions and Answers
What is the most common cause of death attributable to infectious diseases?
What is the most common cause of death attributable to infectious diseases?
Pneumonia
What is the most common nosocomial infection?
What is the most common nosocomial infection?
- Ventilator-associated pneumonia
- Hospital-acquired pneumonia (correct)
- Community-acquired pneumonia
Hospital-acquired pneumonia (HAP) is most common in patients in the intensive care unit recovering from thoracic or upper abdominal surgery and in older adults.
Hospital-acquired pneumonia (HAP) is most common in patients in the intensive care unit recovering from thoracic or upper abdominal surgery and in older adults.
True (A)
The ______ is the second most common nosocomial infection.
The ______ is the second most common nosocomial infection.
A clinical prediction rule for prognosis should be used to determine if hospitalization for CAP is needed.
A clinical prediction rule for prognosis should be used to determine if hospitalization for CAP is needed.
Which of these is NOT a factor that contributes to the Pneumonia Severity Index?
Which of these is NOT a factor that contributes to the Pneumonia Severity Index?
Which classification of surgical procedures carries a 30-100% risk of infection?
Which classification of surgical procedures carries a 30-100% risk of infection?
What is the main endogenous source of infection during a surgical procedure?
What is the main endogenous source of infection during a surgical procedure?
Prophylactic antibiotics should be given postoperatively, as this is more effective than administering no prophylaxis.
Prophylactic antibiotics should be given postoperatively, as this is more effective than administering no prophylaxis.
What are the two main indications for surgical prophylaxis?
What are the two main indications for surgical prophylaxis?
When should antibiotics be administered for surgical prophylaxis?
When should antibiotics be administered for surgical prophylaxis?
Redosing antibiotics should be done for extended surgical procedures.
Redosing antibiotics should be done for extended surgical procedures.
The appropriate dosage of antibiotics for prophylaxis should only be considered for the specific site being operated on, and not for the patient's weight.
The appropriate dosage of antibiotics for prophylaxis should only be considered for the specific site being operated on, and not for the patient's weight.
The duration of antibiotics during a GI procedure should be limited to the time a patient is in the operating room.
The duration of antibiotics during a GI procedure should be limited to the time a patient is in the operating room.
Antibiotics should be avoided if they may be needed for therapy if infection occurs.
Antibiotics should be avoided if they may be needed for therapy if infection occurs.
Antibiotic prophylaxis should not cause greater morbidity than the infection it prevents.
Antibiotic prophylaxis should not cause greater morbidity than the infection it prevents.
What is the appropriate antibiotic recommendation for a patient with morbid obesity undergoing gastric surgery?
What is the appropriate antibiotic recommendation for a patient with morbid obesity undergoing gastric surgery?
The biliary tract is normally colonized with organisms.
The biliary tract is normally colonized with organisms.
What is the recommendation for antibiotic prophylaxis in patients undergoing a high-risk biliary procedure?
What is the recommendation for antibiotic prophylaxis in patients undergoing a high-risk biliary procedure?
What is the recommended antibiotic prophylaxis for a patient undergoing an appendectomy with a perforated appendix?
What is the recommended antibiotic prophylaxis for a patient undergoing an appendectomy with a perforated appendix?
A combined oral and parenteral regimen is typically better than a parenteral regimen alone for colorectal surgery.
A combined oral and parenteral regimen is typically better than a parenteral regimen alone for colorectal surgery.
What is the recommended antibiotic regimen for a routine colorectal surgery?
What is the recommended antibiotic regimen for a routine colorectal surgery?
Mechanical bowel preparation is recommended for patients undergoing colorectal surgery.
Mechanical bowel preparation is recommended for patients undergoing colorectal surgery.
Antibiotics are generally not recommended for vaginal hysterectomies.
Antibiotics are generally not recommended for vaginal hysterectomies.
Cefazolin is the recommend antibiotic for a Cesarean section.
