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IPT: ID > Block 3 > Flashcards

Block 3 Flashcards

1
Q

Difference between uncomplicated and complicated IAI?

A

Uncomplicated is contained in a single organ w/o anatomical disruptions

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2
Q

Primary
Secondary
Tertiary…peritonitis

Which one is polymicrobial?

A

Secondary

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3
Q

Primary
Secondary
Tertiary…peritonitis

Which one is associated w/ low virulence organisms in critically ill or immunocompromised patients?

A

Tertiary

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4
Q

Primary
Secondary
Tertiary…peritonitis

Which one infects peritoneal cavity w/o evident source in the abdomen?

A

Primary

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5
Q

Primary
Secondary
Tertiary…peritonitis

Which one spreads to another organ resulting in focal disease in the abdomen?

A

Secondary

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6
Q

Primary
Secondary
Tertiary…peritonitis

Which one is persistent/recurrent for at least 48hrs after proper management?

A

Tertiary

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7
Q

Primary
Secondary
Tertiary…peritonitis

Which one is monomicrobial?

A

Primary

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8
Q

Primary
Secondary
Tertiary…peritonitis

Which one consists of spontaneous bacterial peritonitis?

A

Primary

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9
Q

Primary vs Secondary Peritonitis

Which one accounts for 80-90% of IAI?

A

Secondary

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10
Q

Primary vs Secondary Peritonitis

Which one occurs in 10-30% alcoholic cirrhotic pt?

A

Primary

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11
Q

Primary vs Secondary Peritonitis

Which one occurs in peritoneal dialysis pt?

A

Primary, average 1 episode

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12
Q

What are the primary etiologies of IAI?

A

Peritoneal dialysis

Cirrhosis w/ ascites

Nephrotic syndrome

CNS shunt

Everything else is secondary

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13
Q

How does bacteria enter the body for primary peritonitis?

A

Blood stream or lymphatic system

Indwelling peritoneal dialysis catheter

Fallopian tubes

Everything else is secondary

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14
Q

Where are the microflora concentrated in the GI tract?

A

Distal ileum and colon

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15
Q

What are the most common bugs for IAI?

A

E. coli (#1)
Strep spp
Bacteroides

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16
Q

Primary vs Secondary peritonitis

Which one has mildly elevated WBC?

A

Primary

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17
Q

Primary vs Secondary peritonitis

Which one has decreased UOP?

A

Secondary

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18
Q

Primary vs Secondary peritonitis

Which one has has normal body temp initially then increases?

A

Secondary

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19
Q

Primary vs Secondary peritonitis

Which one has has cloudy dialysate fluid?

A

Primary

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20
Q

Primary vs Secondary peritonitis

Which one causes loss of appetite and abdominal tenderness

A

Primary

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21
Q

Primary vs Secondary peritonitis

Which one has hypotension?

A

Secondary

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22
Q

Primary vs Secondary peritonitis

Which one has abdominal pain and tachycardia?

A

Secondary

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23
Q

Primary peritonitis diagnosis fluid workup?

A

> 250 PMN/mm3 (ascitic)

> 100 WBC count in peritoneal dialysis

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24
Q

Cirrhotic ascites-SBP Tx?

A

Cefotaxime or ceftriaxone x 5 days

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25
Q

Prophylaxis for cirrhotic ascites-SBP?

A

Cipro or Bactrim

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26
Q

Peritoneal dialysis Tx?

A

Vanco + 3rd gen ceph or amino via intraperitoneal route

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27
Q

Low risk CA-IAI Tx?

A

Cefotaxime or ceftriaxone + Flagyl

Ertapenem

Moxi or Cipro + Flagyl

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28
Q

High risk CA-IAI Tx?

A

Zosyn

Cefepime or Ceftazidime + Flagyl

Dori or imipenem or merrem

Aztreonam + Vanco + Flagyl

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29
Q

Bugs to cover in HA-IAI?

A

E. faecalis, E. faecium, VR Enterococcus spp

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30
Q

What Rx cover E. faecalis HA-IAI?

A

Zosyn, imi+cilastin, addition of amp or vanco

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31
Q

What Rx cover E. faecium HA-IAI?

A

Vanco

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32
Q

What Rx cover VR enterococcus HA-IAI?

A

Dapto or Zyvox

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33
Q

What are the antifungal Tx options for IAI?

A

Candida? -fungin rx for critical pt and fluconazole for less critically ill pt

Non Candida? -fungin only

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34
Q

What is considered Tx failure for IAI?

A

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

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35
Q

Tx duration for IAI?

A

Bad source control = 5-7 days

Good source control = 4 days

Anything to do with bowel operations = 24 hrs

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36
Q

What are some PO options for IAI?

A

Augmentin, moxi, or cipro + flagyl

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37
Q

What should i know for biliary infections, hepatic abscess, pancreatitis, and diverticulitis?

A

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; ??

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38
Q

What is a C. diff infection?

A

≥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

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39
Q

What is healthcare facility-onset CDI?

