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PDAT6 ID > 30 - Intra-abdominal Infections > Flashcards

30 - Intra-abdominal Infections Flashcards

1
Q

What SITES have ANAEROBES?
Bacteriodes / Clostridium / Peptostreptococcus

Intra-Abdominal Infections

A

Anaerobes
Bacteriodes / Clostridium / Peptostreptococcus

Proximal + Distal Small Intestine

COLON

no anaerobes in BILIARY TRACT or STOMACH

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2
Q

What BACTERIA is found in the STOMACH?

A

+STREPTOCOCCUS+
covered by most gram + antibiotics
+
+ LACTOBACILLUS +

Gastric Acid = barrier to infection

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3
Q

What BACTERIA is found in the BILIARY TRACT?

A
  • *Typically STERILE**
  • *Enterics_ (E.Coli + Kleb) + _Enterococcus**
  • NO ANAEROBES*
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4
Q

What BACTERIA is found in the:
COLON?

A

-ENTERICS-
E.Coli + Kleb

Peptostreptococcus** + **Clostridium
ANAEROBES

Candida
Fungi

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5
Q

What Bacteria are considered:
GI ANAEROBES?
+
ABX TREATMENT

A

Bacteroides - Clostridium - PeptoStreptococcus

Treated with:

  • *Carbapenems** - Metronidazole
  • *PIP/TAZO**
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6
Q

Treatment for:
ENTEROBACTERIACEAE
E. Coli + Kleb

A

CEFTRIAXONE** or **CEFEPIME

PIP-TAZO

no fluoroquinolones or Ampicillin / sulbactam
RESISTANCE

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7
Q

Treatment for:
PSEUDOMONAS

A

Psuedomonas = Gram Negative –> common in HOSPITAL

Cefepime

PIP/TAZO

  • *CARBAPENEMS**
  • EXCEPT ERTAPENEM*, usually reserved for ESBL
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8
Q

Treatment for:

+Enterococcus Facium+

A

FAECIUM = most are VANC RESISTANT = VRE

LINEZLOLID** / **DAPOMYCIN

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9
Q

Treatment for:

+Enterococcus Faecalis+

A

Gram + Coverage for Enterococcus

Ampicillin** / **Ampicillin-Sulbactam

Imipenem

VANCOMYCIN

LINEZLOLID** / **DAPOMYCIN

PIP-TAZO

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10
Q

ETIOLOGY + BACTERIA

Spontaneous Bacterial Peritonitis = SBP

A

AKA - PRIMARY Peritonitis (no specific source)

Most Commonly in patients with:
LIVER FAILURE + PPI Use

Typically MONOMicrobial:

  • *Streptococcus_ + _Enterics**
  • no anaerobes, may even be culture NEGative*
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11
Q

Presentation / Diagnosis

Spontaneous Bacterial Peritonitis = SBP

A
  • *PARACENTESIS**
  • *ascitic fluid: PMN>250** cells/mm3

Protein < 1g/dl
suggests primary peritonitis (SBP)

Symptoms:
Fever / ab distention,pain / altered mental status (ECP)
NV / Hypovolemic hypotention

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12
Q

Spontaneous Bacterial Peritonitis = SBP

TREATMENT

A
  • *Streptococcus** + Enterics (E.Coli + Kleb)
  • no anaerobes*

CEFTRIAXONE** or **Cefotaxime
for the ENTERICs, strep is covered by most
5 DAYS
should have improvement within 24-48 hours

PROPHYLAXIS
typically for MOST SBP (until no longer in LIVER FAILURE)
FQs or BACTRIM

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13
Q

ABSCESSES

Diagnosis / Etiology

A

Diagnosed via imaging:
CT** or **ULTRASOUND

Polymicrobial
similar pathogens to 2ndary Peritonitis (CIAI):
Enterics + Anaerobes
Pseudomonas - if HIGH-severity or Healthcare-associated

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14
Q

ABSCESSES

TREATMENT

A

SOURCE CONTROL
DRAIN via Percutaneous Catherer or Surgery
unable to FULLY DRAIN? –> duration could be WEEKS
based on the IMAGING

Treatment is the same as CIAI
CEFTRIAXONE or Cefotaxime​

Polymicrobial

  • *Enterics + Anaerobes**
  • *Pseudomonas - if HIGH-severity or Healthcare-associated**
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15
Q

Presentation / Diagnosis + RISK FACTORS

  • *CIAI**
  • *Complicated Itraabdominal Infection**
A

CIAI = Secondary Peritonitis
Paracentesis = Protein >1g/dL
Ab Symptoms / Infection Symptoms / Imaging

