Info
🌱 來自: Huppert’s Notes
Infections🚧 施工中
Infections
Central line-associated bloodstream infections (CLABSI)
• Pathogens:
- Typically skin flora with coagulase-negative staph, S. aureus, enterococci. Infections with Gram-negative organisms (E. coli, Klebsiella, Pseudomonas) less common
- Often infection from skin colonization but can be from hematogenous spread from bloodstream infection occurring from another, distant focus
• Risk factors: Duration of use, catheter material, insertion conditions, site care, placement site (subclavian < internal jugular ≤ femoral), host immunodeficiency
• Clinical importance: Nosocomial infection associated with higher morbidity and mortality
• Management: Empiric systemic antibiotics, catheter removal. May need ID consultation depending on the organism/clinical situation.
Catheter-associated UTI (CAUTI)
• Definition: Culture growth of ≥1000 CFU/mL with symptoms compatible with UTI in a patient with an indwelling urethral or suprapubic catheter OR in a patient who had catheter (including condom catheters) removed within the past 48 hours
• Risk factors: Duration of catheterization, female sex, older age, DM, factors related to catheter insertion and care
• Pathogens: E. coli, Enterococcus, Pseudomonas, Klebsiella, Candida
• Treatment: Antibiotic selection based on risk factors for multi-drug resistant organisms and prior culture data. Obtain cultures prior to antibiotics if possible and narrow antibiotics based on sensitivities. Typical antibiotic duration 7–14 days. Replace or remove catheter.
Clostridium difficile
• Microbiology: Caused by spore-forming and toxin-producing Gram-positive anaerobic bacterium. Typically presents with diarrhea (≥3 stools in 24 hours). Can also cause more severe, fulminant disease with shock and toxic megacolon
• Diagnosis and Treatment: See Infectious Diseases Chapter 8
Ventilator-associated pneumonia (VAP)
• Definition: Pneumonia diagnosed >48 hours after intubation
• Diagnosis and treatment: See Infectious Diseases Chapter 8