Exam 4 - Intra Abdominal Infections Flashcards
what are the primary peritonitis infections
peritoneal dialysis
spontaneous peritonitis
what are the secondary peritonitis infections
diverticulitis
appendicitis
cholecystitis
intra abdominal abscess
cholangitis
what is an uncomplicated IAI
visceral structure
no extension into the periteneum
what is complicated IAI
extends beyond single organ + peritonitis
what is community acquired IAI
occurs within 48 hours of admin
caused by regular GI bugs
what is hospital acquired IAI
occurs after 48 hours of admin
caused by hospital/MDR bugs
who is at the highest risk of spontaneous bacterial peritonitis
hepatic failure and ascites (alcohol cirrhosis) and continuous peritoneal dialysis (CAPD)
what are the common pathogens for spontaneous bacterial peritonitis
monomicrobial
E. coli (most common)
enterobacter
streptococci
staph aureus and coag neg staph
what is the empiric treatment for spontaneous peritonitis
target e. coli
ceftriaxone
cefepime
pip/tazo
meropenem
what is the treatment for SBP caused by staph w/ MRSA risk
add on vanc, linezolid, daptomycin
what is the anaerobic treatment for SBP
BL + BLase inhibitor
carbapenem
metronidazole
when do you add on anaerobic coverage for SBP
if in past medical history
when should you transition to oral therapy for SBP
once clinically stable and choose agents based on cultures
what is the duration of therapy for SBP w/ cirrhosis and ascites
5-7 days w/ secondary prophylaxis
what is the treatment duration of peritonitis
14-21 days
what are the pathogens of secondary peritonitis
polymicrobial
e. coli, kleb, entero, proteus
strep and enterococcus
bacteroides, clostridium, peptostrepto
candida
what are the characteristics of secondary peritonitis
multiple organs affected
bacterial synergy
secondary peritonitis signs and symptoms
abdominal pain
n/v +/- fever
loss of appetite
lack of bowel movements
secondary peritonitis physical exam presentation
tachypnea, tachycardia
hypotension
abdominal tenderness/rigid
dec bowel sounds
how to diagnose secondary peritonitis
signs and symptoms of IAI + Imaging (CT or X-ray)
what are the main goals of treatment for secondary peritonitis
source control and antimicrobial therapy
what are the considerations for empiric treatment of secondary peritonitis
-local rates
-consider enterococci coverage
-consider antifungal coverage
when should enterococci coverage be recommended in secondary peritonitis
high severity
cephalosporin use
immunocompromised
biliary issues
heart valves
when should antifungal coverage be considered in secondary peritonitis
if not getting better, it could be fungus
what are the empiric regimens for community, mild-mod secondary peritonitis
ceftriaxone + metro
cefazolin + metro
cefoxitin
ertapenem
tigecycline
what is the empiric coverage for community, severe and hospital secondary peritonitis
pip/tazo
meropenem
cefepime + metro
what is the treatment for candida albicans in secondary peritonitis
fluconazole
what are the pathogen directed therapy options for secondary peritonitis
amox/clav
cefpod + metro
cephalexin + metro
cefadroxil + metro
TMP/SMX + metro
what is the treatment duration for general secondary peritonitis
4-7 days
what is the treatment duration for diverticulitis
5-10 days
what is the treatment duration for appendicitis
24 hours
what is the treatment duration for cholecystitis
24 hours
what is the treatment duration for bowel injuries
24 hours
