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PHRM 865 > E4 IAI > Flashcards

E4 IAI Flashcards

1
Q

IAI definitions:
Uncomplicated (2)

A
  • confined within visceral structure
  • does NOT extend into peritoneum
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2
Q

IAI definitions:
complicated (1)

A
  • extends beyond a single organ INTO the peritoneal space and associated with peritonitis
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3
Q

IAI definitions:
Community-acquired infection (2)

A
  • within 48 hours of hospital admission
  • caused by normal intra-abdominal flora
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4
Q

IAI definitions:
Healthcare-associated infection (2)

A
  • 48 hours of hospital admission
  • healthcare exposure in last 12 months (hospitalization/recent surgery
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5
Q

most common source of bacterial contamination for SBP

A

no obvious source

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6
Q

patients at highest risk for SBP (2)

A
  • hepatic failure and ascites - alcoholic cirrhosis*
  • continuous ambulatory peritoneal dialysis (CAPD)
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7
Q

T or F:
SBP is most commonly polymicrobial

A

false, mono

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8
Q

4 common bacteria for SBP and most common one

A
  • e coli *
  • streptococci
  • enterococci
  • s aureus (more common with CAPD)
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9
Q

1 main clinical presentation of SBP

A

ab pain

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10
Q

diagnosis of SBP

A
  • s/sxs of infxn
  • low ascitic fluid protein (<2.5)
  • absolute neutrophil count > 250 **
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11
Q

4 tx options for empiric tx of SBP + most common one

A
  • ceftriaxone **
  • Cefepime
  • Piper/tazo
  • Meropenem
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12
Q

tx of SBP with MRSA risk (3 kinda)

A
  • same as empiric but ADD one of the following:
  • vanc
  • linezolid
  • dapto
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13
Q

Tx for anaerobic coverage in SBP (3)

A
  • b-lactam/b-lactam inhibitor
  • carbapenem
  • add metro
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14
Q

when do you transition to oral therapy in SBP?

A

once clinical stability is achieved

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15
Q

SBP duration in pts with cirrhosis and ascites

A

5-7 days

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16
Q

Secondary prophylaxis is recc in pts with SBP + cirrhosis and ascites. what are the two drug options for this?

A
  • bactrim
  • cipro
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17
Q

duration of tx for pt w/ peritonitis undergoing CAPD

A

14-21 days bc prosthetic material is involved

18
Q

Secondary peritonitis
A. Monomicrobial
B. Polymicrobial

19
Q

what kind of bacteria did he say play a key role in secondary peritonitis

20
Q

what is the most common anaerobic bacteria in secondary peritonitis

A

bacteroides spp (B. fragilis most common)

21
Q

most common aerobic GN bacteria in secondary peritonitis

A

E coli, can also be kleb, entero, or proteus

22
Q

most common aerobic GP bacteria in secondary peritonitis

A

strep spp (usually viridans), can also be enterococcus

23
Q

only fungi species he talks about in secondary peritonitis

24
Q

what is the main thing he said that makes IAI’s unique

A

multiple organ systems are affected

25
Bacterial synergy in IAI: ________ create optimal environment for anaerobic bacteria. ________ cause abscess formation and have several virulence factors
enterobacterales (e.g. E. coli) anaerobes
26
im ignoring clin pres
smart man
27
2 imaging things we use for diagnosis in IAI
CT scan + Xray
28
4 examples of source control procedures for IAI's
- repair perforation - resection of infected organs - removal of foreign material - drain purulent collections
29
when are agents generally not recc in tx for IAI's
resistance rates exceed 10-20% (must look at antibiogram)
30
3 general considerations for empiric selection in IAI's
1. high likelihood to cover common organisms 2. consider if enterococci coverage is necessary 3. consider if antifungal coverage is necessary
31
6 times enterococci coverage is considered necessary in empiric selection for IAI
1. high severity 2. hx of recent cephalosporin use 3. immunocompromised 4. biliary source of infection 5. hx of valvular heart disease 6. prosthetic intravascular material
32
when is enterococci coverage not necessary in IAI
mild/mod community-acquired IAI*
33
CA-IAI mild/mod empiric regimen options (5)
1. ceftriaxone +metro 2. cefazolin+ metro 3. cefoxitin 4. ertapenem 5. tigecycline
34
what drug did he specifically say is not recc empirically for IAI and why
amp/sulb >> e coli resistance
35
CA-IAI, high severity AND HA empiric options (3)
- piper/tazo - meropenem - cefepime + metro
36
1 tx option for IAI caused by candida
fluconazole
37
1 tx option for candida species other than albicans in IAI
micafungin tf lol
38
"really important note about anaerobic bacteria"
common to maintain anaerobic coverage even if culture does not isolate it
39
3 common oral AB regimens for IAI
- amox/clav (q8h*/12h) - cefpodoxime +metro - cephalexin +metro
40
4 common oral IAI regimens that say "if possible, confirm susceptibility"
- cefadroxil + metro - cipro + metro - levo + metro - bactrim + metro
41
general oral tx duration for IAI
4-7 days after source control

PHRM 865 (40 decks)

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