Notes in 03 Surgical Infections

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Published	07/30/2024	In 1846, {{c1::Ignaz Semmelweis}}, a Magyar physician, took a post at the Allgemein Krankenhaus in Vienna. He noticed that the mortality rate from pue…
Published	07/30/2024	{{c1::Joseph Lister}} used a solution of carbolic acid to treat dressings for compound fractures
Published	07/30/2024	{{c1::Colonization Resistance}} - Resident or commensal microbes adherent to the physical surface and to each other may preclude invasion, particularl…
Published	07/30/2024	{{c1::Source Control}} - The primary precept of surgical infectious disease therapy consists of drainage of all purulent material, debridement of all …
Published	07/30/2024	{{c1::De-escalation Therapy}} - Initial antimicrobial selection is broad, with a narrowing of agents based on patient response and culture results. In…
Published	07/30/2024	Culture findings are less important in {{c1::poly::mono/poly}}microbial surgical infections
Published	07/30/2024	Empiric therapy should be limited to {{c1::3 to 5}} day/s or less and should be curtailed if the presence of a local site or systemic infection i…
Published	07/30/2024	Therapy for UTIs should last {{c1::3-5}} day/s
Published	07/30/2024	Therapy for pneumonia should last {{c1::7-8}} day/s
Published	07/30/2024	Therapy for bacteremia should last {{c1::7-14}} day/s
Published	07/30/2024	Therapy for osteomyelitis, endocarditis, or prosthetic infections should last {{c1::6-12 WEEKS not days haha}} day/s
Published	07/30/2024	Therapy for traumatic bowel perforation should last {{c1::1}} day/s and within {{c1::12 hours}}
Published	07/30/2024	Therapy for gastroduodenal perforations should last {{c1::1}} day/s and within {{c1::24 hours}}
Published	07/30/2024	Therapy for extensive peritoneal infections should last {{c1::<4}} day/s
Published	07/30/2024	Patients who do not improve with {{c1::5 to 7}} days of antibiotic therapy should be reevaluated for inadequate source control or a new extra-abdomina…
Published	07/30/2024	3 Types of Surgical Site Infections:{{c1::Superficial InscisionalDeep InscisionalOrgan/Space}}
Published	07/30/2024	The development of SSIs is related to 3 factors:1. The degree of microbial contamination of the wound during surgery{{c1::2. The duration of the proce…
Published	07/30/2024	{{c1::Clean}} wounds (Class {{c1::I}})No infection present (just skin microflora). No hollow viscus with microbes entered[Bonus] Expected Infection Ra…
Published	07/30/2024	{{c1::Clean}} wounds (Class {{c1::I D}})prosthetic device (e.g., mesh or valve) is inserted
Published	07/30/2024	{{c1::Clean/Contaminated}} wounds (Class {{c1::II}})Hollow viscus such as the RT, GIT, or GUT with indigenous bacterial flora is opened under controll…
Published	07/30/2024	{{c1::Contaminated}} wounds (Class {{c1::III}})Open accidental wounds encountered early after injury[Bonus] Expected Infection Rate: {{c1::3.4–13.2}}%
Published	07/30/2024	{{c1::Contaminated}} wounds (Class {{c1::III}})Extensive introduction of bacteria into a normally sterile area of the body due to major breaks in ster…
Published	07/30/2024	{{c1::Contaminated}} wounds (Class {{c1::III}})Gross spillage of viscus contents such as from the intestine, or incision through inflamed, albeit nonp…
Published	07/30/2024	{{c1::Dirty}} wounds (Class {{c1::IV}})Traumatic wounds w/ significant delay in treatment, necrotic tissue, and purulent material[Bonus] Expected Infe…
Published	07/30/2024	{{c1::Dirty}} wounds (Class {{c1::IV}})Created to access a perforated viscus accompanied by a high degree of contamination[Bonus] Expected Infection R…
Published	07/30/2024	You can suture (primary intention) Class {{c1::I and II}} wounds
