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therapeutics V > Gastrointestinal and Intra-abdominal Infections > Flashcards

Gastrointestinal and Intra-abdominal Infections Flashcards

1
Q

How is C. difficile transmitted?

A

person-to-person via fecal-oral route through the ingestion of spores

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2
Q

Which strains are associated with higher
severity of c.diff infection?

A

BI/NAP1/027

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3
Q

Which antibiotics are associated with a high risk for CDI?

A

-fluoroquinolones
-clindamycin
-3rd/4th gen cephalosporins
-carbapenems

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4
Q

How is CDI diagnosed?

A

Laboratory test + symptoms ( 3 or more profuse, watery or mucoid green, foul-smelling stools in 24h )

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5
Q

What are the signs and symptoms of CDI?

A

-profuse, watery or mucoid green, foul-smelling diarrhea
-abdominal pain

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6
Q

Which testing
methods are recommended for CDI?

A

1) Nucleic acid amplification test (NAAT) alone (in conjunction with signs/symptoms)
2) Antigen test (GDH) + Toxin A/B test (NAAT used to resolve discordant results)
3) NAAT + Toxin A/B test

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7
Q

How would you interpret the following C. difficile testing results?
-GDH antigen (+)
-Toxin test (-)
-C. difficile NAAT (+)

A

positive for CDI

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8
Q

How is CDI classified?

A

non-severe, severe, fulminant

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9
Q

What are the treatment options for CDI?

A

-oral vancomycin
-fidaxomicin
-metronidazole

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10
Q

Non-severe C.diff characteristics

A

WBC < 15,000/mcL
SCr <1.5mg/dL

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11
Q

Severe C.diff

A

WBC > 15,000/mcL
SCr > 1.5mg/dL

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12
Q

Fulminant C.diff

A

hypotension or shock
ileus
toxic megacolon

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13
Q

Dosage form for Vancomycin in C.diff

A

Oral

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14
Q

Vancomycin standard dosing - C.diff

A

125mg PO q6h

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15
Q

Fulminant CDI Vancomycin Dosing

A

500mg po q6h

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16
Q

Fidaxomicin (Dificid) MOA

A

protein synthesis inhibitor

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17
Q

Fidaxomicin Dosing

A

fidaxomicin 200mg po q12h

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18
Q

Fidaxomicin Pros

A

-higher rates of sustained tx response and lower recurrence rates

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19
Q

Vancomycin Pros

A

-typically covered by insurance

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20
Q

Vancomycin Cons

A

-liquid is bitter
-liquid is pricey

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21
Q

Fidaxomicin Cons

A

-COST
- requires PA

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22
Q

metronidazole pros

A
  • excellent oral absorption
    -less costly
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23
Q