Cefazolin is the recommend antibiotic for a Cesarean section.
Antibiotics are not generally necessary for cardiac surgery.
Antibiotics are not generally necessary for cardiac surgery.
Vancomycin is recommended for patients undergoing vascular surgery if they have a history of MRSA colonization.
Vancomycin is recommended for patients undergoing vascular surgery if they have a history of MRSA colonization.
What is the general recommendation for antibiotic prophylaxis for urologic procedures?
What is the general recommendation for antibiotic prophylaxis for urologic procedures?
Antibiotic prophylaxis is indicated for head and neck surgery if an incision will be made through the oral or pharyngeal mucosa.
Antibiotic prophylaxis is indicated for head and neck surgery if an incision will be made through the oral or pharyngeal mucosa.
What is the recommended antibiotic regimen for head and neck surgery involving an incision through the oral or pharyngeal mucosa?
What is the recommended antibiotic regimen for head and neck surgery involving an incision through the oral or pharyngeal mucosa?
The most common cause of death attributed to pneumonia is in older adults.
The most common cause of death attributed to pneumonia is in older adults.
Which type of pneumonia is acquired outside of the hospital?
Which type of pneumonia is acquired outside of the hospital?
What is the definition of Community-Acquired Pneumonia (CAP)?
What is the definition of Community-Acquired Pneumonia (CAP)?
Hospitalization for CAP is primarily based on the clinical severity of the infection.
Hospitalization for CAP is primarily based on the clinical severity of the infection.
What is the second most common cause of death from infectious diseases?
What is the second most common cause of death from infectious diseases?
Hospitalized patients with severe CAP who require mechanical ventilation often require a higher level of care.
Hospitalized patients with severe CAP who require mechanical ventilation often require a higher level of care.
VAP is defined as pneumonia that occurs more than 48 hours after endotracheal intubation.
VAP is defined as pneumonia that occurs more than 48 hours after endotracheal intubation.
Which of the following is NOT a risk factor for nosocomial pneumonia?
Which of the following is NOT a risk factor for nosocomial pneumonia?
What is the most common organism responsible for community-acquired pneumonia?
What is the most common organism responsible for community-acquired pneumonia?
The most common organism responsible for hospital-acquired pneumonia is Staphylococcus aureus.
The most common organism responsible for hospital-acquired pneumonia is Staphylococcus aureus.
What is the recommended first-line therapy for a non-hospitalized patient with CAP and no comorbidities?
What is the recommended first-line therapy for a non-hospitalized patient with CAP and no comorbidities?
A respiratory fluoroquinolone is recommended for hospitalized CAP patients with comorbidities or risk factors.
A respiratory fluoroquinolone is recommended for hospitalized CAP patients with comorbidities or risk factors.
What is the recommended treatment for a hospitalized patient with severe CAP?
What is the recommended treatment for a hospitalized patient with severe CAP?
The recommended treatment duration for CAP is at least 5 days and should be guided clinically.
The recommended treatment duration for CAP is at least 5 days and should be guided clinically.
If a patient has a history of MRSA infection, vancomycin is recommended in the empiric treatment regimen for CAP.
If a patient has a history of MRSA infection, vancomycin is recommended in the empiric treatment regimen for CAP.
The recommended treatment duration for VAP is 7 days.
The recommended treatment duration for VAP is 7 days.
What is the recommended first-line therapy for VAP?
What is the recommended first-line therapy for VAP?
Both aminoglycosides and fluoroquinolones can be used as second-line agents in VAP treatment.
Both aminoglycosides and fluoroquinolones can be used as second-line agents in VAP treatment.
A patient with a history of intravenous antibiotic therapy in the past 90 days should receive a regimen that includes MRSA coverage.
A patient with a history of intravenous antibiotic therapy in the past 90 days should receive a regimen that includes MRSA coverage.