Published	07/30/2024	You can suture (primary intention) Class {{c1::III}} wounds as long as antibiotic therapy is administered
Published	07/30/2024	To prevent surgical site infections, blood glucose must be kept at {{c1::<200}} mg/dL ({{c1::11.1}} mmol/L) during the perioperative period
Published	07/30/2024	[VR]1. O22. SSIs{{c1::B}}
Published	07/30/2024	[VR]1. Hypothermia2. SSIs{{c1::A}}
Published	07/30/2024	Effective therapy for incisional SSIs consists of {{c1::solely incision and drainage W/O antibiotic therapy}}
Published	07/30/2024	Antibiotic therapy as an adjunct with inciscion and drainage in px with SSIs is reserved for patients w/ {{c1::significant cellulitis or SIRS}}
Published	07/30/2024	Surveillance for the development of SSIs should last for a period of {{c1::30}} days
Published	07/30/2024	Microbial contamination of the peritoneal cavity is termed {{c1::peritonitis or intra-abdominal infection}}
Published	07/30/2024	{{c1::Primary microbial}} peritonitis occurs when microbes invade the normally sterile peritoneal cavity via hematogenous dissemination from a distant…
Published	07/30/2024	Primary Microbial Peritonitis Diagnosis:{{c1::Diffuse tenderness and guarding without localized findingsAbsence of a surgically treatable source …
Published	07/30/2024	Primary Microbial Peritonitis and Intravascular Catheter Infection Tx:Antibiotics for {{c1::2-3 weeks::time frame}}Removal of indwelling devices
Published	07/30/2024	Common Etiologic Organisms for Primary Microbial Peritonitis are...{{c1::E coli, K pneumoniae, and S pneumoniae::3}}
Published	07/30/2024	{{c1::Secondary microbial}} peritonitis occurs subsequent to contamination of the peritoneal cavity due to perforation or severe inflammation and infe…
Published	07/30/2024	Secondary Microbial Peritonitis Diagnosis:{{c1::Abdominal CT scan then exploratory laparatomy which sees colonic perforation}}
Published	07/30/2024	Secondary Microbial Peritonitis Tx:If a single abscess: {{c1::percutaneous drainage}}If multiple abscesses, contraindication to percutaneous drainage,…
Published	07/30/2024	Patients in whom standard therapy for peritonitis fails typically develop one or more of the following: {{c1::an intra-abdominal abscess, leakage from…
Published	07/30/2024	The most common cause of hepatic abscesses is {{c1::biliary tract manipulation}}
Published	07/30/2024	The most common aerobic bacteria that cause hepatic abscesses are {{c1::E coli, K pneumoniae, and other enteric bacilli, enterococci, and Pseudomonas …
Published	07/30/2024	The most common anaerobic bacteria that cause hepatic abscesses are {{c1::Bacteroides spp., anaerobic streptococci, and Fusobacterium spp.::3}}
Published	07/30/2024	The most common fungi that cause hepatic abscesses is {{c1::Candida albicans}}
Published	07/30/2024	Hepatic/Splenic Abscess Tx:Small (<1 cm) or multiple small abscesses: Antibiotics for {{c1::4-6 weeks::timeframe}}Large abscesses: {{c1::Percutaneo…
Published	07/30/2024	Secondary pancreatic infections (e.g., infected pancreatic necrosis or pancreatic abscess) occur in approximately {{c1::10-15}}% of patients who devel…
Published	07/30/2024	Steps to take in preventing pancreatic infections in px with pancreatitis:CT scan unless renal function is impairedProphylactic antibiotics{{c1::Enter…
Published	07/30/2024	The presence of secondary pancreatic infection should be suspected in patients w/{{c1::systemic inflammatory response fails to resolvethose individual…
Published	07/30/2024	Perform surgical interventions for pancreatic infections {{c1::2 weeks after::timeframe}} illness
Published	07/30/2024	The biggest factor for skin and soft tissue infections in the elderly, immunocompromised, diabetic, or even healthy patients is the {{c1::compromise o…