A

CDI, but lab identified ≥3 days after admission to facility

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40
Q

What is community-onset, healthcare faicility-associated CDI?

A

CDI that occurs within 28 days after discharge

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41
Q

What is community associated CDI?

A

Symptoms onset within 48hrs of admission to hospital or more than 12 weeks after discharge

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42
Q

C. diff organism info?

A

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

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43
Q

Which Rx class contribute to CDI?

A

Abx and PPI

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44
Q

Which Abx are very commonly associated with CDI?

A 
Clinda
Amp
Amox
Ceph
FQ
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45
Q

GDH
EIA
NAAT

Which one is just used as a screen and must be confirmed?

46
Q

GDH
EIA
NAAT

Which one cost the most?

47
Q

GDH
EIA
NAAT

Which one cost the least?

48
Q

GDH
EIA
NAAT

Which one is used alone in acute diseae?

49
Q

GDH
EIA
NAAT

Which one has false positives?

A

NAAT due to high sensitivity and specificity. Use EIA as a backup

50
Q

GDH
EIA
NAAT

Which one has high sensitivity, but low specificity?

A

GDH, EIA is the other way around

51
Q

GDH
EIA
NAAT

Which one measures C. diff nucleic acid?

52
Q

GDH
EIA
NAAT

Which one measures C. diff common antigen?

53
Q

GDH
EIA
NAAT

Which one measures free toxins?

54
Q

Can you get stool samples for C. diff on someone who takes laxatives?

55
Q

Classification of CDI

  • Initial episode, non severe
  • Initial episode, severe
  • Initial episode, fulminant
  • First recurrence
  • Second/subsequent recurrence

Hypotension

56
Q

Classification of CDI

  • Initial episode, non severe
  • Initial episode, severe
  • Initial episode, fulminant
  • First recurrence
  • Second/subsequent recurrence

WBC ≤15k AND SCr <1.5

A

Non-severe

57
Q

Classification of CDI

  • Initial episode, non severe
  • Initial episode, severe
  • Initial episode, fulminant
  • First recurrence
  • Second/subsequent recurrence

Shock

58
Q

Classification of CDI

  • Initial episode, non severe
  • Initial episode, severe
  • Initial episode, fulminant
  • First recurrence
  • Second/subsequent recurrence

WBC ≥15k OR SCr>1.5

59
Q

Classification of CDI

  • Initial episode, non severe
  • Initial episode, severe
  • Initial episode, fulminant
  • First recurrence
  • Second/subsequent recurrence

Reappearance of Sx and positive asay within 2-8wks after tx stopped

A

First recurrence

60
Q

Classification of CDI

  • Initial episode, non severe
  • Initial episode, severe
  • Initial episode, fulminant
  • First recurrence
  • Second/subsequent recurrence

Ileus or toxic megacolon

61
Q

CDI Non severe Tx?

A

Vanc 125 PO QID
Fidax 200 PO BID
Flagyl 500 PO TID

x10 days

62
Q

CDI Severe Tx?

A

Vanc 125 PO QID
Fidaxomicin 200 BID

x10 days

63
Q

CDI Fulminant Tx?

A

Vanc 500 PO or nasogastric QID

Ileus? Do 500mg Vanco in 100mL NS q6h

Present illeus, add flagyl 500mg IV q8h w/ oral or rectal vanc

64
Q

CDI first recurrence Tx?

A

If flagyl was used, use vanco 125 PO QID

If vanc was used, use fidaxomicin 200 BID

x10days

65
Q

CDI second or subsequent recurrence Tx?

A

Vanc 125 PO QID x 10days + Rifaximin 400 TID x20 days

Fidaxo 200 PO x 10 days

Fecal micro transplantation

66
Q

Does flagyl require renal dose adjustments?

67
Q

Oral vanco is only used for what?

A

CDI tx alone, poor oral absorption but concentrates well in the stool

68
Q

Fidaxomicin MOA and age limit?

A

Inhibits RNA polymerase sigma subunit

Must be 18+

69
Q

Bezlotoxumab info?

A

Human monoclonal that binds to toxin B

For 18+

For high risk of CDI recurrence, used in conjunction w/ ABx for CDI

Not indicated to treat CDI

70
Q

Should you use antiperistaltic agents for CDI?

71
Q

Who is at highest risk for acute infectious diarrhea globally and in the US?

A

Globally = younger children <5yo

US = elderly

72
Q

Diarrhea vs dysentery definition

A

Diarrhea = loose or watery stool

Dysentery = intestinal inflammation that leads to diarrhea w/ mucus or blood in feces

73
Q

Water vs Dysentery

Number per day

A

Water <10

Dysentery >10

74
Q

Water vs Dysentery

Occult blood and fecal PMNs

A 
Water
Occult blood (-)
Fecal PMNs (Absent, few)
Dysentery
Occult blood (+)
Fecal PMNs (Many)
75
Q

Bugs found in watery diarrhea?

A

Vibrio cholerae
Enterotoxigenic E. coli
Rotavirus
Norovirus

76
Q

Bugs found in dysentery?

