Quiz CHPT 5-6

HAIs

Healthcare-Associated Infections

Surgical Site Infections (SSIs)

An infection that occurs at or near a surgical incision within 30 days of the procedure (or within 1 year of an implant placement).

Staphylococcus aureus

The most causative agent of SSI, present in the nose and on the skin of approximately 25% of healthy persons.

Endogenous Infection

The infectious microbe comes from the patient's own bacteria.

Exogenous Infection

The infectious microbe comes from outside the patient.

Gram Stain

A rapid identification test that assists the physician in prescribing antibiotic therapy based on the pathogen causing the infection.

Antimicrobials

BLANK that work against microorganisms, including antibacterials, antifungals, antiparasitics, and antiprotozoals.

Aseptic Surgical Practice

The concept developed after discovering bacteria's role in surgical wound infections, leading to modern sterile techniques.

Postoperative Wound Infections

Infections that can occur after surgery, historically leading to high mortality before the use of antimicrobial agents.

Antibacterials

A category of antimicrobial agents specifically used to treat bacterial infections.

Antiprotozoals

A category of antimicrobial agents used to treat infections caused by protozoa.

Antifungals

A category of antimicrobial agents used to treat fungal infections.

Antiparasitics

A category of antimicrobial agents used to treat parasitic infections.

Six

Most SSIs are caused by BLANK types of species of bacteria.

CDC

BLANK and Prevention, which provides up-to-date information on HAIs.

Antimicrobial Resistance

The increase in bacterial species that are resistant to many antimicrobial agents, leading to a resurgence of infections.

Infection Severity

SSIs may range from minor to serious and can even be deadly, depending on several factors.

CST Vigilance/Role

Everyday CSTs apply their knowledge of sterile technique as part of the team's effort to prevent SSIs.

Morphology

The study of shapes - used with Gram staining to identify many common bacteria.

Culture & Sensitivity (C & S)

The process of growing microbes in culture to determine the infecting pathogen and the exposure of the pathogen to various antibiotics to determine which agent will best inhibit growth.

Culture & Sensitivity (C & S) Procedure

a fluid or tissue specimen is obtained with a swab from the infection site and placed in one or more culture tubes. Culture tubes are available in aerobic (in oxygen) and anaerobic (lacking oxygen).

Sepsis

A systemic inflammatory response to the presence of pus-forming bacteria or their toxins in the blood or tissues. It is a life-threatening syndrome that is the leading cause of death in ICUs.

Sepsis Symptoms

Fast heart rate, Fever or hypothermia (very low body temperature), Shaking or chills, Warm or clammy/sweaty skin, Confusion or disorientation, Hyperventilation (rapid breathing) or shortness of breath.

Antimicrobial Action, 5 Different mechanisms

1. Inhibit cell wall synthesis,

2. Interfere with protein synthesis,

3. Alter cell membrane function,

4. Inhibit production of nucleic acids (RNA/DNA),

5. Interfere with cell metabolism.

Antibiotics

natural chemicals produced by microbes to inhibit other microbes.

Antibiotics in Surgery do?

prevent SSIs-prophylactically and treat infections caused by bacterial pathogens.

Antibiotics are also known as?

Antibacterials, the antimicrobial agent routinely used in surgery.

Surgical Safety Checklist

Developed by the World Health Organization (WHO) to help ensure compliance with established standards for antibiotic administration.

Surgical Care Improvement Project (SCIP)

Focused on reducing SSIs and increasing compliance for proven, effective measures for antibiotic administration.

Antibiotic Administration Measures

Selection of proper antibiotic, Timing antibiotic administration before incision, Timing discontinuation of the antibiotic after surgery, Identification of the person responsible for actions, Verification of antibiotic names, times of administration, and documentation.

Semisynthetic Antibiotics

Although antibiotics occur naturally, they can be changed in the laboratory to create semisynthetic antibiotics.

Immune System

Antibiotics only assist the BLANK to fight an infection. The goal of antibiotics is to help the BLANK battle infection.

Bacteriostatic

Inhibit bacterial growth.

Bactericidal

Kill bacteria.

Infectious Microbes Sources

BLANK may come from the patient's own bacteria (endogenous) or outside the patient (exogenous).

Infection cycle

Source of pathogenic microbe plus transmission route plus susceptible host equals infection.

Pathogen

Can be endogenous or exogenous.

Susceptible host

A BLANK that can become infected by pathogenic microorganisms.

Gram staining

Rapid identification test that assists physician in prescribing an initial course of antibiotic therapy.

Antimicrobial agent

Classified as bactericidal (kill bacteria) or bacteriostatic (inhibit bacterial growth).

Broad-spectrum antibiotics

Effective against a wide range of activity, usually effective against gram-positive and gram-negative bacteria.

Narrow-spectrum antibiotics

Effective against a small range of activity, often effective against only one category; gram-negative or gram-positive.

Limited-spectrum antibiotics

Usually effective against only one species of microorganism.

Antibiotic resistance

The ability of some strains of pathogenic microbes to prevent/withstand the activity of antimicrobial agents.

Antibiotic resistance mechanisms

Four major categories:

1. Manufacture microbial enzymes that inactivate the antibiotic.

2. Alter cell membrane to prevent antibiotic entry.

3. Alter target area so the agent is no longer effective.

Gram-negative bacteria

Bacteria that lose the purple stain during Gram staining and appear pink.