Published	07/30/2024	Skin or Soft Tissue Infection Diagnosis:{{c1::Just clinical findings:"Dishwater pus"Skin changes (blebs, crepitus)Excessive pain}}
Published	07/30/2024	Skin or Soft Tissue Infection Tx:{{c1::Radical resection of affected areas and even sometimes amputation}}
Published	07/30/2024	50% of skin and soft tissue infections are polymicrobial, but in the event that they are caused by a single species of bacteria, main causes are {{c1:…
Published	07/30/2024	Postoperative UTI Diagnosis:Urinalysis >10^{{c1::4}} CFU/mL of bacteria in symptomatic pxUrinalysis >10^{{c1::5}} CFU/mL of bacteria in asymptom…
Published	07/30/2024	Postoperative UTI Tx:Antibiotic by common causative agents such as {{c1::E coli and K pneumoniae}} for {{c1::3-5}} days
Published	07/30/2024	[QC] Severity1. CAP2. HAP{{c1::B}}
Published	07/30/2024	Nosocomial Pneumonia Diagnosis:{{c1::Clinical Findings:Purulent sputum,Elevated leukocyte count, FFeverLab Findings:New chest X-ray abnormalities, suc…
Published	07/30/2024	Intravascular Catheter Infection Clinical Findings:{{c1::Many are actualy asymptomatic! Just an elevation in WBCs}}
Published	07/30/2024	Intravascular Catheter Antibiotic DOC: {{c1::No utility and contraindicated}}
Published	07/30/2024	Rescucitation Endpoints for Px with Sepsis:MAP: {{c1::>65}} mmHgUrine output: {{c1::>0.5}} mL/kg/hr Normalization of {{c1::serum lactate}}And re…
Published	07/30/2024	Patients with acute lung injury associated with sepsis should receive mechanical ventilation with tidal volumes of {{c1::6}} mL/kg and pulmonary airwa…
Published	07/30/2024	Patients with anemia associated with sepsis should receive red blood cell transfusion when Hg is {{c1::<7}} g/dL
Published	07/30/2024	Low BP associated with sepsis DOC: {{c1::NE and vassopressin}}
Published	07/30/2024	When dealing with chronically ill pxs who have gone through antibiotic therapy, {{c1::MRSA}} is the most common resistant bug to look out for
Published	07/30/2024	Common Extended spectrum Beta-lactamase-producing strains of enterobacteriaceae that surgeons see are {{c1::E coli and Klebsiella::2}}
Published	07/30/2024	ESBL-producing strains of enterobacteriaceae Infection Antibiotic DOC: {{c1::Carbapenems}}
Published	07/30/2024	The last decade has seen increased isolation of a {{c1::vancomycin}}-resistant strain of Enterococcus
Published	07/30/2024	Bacillus anthracis Infection Post-Exposure Prophylaxis DOC: {{c1::Ciprofloxacin or Doxycycline or Amoxcicillin if penicilli-sensitive}}
Published	07/30/2024	Bacillus anthracis Infection DOC: {{c1::Ciprofloxacin, Clindamycin, and Rifampin}}
Published	07/30/2024	Yersinia pestis Infection DOC: {{c1::Streptomycin, Doxycycline, or Chloramphenicol}}
Published	07/30/2024	Yersinia pestis Infection Post-Exposure Prophylaxis DOC: {{c1::Doxycycline}}
Published	07/30/2024	Smallpox Infection Post-Exposure Prophylaxis DOC: Smallpox vaccine within {{c1::4 days::timeframe}}
Published	07/30/2024	Francisella tularensis (Tularemia) Infection Post-Exposure Prophylaxis DOC: {{c1::Aminoglycosides, Doxycycline, or Ciprofloxacin}}
Published	07/30/2024	Monitoring {{c1::procalcitonin}} may provide information on whether an infection has resolved and we can halt antibiotic therapy
Published	07/30/2024	In the later phases of postoperative antibiotic treatment of serious intra-abdominal infection, these provide assurance that the infection is eradicat…
Published	07/30/2024	{{c1::Monobactams}} are the best alternative for px with penicillin allergies
Published	07/30/2024	Surgical infection rates significantly dropped in incidence with the discovery of {{c1::Antiseptic and aseptic techniques}}
Published	07/30/2024	[QC] Colon flora1. Anaerobes2. Aerobes{{c1::A}}
Published	07/30/2024	Surgery Preoperative Prophylaxis DOC: {{c1::Cefazolin}}
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