127 Intraabdominal Infection Flashcards
Chapter 127. Intrabdominal infections and Abscesses
Occurs most commonly in conjunction with cirrhosis
SBP or primary bacterial peritonitis
Diagnostic of SBP
Ascitic fluid finding of more than 250 PMN/uL
Most encounter organism in SBP
E. Coli, Enteric gram negative bacilli
Reasonable antibiotic coverage for SBP while awaiting for culture results
3rd generation cephalosporins: cefotaxime 2 grams q8hrs, Ceftriaxone
divides the upper and lower peritoneal cavities
transverse mesocolon
anterior retroperitoneal organs
pancreas, duodenum, ascending and descending colon
posterior retroperitoneal organs
kidneys, ureters, adrenals
occurs most commonly in conjunction with cirrhosis of the liver (frequently the result of alcoholism)
primary bacterial peritonitis (PBP)
Diagnostic for Primary bacterial peritonitis
WBC more than 250 /hpf
most commonly encountered organism in PBP
E. Coli
antibiotics of PBP
cefotaxime 2 grams IV q8hrs, piperacillin tazobactam 4.5 grams IV q6hrs, ceftriaxone 2 grams IV q24hrs
patients who may benefit from albumin infusion
Creatinine more than 1 mg/dl, BUN more than 30 mg/dl, T. Bilirubin more than 4 mg/dl
how is albumin infusion done in patient with PBP
1.5 grams/KBW within 6 hours of detection then 1.0 grams/ KBW on day 3
True or false. PBP has a high rate of recurrence of up 70% within 1 year
True.
Secondary prevention of PBP
ciprofloxacin 750 mg weekly, norfloxacin 400 mg daily, TMP SMX 800/160 mg daily
when does secondary peritonitis develop
when bacteria contaminate the peritoneum as a result of spillage from an intraabdominal viscus
antibiotics of choice in secondary bacterial peritonitis
piperacillin tazobactam 4.5 grams IV q4-6 hrs, ceftriaxone 2 grams IV q24hrs + metronidazle 500 mg IV q8hrs, ICU: imipenem 500 mg IV q6hrs; meropenem 1 gram IV q8hrs
common organism in continuous ambulatory peritoneal dialsysis associated peritonitis
skin organism; staph aureus
most common reason for discontinuation of continuous ambulatory peritoneal dialysis
peritonitis
antibiotic for CAPD Peritonitis and duration
MSSA: cefazolin, ceftazidime, flouroquinoline; MRSA: vancomycin + ceftazidime/cefepime/carbapenem; no exit/tunnel infection: 14 days; with exit/tunnel infection: 21 days
infection in which viable infecting organism and PMN are contained in a fibrous capsule
abscess
most prominent organism in abscess but only accounts for 0.5% of the normal flora
B. fragilis
True or false. all intraabdominal abscess, 74% are intraperitoneal or retroperitoneal and not visceral
True.
cause of intraperitoneal abscess
fecal spillage from a colonic source such as inflammed appendix
True or false. Diverticular abscess are least likely to rupture
True.
imaging modality with the highest yield for intraperitoneal abscess
abdominal CT scan
imaging add on which can localized abscesses and useful in finding a collection
indium labeled WBC
management of intraperitoneal abscess
antibiotics + percutaneous drainage
organ most subject to abscess
liver
most common presenting sign of liver abscess
fever
mainstay therapy for intraabdominal abscesses
drainage
treatment of candidal liver abscess
amphotericin B or liposomal amphotericin B with subsequent fluconazole therapy OR if susceptible, fluconazole 6 mg/kg/ day
most common associated infection in splenic abscess
bacterial endocarditis
most common bacterila isolates of splenic abscess
streptococcus
standard treatment of splenic abscess
splenectomy with adjunctive antibiotics
patient undergoing splenectomy should be vaccinated against what?
agains encapsulated bacteria such as Step pneumoniae, H. influenzae, N. Meningitidis
True or false. Most renal or perinephritic abscess are from hematogenous spread
true.
commonly recovered organism in renal abscess
E. Coli, Proteus, Klebsiella
True or false. 75% of perinephric and renal abscesses arise from a urinary tract infection
True.
important risk factor in perinephric abscess
concomitant nephrolithiasis
treatment for renal or perinephric abscess
drainage and antibiotics
how do psoas abscess arise
arise from hematogenous source , by continguous spread from an intraabdominal or pelvic process or by contiguous spread from nearby body structures
When to suspect abscess in patients undergoing peritoneal dialysis
if peritoneal fluid culture is polymicrobial. Then do an abdominal CT scan.
