ACCS Infection Control and Sepsis Management Flashcards

In a patient with septic shock refractory to fluid resuscitation, which vasopressor is recommended as the first-line agent?

Answer: Norepinephrine

Norepinephrine is the first-line vasopressor for septic shock due to its potent vasoconstrictive effect with limited tachycardia.

Which isolation precaution is required for a patient with confirmed Clostridioides difficile infection in the ICU?

Answer: Contact precautions with soap and water handwashing

C. difficile requires contact precautions, and soap and water must be used for hand hygiene because alcohol-based sanitizers do not kill spores.

A patient develops fever, purulent tracheal secretions, and a new infiltrate on CXR after 5 days of mechanical ventilation. What is the most appropriate next step?

Answer: Obtain a bronchoalveolar lavage (BAL) and start empiric antibiotics for VAP

BAL sampling followed by empiric broad-spectrum antibiotics targeting VAP pathogens is the recommended approach for suspected VAP.

Which serum lactate level is used to define occult tissue hypoperfusion (cryptic shock) in sepsis?

Answer: ≥2 mmol/L

A lactate ≥2 mmol/L despite normal blood pressure defines occult or cryptic septic shock and warrants aggressive resuscitation.

Which antifungal agent is recommended as first-line empiric therapy for suspected candidemia in a critically ill ICU patient?

Answer: An echinocandin (caspofungin, micafungin, or anidulafungin)

Echinocandins are first-line for suspected candidemia because they cover fluconazole-resistant Candida species with excellent tolerability.

What is the primary mechanism by which endotoxin (lipopolysaccharide) triggers the systemic inflammatory response in gram-negative sepsis?

Answer: Activation of Toll-like receptor 4 (TLR4) on innate immune cells

LPS binds to TLR4 on macrophages and monocytes, triggering a massive pro-inflammatory cytokine cascade that drives septic shock.