A patient developing septic shock at the time of VAP should receive a regimen that includes MRSA coverage.
A patient developing septic shock at the time of VAP should receive a regimen that includes MRSA coverage.
Vancomycin or linezolid are the recommended treatments for MRSA in VAP.
Vancomycin or linezolid are the recommended treatments for MRSA in VAP.
If a patient has MRSA, ceftazidime and aztreonam can be alternative choices to the antipseudomonal agent.
If a patient has MRSA, ceftazidime and aztreonam can be alternative choices to the antipseudomonal agent.
Antibiotic therapy for MRSA should be de-escalated on the basis of nasal PCR testing.
Antibiotic therapy for MRSA should be de-escalated on the basis of nasal PCR testing.
The recommended treatment duration for HAP is 7 days.
The recommended treatment duration for HAP is 7 days.
If a patient has a history of receiving antibiotics in the past 90 days, the recommended empiric regimen for HAP should include MRSA coverage.
If a patient has a history of receiving antibiotics in the past 90 days, the recommended empiric regimen for HAP should include MRSA coverage.
Which of the following is NOT a common mechanism of antibiotic resistance?
Which of the following is NOT a common mechanism of antibiotic resistance?
Beta-lactamases are enzymes that can degrade penicillin and cephalosporin antibiotics.
Beta-lactamases are enzymes that can degrade penicillin and cephalosporin antibiotics.
Fluoroquinolones can become ineffective due to mutations in the gyrA and parC genes.
Fluoroquinolones can become ineffective due to mutations in the gyrA and parC genes.
Tetracycline antibiotics are effective against bacteria that have developed resistance to macrolides.
Tetracycline antibiotics are effective against bacteria that have developed resistance to macrolides.
What is the major symptom of influenza?
What is the major symptom of influenza?
Influenza epidemics usually occur in the spring and summer months.
Influenza epidemics usually occur in the spring and summer months.
The most common type of influenza is type A.
The most common type of influenza is type A.
Influenza type A is classified by variations in the hemagglutinin and neuraminidase.
Influenza type A is classified by variations in the hemagglutinin and neuraminidase.
Antigenic drift primarily involves wholesale changes in the genetic makeup of the influenza virus.
Antigenic drift primarily involves wholesale changes in the genetic makeup of the influenza virus.
The influenza virus can only mutate through antigenic drift.
The influenza virus can only mutate through antigenic drift.
Which of the following symptoms is more likely to be present in influenza compared to the common cold?
Which of the following symptoms is more likely to be present in influenza compared to the common cold?
When is treatment with neuraminidase inhibitors recommended for influenza?
When is treatment with neuraminidase inhibitors recommended for influenza?
Adamantanes are typically used to treat influenza.
Adamantanes are typically used to treat influenza.
Neuraminidase inhibitors are effective against both influenza A and B.
Neuraminidase inhibitors are effective against both influenza A and B.
The only adverse effects of oseltamivir are gastrointestinal side effects.
The only adverse effects of oseltamivir are gastrointestinal side effects.
Zanamivir is recommended for patients with asthma or COPD.
Zanamivir is recommended for patients with asthma or COPD.
The recommended treatment duration for peramivir is 5 days.
The recommended treatment duration for peramivir is 5 days.
Baloxavir inhibits the viral endonuclease.
Baloxavir inhibits the viral endonuclease.
When is influenza vaccination recommended for patients at very high risk of developing complications?
When is influenza vaccination recommended for patients at very high risk of developing complications?
Amantadine and rimantadine are recommended for preventing influenza because they are effective against both influenza A and B.
Amantadine and rimantadine are recommended for preventing influenza because they are effective against both influenza A and B.
Oseltamivir is recommended for preventing influenza.
Oseltamivir is recommended for preventing influenza.
COVID-19 is caused by the SARS-CoV-2 virus.
COVID-19 is caused by the SARS-CoV-2 virus.