A

Shigella
Salmonella
EnteroHEMORRHAGIC E. coli
C. diff

77
Q

Water vs Dysentery

Which one allows use of Abx?

A

Dysentery except if it EnteroHEMORRHAGIC E. coli (due to HUS)

78
Q

Vibrio cholerae
Enterotoxigenic E. coli
Rotavirus
Norovirus

Infects children <5yo

79
Q

Vibrio cholerae
Enterotoxigenic E. coli
Rotavirus
Norovirus

Not really common in US

80
Q

Vibrio cholerae
Enterotoxigenic E. coli
Rotavirus
Norovirus

Common cause of food and water associated outbreaks?

A

Enterotoxigenic E. coli

81
Q

Vibrio cholerae
Enterotoxigenic E. coli
Rotavirus
Norovirus

Accounts for >90% of viral gastroenteritis amongst all age groups

82
Q

Norovirus vs Rotavirus

Peak time?

A

Noro = winter

Rota = Oct - April

83
Q

Norovirus vs Rotavirus Common Sx?

A

Noro = ab pain, myalgia

Rota = fever, ab pain, lactose intolerance

84
Q

What bug causes most foodborne illnesses?

A

Enterohemorrhagic E. coli

85
Q

What bug causes the most nonviral gastroenteritis?

A

S. sonnei and S. flexneri

86
Q

Which bug for watery diarrhea actually damages the epithelial lining?

A

Rotavirus, the other 3 just cause lots of water secretion

87
Q

What is hemolytic-uremic syndrome?

A

A complication of EnteroHEMORRHAGIC E. coli

Triad of conditions:
Acute renal failure
Thrombocytopenia
Hemolytic anemia

88
Q

What is Reiter syndrome?

A

Result of a shigella infection

Joint pain, eye irritation, painful urination, maybe arthritis

89
Q

DOC for pregnant women + water diarrhea?

A

Azithromycin

90
Q

Common bugs that cause foodborne illnesses?

A

CCENNSS

Campylobacter
Clostridium
E. coli
Norovirus
Nontyphoidal salmonella
Shigella
Staph
91
Q

Ancillary mgmt + diarrhea?

A

Anti-motility agents; give at 18+, only when adequately hyrdated, avoid in toxin producing bacteria (shigella or EHEC) or bloody diarrhea or fever

Anti-emetics; given in ORS 4+yo

Can give probiotics and oral zinc

92
Q

Vibrio cholerae
Enterotoxigenic E. coli
Rotavirus
Norovirus

Supportive care is used when?

A

All of them

93
Q

Vibrio cholerae
Enterotoxigenic E. coli
Rotavirus
Norovirus

Abx is used when?

A

Only in vibrio (doxy) or enterotoxigenic (cipro)

94
Q

Shigella
Salmonella
EnteroHEMORRHAGIC E. coli

Supportive care is used when?

A

All of them

95
Q

Shigella
Salmonella
EnteroHEMORRHAGIC E. coli

Abx is used when?

A

Only salmonella and shigella (cipro for both)

96
Q

What is used to Tx C. botulinum?

A

Respiratory support + botulinum antitoxin

97
Q

Clean
Clean-contaminated
Contaminated
Dirty

Doesnt need Abx

98
Q

Clean
Clean-contaminated
Contaminated
Dirty

Therapeutic Abx indicated

99
Q

Clean
Clean-contaminated
Contaminated
Dirty

Open, fresh, accidental wounds

A

Contaminated

100
Q

Clean
Clean-contaminated
Contaminated
Dirty

Operative wounds in controlled conditions

A

Clean-contaminated

101
Q

Clean
Clean-contaminated
Contaminated
Dirty

Perforated viscera or clinical infection

102
Q

Clean
Clean-contaminated
Contaminated
Dirty

Major break in sterile technique

A

Contaminated

103
Q

Clean
Clean-contaminated
Contaminated
Dirty

Gross spillage from GI tract

A

Contaminated

104
Q

Clean
Clean-contaminated
Contaminated
Dirty

Nonpurulent inflammation is is encountered

A

Contaminated

105
Q

Top bugs in surgery?

A

S. aureus + CoNS

106
Q

Greatest risk of contamination in surgery?

A

Incision -> closure

107
Q

Which surgical procedures require anaerobic coverage?

A

Appendicitis, small intestines, colorectal, urologic, or hand and neck

Therefore dont choose Ancef

108
Q

Cefazolin dosing + surgery?

A

2g

3g if ≥120kg

109
Q

Gent dosing + surgery?

A

5mg/kg as a single dose

110
Q

When should Abx be given for surgery?

A

1 hr before incision

2 for vanco + FQs

111
Q

When should Abx be redosed during surgery?

A

If procedure exceeds two half-lives of Abx

or

Blood loss ≥1500mL

112
Q

If bowel prep is used, what PO Abx can be given?

A

MEN

Metro
Erytho
Neo

Prophylaxis Abx will still be given like IV cefazolin or metro

IPT: ID (11 decks)

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