Metronidazole standard dosing

A

500mg PO Q8H

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24
Q

metronidazole Fulminant CDI dosing

A

500mg IV Q8H
not a single agent

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25
Is spontaneous bacterial peritonitis monomicrobial or polymicrobial infetion?
26
metronidazole cons
-less efficacious -higher risk for recurrence -not preferred
27
Risk factors for CDI Recurrence
- >65yo -immunocompromised - severe CDI on presentation
28
Indications for Fecal Microbiota Transplant
- three or more episodes of CDI - poor response to initial abx therapy for CDI
29
Fecal Microbiota Transplant
administration of fecal material from a healthy person to restore a balance gut microbiome -treatment option and method to reduce recurrences
30
Rebyota
fecal microbiota suspension
31
Reboyta Indication
-prevention of recurrence for CDI for patients following abx treatment for recurrent CDI
32
Rebyota Dosing
150ml administered via rectal tube 24-72h after treatment completion
33
Vowst
- bacterial spore suspension -modulate bile acid concentrations and restore fatty acids, which results in resistance to C.diff colonization and restoration of the gut microbiome
34
Vowst Indication
-prevention of recurrence of CDI for patients following abx treatment for recurrent CDI
35
Vowst Dosing
4 caps po qd x 3 days starting 2-4 days after treatment completion
36
Vost Side Effects
abdominal distention, fatigue, constipation, chills, diarrhea
37
Bezlotoxumab (Zinplava)
MAB targeting C.diff toxin B to neutralize its effect
38
Bezlotoxumab Indication
-prevention of recurrence of CDI for high risk patients
39
Bezlotoxumab Dosing
10mg/kg iv x 1 dose during course of CDI treatment
40
CDI Prophylaxis
-limited studies -vanc 125mg po q12h during and for 3-5 days after completion of abx therapy
41
For spontaneous bacterial peritonitis, which patient population is at the highest risk? Why?
- hepatic failure and ascites (alcoholic dialysis) - continuous ambulatory peritoneal dialysis
42
Presentation of Spontaneous Bacterial Peritonitis
- abdominal pain - N/V/D - fevers, chill - reduced/ abdominal bowel sounds - altered mental status / encephalopathy
43
Spontaneous Bacterial Peritonitis Diagnosis
- signs and symptoms of infection - ascitic fluid analysis -> low ascitic fluid protein (< 2.5g/dL) -> ABSOLUTE NEUTROPHIL COUNT (>250/mm3)
44
Common Pathogens for spontaneous bacterial peritonitis
- E. coli -other enterobacterales -streptococci - enterococci - staphylococcus aureus - coagulase negative staphylococci
45
Empiric therapy: Treatment options for SBP
-Cefriaxone 1-2g IV q24h - Cefepime 1g IV q8h - piperacillin/tazobactam 3.375g IV q6-8h -meropenem 1g iv q8h
46
SBP Treatment MRSA risk
Add: -vancomycin -linezolid 600mg iv/po q12h -daptomycin 6-12mg/kg iv q24h
47
SBP Treatment anaerobic coverage
-beta lactam/ beta-lactamase inhibitor - carbapenem - add metronidazole
48
Treatment duration SBP
SBP in patient w/ cirrhosis and ascites -> 5-7 days Peritonitis in patients undergoing CAPD -> 14-21 days
49
Pathogens for secondary peritonitis
- aerobic, gram negative bacteria -> e.coli -aerobic, gram positive -> strept -Anerobic bacteria -> B. fragillis -Fungi -> candida species
50
Secondary peritonitis mono or poly microbacterial
Polymicrobial (bacterial synergy)
51
Clinical presentation of secondary peritonitis
Signs/symptoms: -abdominal pain -n/v -fever, chills -loss of appetite -inability to pass gas or feces Physical exam findings/ vitals: -tachypenia, tachycardia -hypotension -significant abdominal tenderness -rigidity of abdominal wall - reduced or absent bowel sounds
52
Diagnosis of secondary peritonitis
signs and symptoms + imaging (CT or XRAY)
53
what are the pillars of treatment
-source control - antimiicrobial therapy
54
how do you select empiric abx therapy (intra-abdominal infections)
1) select agent or combination w/ high likelihood to cover common organism (dont use agents w/ resistance rates exceed 10-20%) 2) consider if enterococci coverage is necessary 3) consider if anti-fungal coverage is necessary
55
primary peritonitis infections
-peritoneal dialysis related peritonitis -spontaneous bacterial peritonitis
56
Secondary Peritonitis Infections
-diverticulitis -appendicitis -intra-abdominal abscess -cholecystitis -cholangitis - necrotizing pancreatitis
57
uncomplicated infection
- confined w/in visceral structure - does not extend into peritoneum
58
complicated infection
-extends beyond a single organ into the peritoneal space and associated with peritonitis
59
community -acquired mild/moderate treatment SP
-ceftriaxone + metronidazole - Cefoxitin - ertapenem -tigecycline
60
SP: community acquired severe and hospital acquired treatment
- piperacillin/tazobactam -meropenem -cefepime + metronidazole
61
SP: candida albicans treatment
fluconazole
62
SP: other candida treatment
micafungin
63
General AI treatment duration
4-7 days after source control
64
diverticulitis treatment duration
uncomplicated -> abx not needed complicated -> 5-10 days
65
appendicitis treatment duration
24h
66
Cholecystitis treatment duration
24h
67
bowel injuries treatment duration
24h

therapeutics V (19 decks)

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