COVID-19 is a seasonal illness that only occurs in the winter months.
COVID-19 is a seasonal illness that only occurs in the winter months.
The incubation period for COVID-19 ranges from 3 to 6 days.
The incubation period for COVID-19 ranges from 3 to 6 days.
Older adults and those with chronic illness are most susceptible to severe COVID-19.
Older adults and those with chronic illness are most susceptible to severe COVID-19.
Ritonavir-boosted nirmatrelvir is the preferred treatment for COVID-19 in non-hospitalized patients who are not on supplemental oxygen.
Ritonavir-boosted nirmatrelvir is the preferred treatment for COVID-19 in non-hospitalized patients who are not on supplemental oxygen.
Remdesivir is the preferred treatment for hospitalized patients with COVID-19 who have not been placed on supplemental oxygen.
Remdesivir is the preferred treatment for hospitalized patients with COVID-19 who have not been placed on supplemental oxygen.
Molnupiravir can be used for hospitalized patients with COVID-19 if the other preferred therapies are not available or appropriate.
Molnupiravir can be used for hospitalized patients with COVID-19 if the other preferred therapies are not available or appropriate.
Dexamethasone is not recommended for hospitalized patients with COVID-19.
Dexamethasone is not recommended for hospitalized patients with COVID-19.
Dexamethasone is typically used in combination with ritonavir-boosted nirmatrelvir for patients with COVID-19.
Dexamethasone is typically used in combination with ritonavir-boosted nirmatrelvir for patients with COVID-19.
The preferred COVID-19 vaccine in the US is Pfizer-BioNTech.
The preferred COVID-19 vaccine in the US is Pfizer-BioNTech.
Moderna's and Pfizer-BioNTech's vaccines are both mRNA vaccines.
Moderna's and Pfizer-BioNTech's vaccines are both mRNA vaccines.
Janssen/J&J’s vaccine is an mRNA vaccine.
Janssen/J&J’s vaccine is an mRNA vaccine.
Novavax's vaccine is a protein subunit vaccine.
Novavax's vaccine is a protein subunit vaccine.
Sinusitis is an inflammation of the mucosal lining of the nasal passage and paranasal sinuses.
Sinusitis is an inflammation of the mucosal lining of the nasal passage and paranasal sinuses.
Viruses are the most common cause of sinusitis.
Viruses are the most common cause of sinusitis.
A patient with sinusitis is typically treated empirically without the need for diagnostic confirmation.
A patient with sinusitis is typically treated empirically without the need for diagnostic confirmation.
If the patient's symptoms have persist for 2-3 days and their temperature is above 39 degrees Celsius, delayed antibiotic prescribing is recommended.
If the patient's symptoms have persist for 2-3 days and their temperature is above 39 degrees Celsius, delayed antibiotic prescribing is recommended.
Antibiotics should be avoided for children between the ages of 6 months and 2 years if they are otherwise healthy and their symptoms are mild and the otitis media is unilateral.
Antibiotics should be avoided for children between the ages of 6 months and 2 years if they are otherwise healthy and their symptoms are mild and the otitis media is unilateral.
Antibiotics are not recommended for patients with Otitis Media with Effusion (OME).
Antibiotics are not recommended for patients with Otitis Media with Effusion (OME).
Corticosteroids, antihistamines, and descongestants are recommended for patients with OME.
Corticosteroids, antihistamines, and descongestants are recommended for patients with OME.
Cellulitis is most commonly caused by Streptococcus pyogenes.
Cellulitis is most commonly caused by Streptococcus pyogenes.
If there is evidence of MRSA, clindamycin is the preferred treatment for cellulitis.
If there is evidence of MRSA, clindamycin is the preferred treatment for cellulitis.
Erysipelas is a skin infection that involves the superficial dermis and spreads rapidly.
Erysipelas is a skin infection that involves the superficial dermis and spreads rapidly.
Erysipelas most commonly affects the arms and hands.
