PC 2 mod 1.1 lec 2-5

sepsis is presence of ______ and ______ vs. bacteremia is ________

- microorganism

- infection symptoms

- microorganism

_______ infection is bloodstream infection without evidence of infection site

primary infection

_______ infection is isolation of organisms from blood and another site (bacterial load in lung moves to blood)

secondary infection

________ infection is translocation of bacteria (chewing) with rapid clearance

transient bacteremia

clinical indications for blood cultures...

--> hyper or hypo _____

--> low _____ count

--> high _____ count

--> _____ or septic shock

--> known site of _____

--> _____ of unknown origin

- thermic

- nuetropenia

- leukocytosis

- sepsis

- infection

- fever

which site is preferred for blood culture?

peripheral venipuncture

if access is limited for blood culture, ______ or _____ can be used

- central venous catheter

- peripheral arterial lines

watch out for _______ with CVC and peripheral arterial lines

colonization

blood culture set consists of ______ and ______ bottle and you collect _____ of each bottle so _____ bottles total

- anaerobic

- aerobic

- 2

- 4

anaerobic bottles have increased _____ and _____

CO2 and nitrogen

timing of blood culture is best to collect at time of ______ and send two sets within ______ from ______ site PRIOR/AFTER antibiotic admin

- fever

- minutes

- DISTINCT

- prior

four ___mL bottles of blood identify >90% of bacteremia

--> for children, ____mL/year of age

--> weight, ___% of total blood volume

10mL

- 1mL

- 2-4%

overfilling blood cultures can cause false NEGATIVE/POSITIVE

positive

variables affecting contamination rates of blood culture

--> improper use of ______

--> improper ______ preparation

--> collection from a ______

- skin antiseptic

- bottle prep

- vascular catheter (biofilm)

______ is an organism likely to be a contaminate of blood cultures

coagulase-negative staphylococci

steps of blood culture

--> obtain culture

--> ______ culture

--> do a ______ and also _____

--> place specimen on _____

--> perform appropriate ________ AND _______

--> final identification and sensitivities

- incubate (BACTEC)

- gram stain and PCR (rapid)

- appropriate media

- preliminary biochemical test/differential media

- automated system

total time for blood culture results is ____ hours

48-72h

_____ will vary among organisms during incubation period of blood culture and this aids in differentiation from _____ and helps with ______

time to bottle positivity (TTP)

--> contamination

--> de-escalation

variables predictive of TTP

--> intrinsic _____ of organism

--> _____ size

--> presence of _____

--> _____ failure or ____

- growth rates

- inoculum

- antibiotics

- liver failure or neutropenia

most aerobic bacteria grow in ___ hours, and over this is suspicion of ______

48

contamination

_____ agar can grow almost all bacteria and differentiates hemolytic organisms

blood agar

blood agar can grow almost ____ bacteria and differentiates ______ organisms

- all

- hemolytic

_____ agar can identify fastidious organisms (neisseria or haemophilus) difficult to grow

chocolate agar (lysed RBC)

chocolate agar can identify _____ organisms (neisseria or haemophilus) difficult to grow

fastidious

_____ agar can grow gram negative bacteria and contains bile salts to inhibit gram positive

MacConkey

MacConkey agar can grow ______ bacteria and contains _____ to inhibit _____

- gram negative

- bile salts

- gram positive

_____ agar is used to determine antimicrobial susceptibility

Mueller-Hinton

Mueller-Hinton agar is used to determine ______

antimicrobial susceptibility

most common infections in clinical practice are...

UTIs (nearly 1/2 of all women)

_______ bacteriuria is >10^5 cfu/mL without symptoms

asymptomatic bacteriuria

_______ UTI is bacteriuria along with urinary tract symptoms in patients with normal GU tract

acute, uncomplicated UTI

______ UTI is in patients with functional or structural abnormalities

complicated UTI

______ UTI is progression which results in kidney infection

pyelonephritis

asymptomatic bacteriuria is ___ cfu/mL

10^5

______ is recurrent UTI with SAME organism while ______ is recurrent UTI with DIFFERENT organism

- relapse

- reinfection

_____ is presence of increased number of polymorphonuclear leukocytes in urine

pyuria

pyuria is presence of...

polymorphonuclear leukocytes

complicated UTI can occur in...

--> MEN/WOMEN

--> which chronic disease state?

--> _____ UTI

- men

- diabetes

- relapse/recurrent

pyelonephritis UTI can occur in patients with...

--> _____

--> _____ transplant

--> recent ______

- pregnancy

- kidney

- catheterization

most common collection method for urine is

clean catch midstream specimen

clean catch midstream specimen is collected after ______ of periurethral area and _____ first few mL

- cleaning

- voiding

3 other methods for urine collection if clean-catch midstream is not available...

- indwelling catheter

- straight catheterization

- suprapubic aspiration

indwelling catheters have ______ for collecting sample, and the specimen should never be taken from ______

- collection port

- collection bag

_____ collection method for urine is used when patient is unable to produce collection

straight catheterization

gold standard for collecting urine

suprapubic aspiration

suprapubic aspiration is performed on FULL/EMPTY bladder and commonly on _____ age and be sure the urine is not coming from _____

- full

- infants

- catheter

need to minimize bacteria growth in urine by processing it rapidly, and can sometimes use _____ or collection systems that contain a preservative like _____ that maintain for up to ___hrs

- refrigeration

- boric acid

- 24h

challenges to urine DIPSTICK are that drugs and conditions can cause false positives, such as _____ showing ______ or negatives such as ______ breaking down over long time and exposure to ____ effects it

