E4 IAI Flashcards
IAI definitions:
Uncomplicated (2)
- confined within visceral structure
- does NOT extend into peritoneum
IAI definitions:
complicated (1)
- extends beyond a single organ INTO the peritoneal space and associated with peritonitis
IAI definitions:
Community-acquired infection (2)
- within 48 hours of hospital admission
- caused by normal intra-abdominal flora
IAI definitions:
Healthcare-associated infection (2)
- 48 hours of hospital admission
- healthcare exposure in last 12 months (hospitalization/recent surgery
most common source of bacterial contamination for SBP
no obvious source
patients at highest risk for SBP (2)
- hepatic failure and ascites - alcoholic cirrhosis*
- continuous ambulatory peritoneal dialysis (CAPD)
T or F:
SBP is most commonly polymicrobial
false, mono
4 common bacteria for SBP and most common one
- e coli *
- streptococci
- enterococci
- s aureus (more common with CAPD)
1 main clinical presentation of SBP
ab pain
diagnosis of SBP
- s/sxs of infxn
- low ascitic fluid protein (<2.5)
- absolute neutrophil count > 250 **
4 tx options for empiric tx of SBP + most common one
- ceftriaxone **
- Cefepime
- Piper/tazo
- Meropenem
tx of SBP with MRSA risk (3 kinda)
- same as empiric but ADD one of the following:
- vanc
- linezolid
- dapto
Tx for anaerobic coverage in SBP (3)
- b-lactam/b-lactam inhibitor
- carbapenem
- add metro
when do you transition to oral therapy in SBP?
once clinical stability is achieved
SBP duration in pts with cirrhosis and ascites
5-7 days
Secondary prophylaxis is recc in pts with SBP + cirrhosis and ascites. what are the two drug options for this?
- bactrim
- cipro
duration of tx for pt w/ peritonitis undergoing CAPD
14-21 days bc prosthetic material is involved
Secondary peritonitis
A. Monomicrobial
B. Polymicrobial
B
what kind of bacteria did he say play a key role in secondary peritonitis
anaerobic
what is the most common anaerobic bacteria in secondary peritonitis
bacteroides spp (B. fragilis most common)
most common aerobic GN bacteria in secondary peritonitis
E coli, can also be kleb, entero, or proteus
most common aerobic GP bacteria in secondary peritonitis
strep spp (usually viridans), can also be enterococcus
only fungi species he talks about in secondary peritonitis
candida
what is the main thing he said that makes IAI’s unique
multiple organ systems are affected
Bacterial synergy in IAI:
________ create optimal environment for anaerobic bacteria. ________ cause abscess formation and have several virulence factors
enterobacterales (e.g. E. coli)
anaerobes
im ignoring clin pres
smart man
2 imaging things we use for diagnosis in IAI
CT scan + Xray
4 examples of source control procedures for IAI’s
- repair perforation
- resection of infected organs
- removal of foreign material
- drain purulent collections
when are agents generally not recc in tx for IAI’s
resistance rates exceed 10-20%
(must look at antibiogram)
3 general considerations for empiric selection in IAI’s
- high likelihood to cover common organisms
- consider if enterococci coverage is necessary
- consider if antifungal coverage is necessary
6 times enterococci coverage is considered necessary in empiric selection for IAI
- high severity
- hx of recent cephalosporin use
- immunocompromised
- biliary source of infection
- hx of valvular heart disease
- prosthetic intravascular material
when is enterococci coverage not necessary in IAI
mild/mod community-acquired IAI*
CA-IAI mild/mod empiric regimen options (5)
- ceftriaxone +metro
- cefazolin+ metro
- cefoxitin
- ertapenem
- tigecycline
what drug did he specifically say is not recc empirically for IAI and why
amp/sulb»_space; e coli resistance
CA-IAI, high severity AND HA empiric options (3)
- piper/tazo
- meropenem
- cefepime + metro
1 tx option for IAI caused by candida
fluconazole
1 tx option for candida species other than albicans in IAI
micafungin tf lol
“really important note about anaerobic bacteria”
common to maintain anaerobic coverage even if culture does not isolate it
3 common oral AB regimens for IAI
- amox/clav (q8h*/12h)
- cefpodoxime +metro
- cephalexin +metro
4 common oral IAI regimens that say “if possible, confirm susceptibility”
- cefadroxil + metro
- cipro + metro
- levo + metro
- bactrim + metro
general oral tx duration for IAI
4-7 days after source control