Erysipelas most commonly affects the arms and hands.
Necrotizing fasciitis is a serious infection that requires immediate medical attention.
Necrotizing fasciitis is a serious infection that requires immediate medical attention.
Necrotizing fasciitis is typically caused by Streptococcus pyogenes.
Necrotizing fasciitis is typically caused by Streptococcus pyogenes.
The primary treatment for necrotizing fasciitis is antibiotics.
The primary treatment for necrotizing fasciitis is antibiotics.
Osteomyelitis is an infection of the bone.
Osteomyelitis is an infection of the bone.
The most common cause of osteomyelitis is hematogenous spread.
The most common cause of osteomyelitis is hematogenous spread.
Osteomyelitis is most common in children.
Osteomyelitis is most common in children.
What is the recommended treatment for osteomyelitis caused by Staphylococcus?
What is the recommended treatment for osteomyelitis caused by Staphylococcus?
A patient with osteomyelitis should receive at least 4 weeks of parenteral therapy.
A patient with osteomyelitis should receive at least 4 weeks of parenteral therapy.
Flashcards
Infective Endocarditis
Infective Endocarditis
Infection of heart valves or endocardial tissue, often caused by microorganisms attaching to platelet-fibrin complexes (vegetation).
Risk Factors (Endocarditis)
Risk Factors (Endocarditis)
Mitral valve prolapse, prosthetic valves, intravenous drug abuse are risk factors for infective endocarditis.
Endocarditis Presentation
Endocarditis Presentation
Symptoms include fever (low-grade, intermittent), skin manifestations (petechiae, Janeway lesions, splinter hemorrhage), cardiac murmur, joint pain, fatigue, anorexia, weight loss, and night sweats; lab findings include anemia, leukocytosis, elevated ESR/CRP, and positive blood cultures.
Surgical Prophylaxis
Surgical Prophylaxis
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Surgical Procedure Risk Factors
Surgical Procedure Risk Factors
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Endocarditis Complications
Endocarditis Complications
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Blood Cultures (Endocarditis)
Blood Cultures (Endocarditis)
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Postoperative Wound Infections
Postoperative Wound Infections
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Study Notes
Student Book of Pharmacology-IV
- Fourth year Pharm D students
- Authors: Prof. Salah Gharieb, Prof. Mona Fouad, Ass. Prof. Islam Ahmed Elazizy
Course Contents
- Week 1: Endocarditis, lectured by Prof. Salah Ghareib
- Week 2: Surgical prophylaxis, lectured by Prof. Salah Ghareib
- Week 3: Pneumonia, lectured by Prof. Mona Fouad
- Week 4: Pneumonia, lectured by Prof. Mona Fouad
- Week 5: Influenza, Sinusitis, RSV infection, lectured by Prof. Mona Fouad
- Week 6: Urinary tract infections, lectured by Prof. Mona Fouad
- Week 7: Midterm exam
- Week 8: Acute otitis media; Eye infection, lectured by Prof. Mona Fouad
- Week 9: Skin and skin-structure infections, lectured by Ass. Prof. Islam Ahmed
- Week 10: Osteomyelitis, lectured by Ass. Prof. Islam Ahmed
- Week 11: Meningitis; Brain abscess, lectured by Ass. Prof. Islam Ahmed
- Week 12: Peritonitis, lectured by Ass. Prof. Islam Ahmed
- Week 13: Clostridium difficile infection, lectured by Ass. Prof. Islam Ahmed
Infectious Diseases
- Infective Endocarditis:
- Infection of heart valves or endocardial tissue
- Microorganism colonization forms vegetation
- Risk factors: mitral valve prolapse, prosthetic valves, intravenous drug abuse
- Incidence: 3 to 4 cases per 100,000 people per year
- Symptoms: fever, cutaneous manifestations (petechiae), cardiac murmur, arthralgias, myalgias
- Lab findings: anemia, leukocytosis, elevated erythrocyte sedimentation rate, positive blood culture
