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BCIDP > Abdominal infections > Flashcards

Abdominal infections Flashcards

1
Q

What organisms should be considered in health-care associated IAI?

A

Candida, Enterococcus, and MRSA

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2
Q

What risk factors are there for healthcare association IAI?

A 
Invasive device
History of MRSA or colonization
history of surgery
Hospitalization
Dialysis
Residence in long term care facility in last year
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3
Q

What risk factors there are for community acquired IAI with high severity?

A

Age > 70
Immunosuppression
Malignancy
Liver/Renal Disease

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4
Q

Which anatomical area for IAI should anaerobic coverage be included in?

A

Distal ileum/colon - Bacteroides fragilis, Clostridium spp., Enterobacter spp, E. coli, Klebsiella spp., Peptostreptococcus spp.

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5
Q

How would you treat mild-mod or high risk (also healthcare associated) IAI?

A

Mild-Moderate: Cefoxitin, ertapenem, moxifloxacin, tigecycline OR 1st/2nd/3rd gen cephalosporin, cipro/levo + metronidazole

High risk/Healthcare associated: Carbapenem or P/T or anti-pseudomonal cephalosporin or cipro/levo + metronidazole

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6
Q

When should anti-enterococcal therapy be added in HA IAI?

A

Post-op infection,
Previous use of of cephalosporin (select for enterococcus)
Valvular Heart Dx

*VRE in liver transplant or VRE colonization

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7
Q

How should pancreatitis be treated?

A

Per American College of Gastroenterology,

Aggressive hydration (250-500 mL/hr) first 12-24 hr, LR preferred

Only use antibiotic in EXTRApancreatic infection (e.g. cholangitis, bloodstream infection) or infected necrotic pancreatitis

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8
Q

What is the preferred treatment for SBP per AASLD?

A

Community acquired: Cefotaxime 2 g IV Q8H or CTX 1 g IV BID; PCN allergy: Levofloxacin 500 mg QD

HA: P/T 3.375 g IV Q6H + Vancomycin

Duration: 5 days

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9
Q

When should enterococcal coverage be added for acute cholangitis?

A

Hepatic disease or severely immunocompromised

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10
Q

What are the treatment regimens for H. pylori?

A

FDA approved: PPI + Clarithromycin + Amoxicillin (or metronidazole in PCN allergic) x 14 days

Non-FDA approved: PPI + bismuth subsalicylate + tetracycline + metronidazole x 10-14 days

Alternate: Levo + PPI + amox

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11
Q

What is the treatment regimen for Campylobacter?

A

Preferred: Azithromycin

Ciprofloxacin

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12
Q

What is the treatment regimen for Nontyphoidal Salmonella enterica?

A

Treatment not necessary

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13
Q

What is the treatment regimen for Salmonella enterica, Typhi or Paratyphi?

A

CTX

Cipro

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14
Q

What is the treatment regimen for Shigella?

A

Azithromycin
Ciprofloxacin
CTX

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15
Q

What is the treatment for Vibrio cholerae?

A

Doxycycline

Ciprofloxacin

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16
Q

What is the treatment for Non-Vibrio cholera?

A

Non-invasive: no treatment

Invasive disease: CTX + doxycycline

17
Q

What is the treatment regimen for Yersinia enterocolitica?

A

TMP/SMX

18
Q

What are the antiparasitic therapy for Cryptosporidium?

A

Nitazoxanide

19
Q

What are the anti-parasitic therapy for cyclospora?

A

TMP-SMX

20
Q

What is the anti-parasitic therapy for giardia?

A

Tinidazole or nitaxoxanide

21
Q

What is the anti-parasitic therapy for cystoisospora?

A

TMP-SMX

22
Q

What is the anti-parasitic therapy for Trichinella?

A

Albendazole

23
Q

How is initial episodie, non-severe Cdiff definited? How is it treated?

A

WBC < 15K, SCr < 1.5 mg/dL

Vanc 125 mg PO QID x 10 days
FDX 200 mg PO BID x 10 days

Only use metronidazole 500 mg TID x 10 days if no alternative agents

24
Q

How is initial episode, severe Cdiff defined? How is it treated?

A

Vanco 125 mg QID x 10 days

FDX 200 mg PO BID x 10 days

25
Q

How is initial episode, fulminant defined? How is it treated?

A

Hypotension or shock, ileus, megacolon

Vancomycin 500 mg PO QID
If ileus, consider rectal instillation of vancomycin.
*Add metronidazole 500 mg IV TID for ileus

26
Q

How do you treat first recurrence of Cdiff?

A

Vancomycin 125 mg PO QID if metronidazole was used first time

Prolonged tapered and pulsed vancomycin if vancomycin 125 mg PO QID was used initially

FDX 200 mg PO BID if vancomycin was used initially

27
Q

How do you treat second or subsequent recurrences for Cdiff?

A

Vanc in a tapered/pulsed

Vancomycin 125 mg PO QID + rifaximin 400 mg TID x 10 days

FDX 200 mg PO BID

FMT

28
Q

What is the minimal period that repeat testing of Cdiff should be avoided?

A

7 days during the same episode of diarrhea

BCIDP (13 decks)

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