- iodinated radiocontract --> proteinuria

- ketones

- air

urine is slightly ACIDIC/BASIC and ______ may raise pH in urinalysis

acidic (5.5-6.5)

urea splitting organisms

______ are found in urinalysis from WBC inflammatory process

leukocyte esterase

urea-splitting organisms can RAISE/LOWER pH

raise (more basic)

if urinalysis finds nitrites, this is indicative of ______ bacteria such as ______

- gram-negative

- enterobacterales

nitrites in urinalysis may show false positive with use of ______

phenazopyridine

blood in urine can be seen with _____ or ______ type of UTI

cystitis

pyelonephritis

4 parts of urinalysis to observe

- pH

- leukocyte esterase

- nitrites

- blood

4 parts of microscopic urinalysis to observe

- WBC

- squamous epithelial cells

- presence of bacteria

- RBC

WBC in urine is also called ______ and indicates inflammation, so absence of this eliminates ______

- pyuria

- infection

squamous epithelial cells in urine reflect _____ sample

contaminated

which culture media are used for urine cultures? (2)

blood and MacConkey

significant bacteriuria is considered ___ cfu/mL and lower colony counts of ___ cfu/mL may be considered if urine is collected by "in and out" catheterization or following new indwelling catheter

- >10^5

- 10^2 to 10^5

______ can cause contamination of urine culture by increasing cell count

traumatic catheter insertion

clue to contamination of urine cultures

--> LOW/HIGH colony counts

--> ____ isolates growing

--> presence of _____

--> large quantity of _____

- low

- 2+

- skin flora

- squamous epithelial cells

hospital acquire pneumonia occurs in patients hospitalized for >__hr

48h

VAP is pneumonia after ___hr after ____

- 48h

- endotracheal intubation

non invasive collection method for respiratory sample... (2)

invasive... (2)

- expectorated sputum from deep cough

- endotracheal aspirate

- bronchoalveolar lavage (BAL)

- protected specimen brush (PSB)

in BAL method, camera is passed down endotracheal tube into lungs and ______ is squirted into infected portion and brought up

saline

in PSB method, bronchoscope with _____ is passed through endotracheal tube and scrapes area that is infected, then shaken into ______

- brush

- saline

endotracheal aspirate can be done on patient if they are _____

intubated

most controversial strategy of respiratory culture is _____ due to variation in sample quality and ____ of patients cannot provide

- expectorated sputum

- 1/3

ways to improve expectorated sputum sample...

--> obtaining PRIOR/AFTER antibiotic use

--> _____ prior to expectoration

--> no food for ____h prior

--> prompt _____ of culture

- prior

- rinsing mouth

- 2h

- inoculation

gram stain can be used for respiratory culture to assess _____ of specimen for continued processing and can determine _____ by reporting _____ and ______

- suitability

- causative organism

- morphology

- arrangement

direct specimen examination of respiratory sample determine ______ for further testing, identifies suspected organisms, and identifies _______ and ______

- suitability

- debris

- cellular components

cellular components of respiratory sample determine quality and _____ of >___ suggest contamination from mouth

- squamous epithelial cells

- >10 SEC/LPF

_____ of respiratory culture are quantitive that show infection

WBC

____ WBC count in respiratory culture show likely infection

>25WBC

3 agars used for respiratory cultures

- blood agar

- chocolate agar

- MacConkey agar

chocolate agar permits recovery of ______ and other _____ organisms

- H. influenza (resp)

- fastidious

______ agar allows classification into lactose positive or negative organisms

MacConkey agar

MacConkey agar turns ______ if organism can convert lactose to lactic acid

pink

two ways to quantify respiratory sample

- semiquantitative

- quantitative

semiquantitative is quantified based on growth in each ______

how are semiquantitative samples reported... (4)

quadrant

1 --> rare

2 --> few

3 --> moderate

4 --> many

quantitative respiratory culture is reported as _______

--> threshold is

- cfu/mL

- 10^4

- 10^3

direct testing of sputum can be done by ______ technology using ______ performed on BAL or sputum and can detect resistance and semiquantitative results

- PCR

- biofire filmarray resp panel

PCR biofire filmarray can be performed on ____ or ____ sample and can detect RESISTANCE/SUSCEPTIBILITY and QUANTITATIVE/SEMIQUANTITATIVE

- BAL

- sputum

- resistance

- semiquantitative

micobiotia on skin live in ____, ____ or _____ sites

- dry

- moist

- sebaceous

moist site of skin contains which 3 microbiota?

- c. tuberculosteacum

- c. acnes

- s. hominis

dry site of skin contains which 3 microbiota?

- c. tuberculosteacum

- c. acnes

- s. mitis

sebaceous site of skin contains which 3 microbiota?

- c. tuberculosteacum

- c. acnes

- s. epidermidis

most common and least expensive specimen collection technique for skin culture

swab

swab technique has...

--> increased risk of _____

--> FEW/MANY organisms identifies

--> INCREASED/DECREASED bacterial survival

- contamination

- few

- decreased

______ can be done for collection method for cellulitis

needle aspiration

needle aspiration can be done for _____ at ____ or ____ of wound by injecting area with small volume of _____ and aspirating

- cellulitis

- center or leading edge

- saline

needle aspiration has POOR/HIGH yield of ____%

- poor

- 10%

collection method for abscess is...

incision and draining

is swab recommended for abscess?

no

initial antimicrobial therapy of bone is usually based of _____ or _____

- direct observation

- radiographic evidence of info

_____ can be performed on bone to direct antimicrobial therapy and this is used with chronic wounds, post-surgical assessment of infection or failure to respond to therapy

bone biopsy

for joints, ____ is drawn and a gram stain and culture can be done, along with _____ analysis for _____ count and _____ analysis

- synovial fluid

- fluid analysis

- cell count

- crystal analysis

fluid analysis for synovial fluid can differentiate between ______ and ______

- infections

- other inflammatory disease states

HIGH/LOW PMNs indicate infection

high