- Complications: congestive heart failure, emboli, mycotic aneurysm
- Microbiology: Three to five blood cultures (10 mL each) within first 24-48 hours. Empiric therapy initiated only in acutely ill patients after 15-20 minute blood sample collection period
Surgical Prophylaxis
- Clean: Respiratory, GI, genitourinary tracts or oropharyngeal cavity without break in technique and no inflammation encountered, infection rate 1-4%
- Clean Contaminated: Entry in respiratory, GI, genitourinary or biliary tracts, oropharyngeal cavity without unusual contamination; Infection Rate 5-15%
- Contaminated: fresh traumatic wounds; gross spillage from the GI tract; major break in technique; or incisions encountering acute nonpurulent inflammation, Infection Rate 16-25%
- Dirty: old traumatic wounds; perforated viscera; or clinically evident infection; Infection Rate 30-100%
- Risk factors: Exogenous sources (flaws in aseptic techniques), Endogenous sources (patient flora); extremes of age, nutrition, obesity, diabetes, immunocompromise, hypoxemia, remote infection, foreign body
- Treatment (treatment Recommendation for Endocarditis): Specific regimens are detailed, covering various organisms and valve types.
Respiratory Tract Infections
- Pneumonia:
- Most common cause of infectious disease related death, especially in older adults
- Hospital-acquired pneumonia (HAP) is second most common nosocomial infection (0.6%-1.1% of all hospitalized patients).
- Community-acquired pneumonia (CAP) without hospitalization rate <1%, with hospitalization rate ~14%
- Ventilator-associated pneumonia (VAP): ~20%-50%
- Community-Acquired Pneumonia (CAP): Infection of pulmonary parenchyma with acute infiltrate evidenced on chest radiograph/auscultatory examination.
- Patients must not have been hospitalized recently, nor have had regular exposure to health care
- Hospital-Acquired Pneumonia (HAP): Occurs 48 hours or more after admission and was not incubating at the time of admission.
- Ventilator-Associated Pneumonia (VAP): Appears 48 hours or more after endotracheal intubation.
Skin and Skin Structure Infections
- Cellulitis: Acute spreading skin infection, deep dermis and subcutaneous fat; non-elevated poorly defined margins; warmth, pain erythema and edema, and tender lymphadenopathy, malaise, fever, and chills. Commonly caused by Streptococcus pyogenes and Staphylococcus aureus.
- Erysipelas: acute spreading skin infection involving primarily superficial dermis; spreads rapidly through the lymphatic system; usually on legs or feet (face less common), warmth, erythema, pain. Usually caused by group A streptococcus.
- Necrotizing fasciitis: Acute necrotizing cellulitis involves subcutaneous fat and superficial fascia; infection extensively alters surrounding tissue leading to cutaneous anesthesia or gangrene; very painful. Usually caused by group A streptococci, or mixed infection with facultative and anaerobic bacteria.
Osteomyelitis
- Infection of bone with subsequent bone destruction; ~20 cases per 100,000 people
Urinary Tract Infections (UTIs)
- Most common bacterial infection in humans (7 million office visits per year; 1 million hospitalizations).
- More common in women (15%–20%).
- UTIs occur predominantly in women between ages 1-50 years.
- Lower UTI: Cystitis (nonspecific symptoms such as mental status changes, abdominal pain, and decreased eating or drinking); dysuria, frequency, urgency.
- Upper UTI: Pyelonephritis (nonspecific symptoms such as mental status changes, abdominal pain, and decreased eating or drinking)
- Risk factors: age (older adults), female gender, diabetes, pregnancy, immunosuppression, urinary tract instrumentation, urinary tract obstruction, etc.
- Recurrence: Relapse (infection with same organism within 14 days), Reinfection (infection with completely different organism).