Risk Factors for CIAI
CRITICALLY ILL in ICU / Trauma Patients / Surgical Procedures

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16
Q

ORGANISMS

  • *CIAI**
  • *Complicated ItraAbdominal Infection = Secondary Peritonitis**
A

Often POLYmicrobial:

  • *ENTERICS**
  • *E. Coli + Kleb**
  • *GI ANAEROBES**
  • *Bacteroides / Clostridium / Peptostreptococcus**
  • PSEUDOMONAS*
  • *Mainly if HIGH-SEVERITY** or HEALTHCARE-ASSOCIATED
17
Q

TREATMENT

Community-Acquired MILD-MODERATE
CIAI
Complicated ItraAbdominal Infection = Secondary Peritonitis

A
  • *CEFOXITIN**
  • *Enteric + Anaerobic** Activity
  • Ertapenem* –> only for pt w/ ho ESBL

or

METRONIDAZOLE** + **CEFTRIAXONE** or **Cefotaxime

18
Q

TREATMENT

HEALTHCARE-ASSOCIATED
CIAI
Complicated ItraAbdominal Infection = Secondary Peritonitis

Invasive Device
H/O MRSA infxn/colonization
H/O Surgery/hospitilization / dialysis / long term care
Onset/culture > 48 hours after admission

A

Treatment is the SAME with High Risk / Severe CIAI

PIPERACILLIN / TAZOBACTAM
want to cover ALL
Enterics + Anaerobes + PSEUDOMONAS

Carbapenems –> reserved for ESBL

19
Q

TREATMENT

HIGH-RISK / SEVERE Community-Aquired
CIAI
Complicated ItraAbdominal Infection = Secondary Peritonitis

ICU PATIENT
Advanced Age / Comorbidities
Immunocomprimised / Malignancy
DELAY in initial intervention >24 hours

A

Treatment is the SAME with Healthcare-Associated CIAI

PIPERACILLIN / TAZOBACTAM
want to cover ALL
Enterics + Anaerobes + PSEUDOMONAS

Carbapenems –> reserved for ESBL

20
Q

TREATMENT

Community Acquired, Mild/Moderate
CHOLECYSTITIS
Infection/Inflammation of gallbladder

A
  • does NOT need anaerobic activity*
  • *Typically Sterile**
  • *Enterics_ + _Enterococcus**

CEFTRIAXONE

21
Q

TREATMENT

Healthcare-Associated or High Severity Community-Acquired
CHOLECYSTITIS
Infection/Inflammation of gallbladder

A

Enterics** + **Enterococcus
With additional coverage for:
ANAEROBES** + **PSEUDOMONAS

So treat with:
PIP/TAZO
or
CARBAPENEMS
except ERTAPENEM

ALSO:
SOURCE CONTROL –> REMOVE GALL BLADDER or ERCP

22
Q

TREATMENT

CHOLANGITIS + Biliary-Enteric Anastamosis
Infection/Inflammation of bile ducts

A

Enterics** + **Enterococcus
With additional coverage for:
ANAEROBES** + **PSEUDOMONAS

So treat with:
PIP/TAZO
or
CARBAPENEMS
except ERTAPENEM

ALSO:
SOURCE CONTROL –> REMOVE GALL BLADDER or ERCP

23
Q

Presentation / Diagnosis

Appendicitus

A

Accute Inflammation of Appendix related to obstruction

Presents with:
Deep Periumbical pain + Subsequent Right-lower quadrent pain
after 6-24 hours

Need to:
Rule out uterine/ectopic pregnancy
for child-bearing aged women

24
Q

Treatment / Bacteria

APPENDICITIS

A

Polymicrobial
Enterics + Anaerobes + Streptococci

ABx Choice is SAME as Community-Acquired CIAI

CEFOXITIN
Enterics + Anaerobic
OR
Ceftriaxone** + **Metronidazole

25
Q

When would we ADD:
EMPIRIC DAPTOMYCIN / LINEZOLID
to current:
CIAI Regimen?

A

+ Daptomycin or Linezolid +

Liver Transplant** w/ CIAI from **HepatoBiliary Tree

OR

known to be colonized with VRE
vancomycin resistant enterococcus

26
Q

When would we ADD:
EMPIRIC VANCOMYCIN
to current:
CIAI Regimen?

A

+ Vancomycin +

Healthcare-Associated CIAI** + **Colonized w/ MRSA

OR

Previously FAILED treatment** + **Significant ABX Exposure

27
Q

Treatment DURATION

for
Short-Corse Antimicrobial Therapy
Intrabdominal Infections

A

after SOURCE CONTROL:

(fix leak / aspirating abscess)

4 DAYS

PDAT6 ID (31 decks)

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