bomkamp Flashcards
types of intra-abdominal infections
intraperitoneal
retroperitoneal
types of peritonitis
primary peritonitis
secondary peritonitis
what is primary peritonitis
spontaneous bacterial peritonitis
sometimes also due to peritoneal dialysis
what is secondary peritonitis
due to another cause
- diverticulitis
- appendicitis
- abscess
what is an uncomplicated infection for peritonitis
confined in one organ and not extending past peritoneum
what is a complicated infection for peritonitis
extending to multiple organs and into peritoneal space
which patients are at highest risk for spontaneous bacterial peritonitis and why
hepatic failure and ascites
alcoholic cirrhosis
- kinda immunocompromised bc liver not functioning and body not making proteins
most common pathogen spontaneous bacterial peritonitis (primary)
e. coli
is spontaneous bacterial peritonitis monomicrobial or polymicrobial
monomicrobial
symptoms of spontaneous bacterial peritontis
abdominal pain
N/V/D
fevers/chills
reduced bowels
diagnosis of SBP
ANC > 250
how to calculate ANC
TNC body fluid x band/neutrophils (%)
treatments for SBP
ceftriaxone primarily
could add MRSA coverage:
vanc
dapto
linezolid
could add anaerobic coverage:
beta lactam/beta lactamase inhib
carbapenem
add metronidazole
treatment duration in SBP
5-7 days
most common pathogens for secondary peritonitis
e. coli
bacteoides
enterobacter
enterococcus
which pathogens not common in secondary peritonitis
pseudomonas
staph
is secondary peritonitis monomicrobial or polymicrobial
polymicrobial
presentation of secondary peritonitis
abdom pain
fever/chills
cant poop
tachypnea
hypotension
diagnosis of secondary peritonitis
imaging + symptoms
(CT scan or XRay)
pillars of treatments for intraabdominal infections
source control
antimicrobial therapy
how do we select empiric therapy for secondary peritonitis
look at antibiogram
if severe, recent cephalo use, immunocomp then get enterococci covered
antifungal if on culture
if candida albicans found what do we use
fluconazole
mild to moderate treatment of secondary peritonitis
ceftriaxone
cefazolin
+ metro
moderate to severe treatment of secondary peritonitis
pip/tazo
meropenem
cefepime
which agent not recommended empirically in secondary peritonitis
amp/sulbactam
length of treatment for secondary peritonitis
4-7 days
5-10 days if diverticulitis
24 hours if surgery
oral antibiotic options for secondary peritonitis
amox/clav q8-12h hr
how is c diff transmitted
person to person via fecal oral route
which strains of c. diff are associated with higher severity of infection
BI
NAP1
027
which antibiotics associated with highest risk of c. diff infections
fluroquinolones
clindamycin
ceftriaxone
carbapenems
symptoms of c. diff infection
profuse watery foul smelling diarrhea
abdominal pain
when do we test for c. diff
3+ profuse watery green foul smelling stools in 24 h
imgaing finding leading us to believe C. diff
evidence of colitis
testing methods for c. diff
NAAT testing
antigen test (GDH) + toxin A/B
NAAT + toxin A/B test
if toxin test is negative what might that mean
has c. diff but not colonized/ infection
is repeat testing recommended in c. diff
no repeat testing within 7 days
can we use loperamide in c. diff
no dont use
classifications of c. diff
non severe
WBC < 15 K
SCr < 1.5
severe
WBC > 15 k
SCr > 1.5
fulminant
hypotension or shock
ileus
toxic megacolon
treatment options for c. diff
oral vancomycin
fidaxomicin
metronidazole (IV or PO)
considerations of oral vancomycin
its cheap
kills everything
considerations of fidaxomicin
expensive
sustained response and lower recurrence rates
kills weeds only
when do we use metronidazole
only in fulminant in combo with another agent
treatment examples
fidaxomicin first
then vanc
key is to just keep switching up and can do tapered vanc or fidax
risk factors for c. diff reurrence
65+
severe infection
immunocompromised
what is Rebyota
fecal microbiota suspension administered via rectal tubule
given following antibiotic therapy
(rolling out new grass)
what is Vowst
bacterial spore suspension
given after completion of antibiotic treatment
oral option but expens
(planting new seeeds)
what is bezlotuxumab
MAB targeting c. diff toxin to neutralize its effect
given during course of CDI treatment
(reduces weed damage)