- Microbiota: E. Coli (most common)
- Treatment (Uncomplicated): Low or moderate severity: Trimethoprim/sulfamethoxazole 160/800 mg BID x 3 days, Nitrofurantoin monohydrate 100 mg BID x 5 days; Ciprofloxacin 500 mg, or Levofloxacin 750 mg daily x 5 days
Diabetic Foot Infections
- Epidemiology: 25% of people with diabetes and ~1 in 15 need amputation
- Etiology: Neuropathy (mechanical, thermal injuries); Vasculopathy (decreased lower-limb perfusion); Immunologic defects (cellular and humoral).
- Causative Organisms: Polymicrobial (average 2.1-5.8 microorganisms); S. aureus, Group A or B Streptococcus, Enterococcus, Proteus, E. coli, Klebsiella, and others.
- Treatment: Preventive; Antimicrobial for mild infections (<2cm erythema); Severe/moderate infections include extended-duraction antibiotics and surgical intervention.
Impettigo
- Highly contagious superficial skin infection commonly in children
- Commonly caused by S. pyogenes or S. aureus
Otitis Media
- Inflammation of middle ear and usually characterized by middle ear effusion and inflammation.
- Risk factors: Younger age, day care attendance, absence of breastfeeding, family history of AOM, lower socio-economic status.
- Diagnosis: Signs include bulging tympanic membrane, reduced or absent movement of tympanic membrane, presence of purlulent fluid in middle ear, erythema of tympanic membrane, otalgia.
Conjunctivitis
- Definition: Inflammation of bulbar and or palpebral conjunctiva
- Etiologies: Bacterial (30%), Viral, Fungal (rare). Staphylococcus, Streptococcus, Corynebacterium, Haemophilus, Pseudomonas, Moraxella are common bacteria.
- Treatment: Topical (eye drops or ointment) antibiotics.
Meningitis
- Definition: Inflammation of the meninges (protective membranes surrounding the brain and spinal cord)
- Microbiota: Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type B
- Risk factors: Head trauma, immunosuppression, CNS shunts, neurosurgical patients, alcoholism.
- Diagnosis: History and physical exam, elevated WBC count in cerebral spinal fluid (CSF), Gram stain of CSF (suggestive of Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type B), CSF culture
Neonatal Sepsis
- Infection in first 3 days of life
- Early onset (within 3 days): Risk factors - extremely low birth weight, prolonged rupture of amniotic membranes, prolonged labor, maternal GBS colonization, maternal endometritis, chorioamnionitis.
- Late onset (after 3 days): Risk factors – obstetric risk factors, iatrogenic factors (e.g., endotracheal tubes, central venous catheters).
Brain Abscess
- Extension or retrograde septic from otitis media, mastoiditis, sinusitis, or facial cellulitis.
- Hematogenous spread is often from lung abscess or infective endocarditis.
- Signs: headache, fever, seizures, expanding intracranial mass lesion – focal neurologic deficits.
- Treatment: surgical intervention including incision and drainage using craniotomy or stereotactic needle aspiration.
Peritonitis
- Inflammation of the peritoneum;
- Definitions: Primary (spontaneous or idiopathic; no primary focus of infection), Secondary (occurs secondary to an abdominal process)
- Etiology: Peptic ulcer, perforation of a GI organ, appendicitis, or secondary to intrauterine device implantation, pancreatitis, operative contamination, diverticulitis, intestinal neoplasms, secondary to peritoneal dialysis.
- Microbiota: E. coli, Enterococcus, obligate anaerobes (e.g., Bacteroides, Clostridium perfringens), aerobic and facultative gram-positive and gram-negative organisms (e.g., Streptococcus, Enterococcus, Klebsiella, Proteus, Enterobacter).
- Clinical Presentation: Fever, tachycardia, elevated WBC, pain aggravated by motion, rebound tenderness, bowel paralysis, pain with breathing, decreased renal perfusion, ascitic fluid.
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