Gram-positive bacteria

Bacteria that retain the purple stain during Gram staining.

Bacilli

Rod-shaped bacteria.

Cocci

Round-shaped bacteria.

Spirals

Spiral-shaped bacteria.

Inoculated plates

Plates that are incubated for 24 to 48 hours to grow microbes.

Selective toxicity

The ability of an antimicrobial agent to act against a pathogen without harming host cells.

Ribosomes

Tiny structures whose size in prokaryotes and eukaryotes affects the binding action of antibiotics.

Prokaryote

One-celled organisms (i.e., bacteria).

Eukaryote

Multicellular organisms.

Culture

The process of growing microbes in a controlled environment.

Superbugs

Pathogenic microorganisms that have developed resistances to two or more current antibiotics.

MRSA

Methicillin-resistant Staphylococcus aureus, a type of bacteria that is resistant to several antibiotics.

VRE

Vancomycin-resistant enterococci, bacteria that have developed resistance to vancomycin.

CRE

Carbapenem-resistant Enterobacteriaceae, a group of bacteria that are resistant to carbapenem antibiotics.

Antibiotic mis-use

The inappropriate prescribing of antibiotics, particularly for viral infections, leading to the development of resistant pathogens.

Normal enteric bacteria

Bacteria that normally reside in the intestines,

(which can become resistant to antibiotics through indirect exposure)

Beta-Lactams

A class of antibiotics that includes penicillins, cephalosporins, and carbapenems, considered bacterial.

Penicillins

The first true antibiotics, extracted from the mold Penicillium, known for low cost and low toxicity.

Broad-spectrum penicillins

Penicillins that are effective against a wider range of bacteria.

Cephalosporins

Broad spectrum antibiotics derived from fungus, with five generations, each effective against different types of bacteria.

First-generation cephalosporins

Cephalosporins that are active against many gram-positive and some gram-negative microbes.

Second-generation cephalosporins

Cephalosporins effective on a wider variety of gram-negative but fewer gram-positive organisms.

Third-generation cephalosporins

Cephalosporins that may be used in treating some hospital-acquired infections (HAIs).

Fourth-generation cephalosporins

Cephalosporins with an expanded spectrum of activity.

Fifth-generation cephalosporins

New generation of cephalosporins that may be used as topical irrigation solutions in surgery.

Carbapenems

Considered the last line of defense against a number of multidrug-resistant (MDR) bacteria.

Primaxin

The first approved agent in the carbapenem class.

Monobactams

A small class of antibiotics with Aztreonam as the only drug, used for infections caused by gram-negative bacteria.

Aztreonam

The only drug in the monobactam class, available for intramuscular or intravenous injection.

Post/Pre-operative antibiotic use

Administered either IV or orally to prevent or treat infections after surgery.

Inappropriate antibiotic prescribing

Prescribing antibiotics for conditions that do not require them, such as viral infections.

Non-compliance with antibiotic regimen

When patients do not take antibiotics as prescribed, including not completing the entire prescription.

Aminoglycosides

Derived from various strains of Actinomyces bacteria.

Gentamycin/Tobramycin

An aminoglycoside antibiotic.

Neomycin

Topical ONLY as eye drops or ointment due to adverse systemic side effects.

Mechanism of Aminoglycosides

Interfere with protein synthesis by binding to bacterial ribosomes and create small holes in bacterial cell membrane causing leakage.

Major adverse effects of Aminoglycosides

Nephrotoxicity and ototoxicity.

Ototoxicity

Approximately 10% of patients receiving aminoglycosides may experience BLANK in the form of damage to the sensory cells of the inner ear, which may be permanent.

Nephrotoxicity in Aminoglycosides

An estimated 10% of patients may experience BLANK because of damage of the cell membrane of renal tubules; this adverse effect is usually mild and may be reversible if the agent is discontinued.

Fluoroquinolones

Relatively low toxicity and a broad spectrum of activity against both gram-positive and gram-negative aerobes.

Uses of Fluoroquinolones

Given for systemic infections, urinary tract infections, and osteomyelitis.

Cipro/Levaquin

A fluoroquinolone antibiotic.

Fluoroquinolones are ineffective against?

MRSA and VRE are resistant.

Macrolides

Includes erythromycins-broad spectrum which inhibit bacterial protein synthesis.

Source of Macrolides

May be obtained from isolates of Streptococcus erytheus or synthesized in the lab.

Metabolism of Macrolides

Only partially metabolized and are excreted almost unchanged in bile.

Administration of Macrolides

Most administered orally.

Tetracyclines

First broad-spectrum antibiotics.

Examples of Tetracyclines

Tetracycline & Doxycycline.

New subclass of Tetracyclines

Glycylcyclines.

Bacitracin

IM (aminoglycosides) is associated with nephrotoxicity, a serious adverse effect, so its use is strictly limited.

Uses of Bacitracin

Used as a topical ointment to prevent or treat minor skin infections or ophthalmic ointment to treat eye infections.

Clindamycin

Used to treat infections in patients who are allergic to penicillin.

Uses of Clindamycin

Used for severe infection and has a high affinity for bone - to treat osteomyelitis.