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5| Infection & sepsis
Principles
Interaction w host
S&Sx
…
5| Infection & sepsis
- Principles
- Interaction w host
- S&Sx
- Common infection &therapy
- Case Study :check:
Infection: Detrimental colonization by foreign species
Response: Host inflammation
First principles of infection :check:
1 Control source (Curettage, I&D)
2 Ab
- Prophylatic
- Empirical
- Targetted
SIRS :check:
qSOFA - quick sequential organ failure assessment
Purpose: Measure mortality and morbidity due to sepsis
- RR >22bpm
- Systolic BP <100mmHg
- GCS
Signs:
- Increase BR
- Increase HR
- Variable Temp/WBC
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Septic shock :red_cross:
Definition: Sepsis + Hypotension, reduced perfusion
Barriers to infection :check:
- Skin (Low pH)
- Mucous membrane (cillary/mucous)
- Humoral (Ab, complements)
- Cellular
- Cytokines
Commensals: :red_cross:
- Distal gut: Gram negative anaerobes protecting from gram negative aerobes
Examples of wound classification :check:
- Clean
- Clean contaminated: Appendicitis removed appendix in a controlled environment, minimal bacteria spillage
- Contaminated: Intestinal perforation, emergency bowel resection
- Dirty: Contaminated for a long duration (necrosis)
Perforation in upper/lower is better, upper lower pH sterile perforation. :red_cross: lower eg. colon
Factors of infection:
- Host: Suppression, DM, renal failure
- Surgeon: technique
- Environment: Contam
Wound closure: :check:
- Primary intention: 5-6days, remove suture 10-12days
- Secondary intention: variable
Mx: Intra-abdonimal infection:
- Surgical
- Aggressive Ab tx
Common post surgical infections :check:
- Pneumonia (Mx: CXR, physio)
- UTI (Mx: Hydration, Prophylatic Ab)
- Catherization: Skin organism (S.Aureus)
- Necrotizing soft tissue (Suspect MRSA)
- Inflammation (Tonsil, Sinus, Parotid)
Risk factors of MRSA :check:
- Hx of MRSA
- Recurrent use of Ab
- MRSA px contact
- Crowded living conditions
Tx
- Mupirocin 2% ointment + CHX body wash
- Systemic therapy w Ab (Vancomycin)
Multiorgan failure syndrome: Failure of 2 or more organ systemss (Respi, CVS, CNS, Renal, Hep, GIT) :check: