Block 3 Flashcards
Difference between uncomplicated and complicated IAI?
Uncomplicated is contained in a single organ w/o anatomical disruptions
Primary
Secondary
Tertiary…peritonitis
Which one is polymicrobial?
Secondary
Primary
Secondary
Tertiary…peritonitis
Which one is associated w/ low virulence organisms in critically ill or immunocompromised patients?
Tertiary
Primary
Secondary
Tertiary…peritonitis
Which one infects peritoneal cavity w/o evident source in the abdomen?
Primary
Primary
Secondary
Tertiary…peritonitis
Which one spreads to another organ resulting in focal disease in the abdomen?
Secondary
Primary
Secondary
Tertiary…peritonitis
Which one is persistent/recurrent for at least 48hrs after proper management?
Tertiary
Primary
Secondary
Tertiary…peritonitis
Which one is monomicrobial?
Primary
Primary
Secondary
Tertiary…peritonitis
Which one consists of spontaneous bacterial peritonitis?
Primary
Primary vs Secondary Peritonitis
Which one accounts for 80-90% of IAI?
Secondary
Primary vs Secondary Peritonitis
Which one occurs in 10-30% alcoholic cirrhotic pt?
Primary
Primary vs Secondary Peritonitis
Which one occurs in peritoneal dialysis pt?
Primary, average 1 episode
What are the primary etiologies of IAI?
Peritoneal dialysis
Cirrhosis w/ ascites
Nephrotic syndrome
CNS shunt
Everything else is secondary
How does bacteria enter the body for primary peritonitis?
Blood stream or lymphatic system
Indwelling peritoneal dialysis catheter
Fallopian tubes
Everything else is secondary
Where are the microflora concentrated in the GI tract?
Distal ileum and colon
What are the most common bugs for IAI?
E. coli (#1)
Strep spp
Bacteroides
Primary vs Secondary peritonitis
Which one has mildly elevated WBC?
Primary
Primary vs Secondary peritonitis
Which one has decreased UOP?
Secondary
Primary vs Secondary peritonitis
Which one has has normal body temp initially then increases?
Secondary
Primary vs Secondary peritonitis
Which one has has cloudy dialysate fluid?
Primary
Primary vs Secondary peritonitis
Which one causes loss of appetite and abdominal tenderness
Primary
Primary vs Secondary peritonitis
Which one has hypotension?
Secondary
Primary vs Secondary peritonitis
Which one has abdominal pain and tachycardia?
Secondary
Primary peritonitis diagnosis fluid workup?
> 250 PMN/mm3 (ascitic)
> 100 WBC count in peritoneal dialysis
Cirrhotic ascites-SBP Tx?
Cefotaxime or ceftriaxone x 5 days
Prophylaxis for cirrhotic ascites-SBP?
Cipro or Bactrim
Peritoneal dialysis Tx?
Vanco + 3rd gen ceph or amino via intraperitoneal route
Low risk CA-IAI Tx?
Cefotaxime or ceftriaxone + Flagyl
Ertapenem
Moxi or Cipro + Flagyl
High risk CA-IAI Tx?
Zosyn
Cefepime or Ceftazidime + Flagyl
Dori or imipenem or merrem
Aztreonam + Vanco + Flagyl
Bugs to cover in HA-IAI?
E. faecalis, E. faecium, VR Enterococcus spp
What Rx cover E. faecalis HA-IAI?
Zosyn, imi+cilastin, addition of amp or vanco
What Rx cover E. faecium HA-IAI?
Vanco
What Rx cover VR enterococcus HA-IAI?
Dapto or Zyvox
What are the antifungal Tx options for IAI?
Candida? -fungin rx for critical pt and fluconazole for less critically ill pt
Non Candida? -fungin only
What is considered Tx failure for IAI?
No clinical improvement in organ dysfunction 48 hr+ after source control
Progressive organ dysfunction within 1-2 days after source control
Persistent signs of inflammation 5-7 days after source control
Tx duration for IAI?
Bad source control = 5-7 days
Good source control = 4 days
Anything to do with bowel operations = 24 hrs
What are some PO options for IAI?
Augmentin, moxi, or cipro + flagyl
What should i know for biliary infections, hepatic abscess, pancreatitis, and diverticulitis?
Biliary infection; source control, use narrow therapy for CA mild-moderate severity
Hepatic abscess; B-lactams, 3/4th gen + flagyl or FQ+Flagyl
Pancreatitis; dont use unless you want to prevent resistance or decrease AE rxns
Diverticulitis; ??
What is a C. diff infection?
≥3 unformed stools in 24hrs with either
a positive c. diff toxin in stool test or detection of toxigenic c. diff
or
colonoscopic or histopathologic findings of pseudomembranous colitis
What is healthcare facility-onset CDI?
CDI, but lab identified ≥3 days after admission to facility
What is community-onset, healthcare faicility-associated CDI?
CDI that occurs within 28 days after discharge
What is community associated CDI?
Symptoms onset within 48hrs of admission to hospital or more than 12 weeks after discharge
C. diff organism info?
Exist in spore (resistant to heat, acid and Abx) and vegetative (active, toxin producing) form
Produces two exotoxins: A+B
A=inflammation leading to interstitial fluid secretions and mucosal injury
B=10x more potent than A
Spread by fecal-oral route
Which Rx class contribute to CDI?
Abx and PPI
Which Abx are very commonly associated with CDI?
Clinda Amp Amox Ceph FQ