EXAM 4 IAI

Question 1

primary peritonitis types

Answer 1

Spontaneous bacterial peritonitis
Peritoneal dialysis related peritonitis

Question 2

Secondary peritonitis types

Answer 2

Diverculitis, appendicitis, cholecystits, intraabdominal abscess, cholangitis, necrotizing pancreatitis

Question 3

Uncomplicated infection

Answer 3

confined within visceral structure
Does not extend into peritoneum

Question 4

Complicated infection

Answer 4

extends beyond single organ into peritoneal space and associated with peritonitis

Question 5

Community-acquired infection

Answer 5

occurs within 48 hours hospital admission
caused by normal intra-abdominal flora

Question 6

Healthcare-associated infection

Answer 6

After 48 hrs of hospital admission

Healthcare exposure in last 12 months

Question 7

SBP basics

Answer 7

No obvious source of bacterial contamination

Question 8

Patients at highest risk SBP

Answer 8

hepatic failure and ascites – alcoholic cirrhosis

Question 9

SBP most commonly monomicrobial

Answer 9

E. Coli and other enterobacterales

Question 10

SBP clinical presentaton

Answer 10

Abd pain, N/V/D, fever chills, reduced bowel sounds, altered mental status/encephalopathy

Question 11

SBP diagnosis

Answer 11

Signs and Sx of infection

Ascitic fluid analysis: low ascitic fluid protein (<2.5g/dL)
Absolute neutrophil count >250 mm3 (main focus)

Question 12

SBP treatment

Answer 12

Empiric:
ceftriaxone, cefepime, piperacillin/tazobactam, meropenem

S. Aureus/coagulase (-) (risk for MRSA):
vancomycin, linezolid, daptomycin

Anaerobic coverage:
B-lactam/b-lactamase inhibitor, carbapenem, add metronidazole

Question 13

SBP treatment duration

Answer 13

SBP in patients with cirrhosis and ascites: 5-7 days

Peritonitis undergoing CAPD: 14-21 days

Question 14

Secondary peritonitis: intra-abdominal infections most common pathogens

Answer 14

POLYMICROBIAL
E. COLI is most common
Staph aureus and pseudomonas are possible

Question 15

What makes intraabdominal infections unique?

Answer 15

multiple organ systems affected

bacterial synergy

Question 16

multiple organ systems affected in IAI

Answer 16

GI – bowel paralysis
cardiovascular – fluid shifts
respiratory – hypoxemia
renal – decreased renal perfusion

Question 17

bacterial synergy

Answer 17

E. coli make an optimal environment for anaerobic bacteria

Anaerobes cause abscess formation and have several virulence factors

Question 18

IAI Clinical presentation

Answer 18

Abdominal pain, loss of appetite, inability to pass flatus and/or feces

Physical exams: tachypnea/tachycardia, hypotension

Question 19

IAI diagnostic work up

Answer 19

Signs/Sx + imaging (CT or XR)

Question 20

IAI treatment considerations

Answer 20

source control
antimicrobial therapy

Question 21

IAI source control

Answer 21

Repair perforations
resection of infected organs/tissue
removal of foreign material
drain purulent collections

important to obtain cultures

Question 22

IAI empiric ABX selection

Answer 22

• Select with high likelihood to cover E. Coli (85-90%)
• Consider if enterococci coverage is necessary
• Consider if antifungal coverage is necessary (generally not)

Question 23

IAI empiric treatment for Mild to moderated

Answer 23

Ceftriaxone/cefazolin + metronidazole
Cefoxitin
Ertapenem
Tigecycline

Question 24

IAI empiric treatment for high/healthcare associated

Answer 24

Piperacillin/tazobactam
Meropenem
Cefepime + metronidazole

Question 25

IAI empiric treatment for candida

Answer 25

Candida albicans: fluconazole

Candida not albicans: micafungin

Question 26

when is it acceptable to de-escalate ABX regiment for IAI?

Answer 26

once culture results are available

Question 27

IAI oral ABX regimen

Answer 27

Amoxicillin/clavulanate
Cefpodoxime
Cephalexin
TMP/SMX