Gastrointestinal Infections Flashcards

1
Q

Intra-abdominal infections

What is the criteria for high-risk community acquired intra-abdominal infection?

A
  • APACHE II > 10
  • septic shock/severe sepsis
  • 2 of the following: age > 70, poor nutritional status, diffuse peritonitis, precense of maligancy, immunocompromised
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2
Q

Intra-abdominal infections

What pathogens are associated with community acquired low-risk intra-abdominal infections?

A
  • E. coli
  • bacteroides fragllis
  • streptococcus spp.
  • enterococcus spp.
  • klebsiella spp.
  • clostridium spp.

NOT pseudomonas aeruginosa (SPACE)

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3
Q

Intra-abdominal infections

What pathogens are associated with community acquired high-risk intra-abdominal infections?

A
  • E. coli
  • bacteroides fragllis
  • streptococcus spp.
  • enterococcus spp.
  • klebsiella spp.
  • clostridium spp.
  • INCLUDING pseudomonas aeruginosa
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4
Q

Intra-abdominal infections

What pathogens are associated with healthcare associated intra-abdominal infections?

A
  • E. coli
  • bacteroides fragllis
  • streptococcus spp.
  • enterococcus spp.
  • klebsiella spp.
  • clostridium spp.
  • pseudomonas aeruginosa
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5
Q

Intra-abdominal infections

What are the 3 components of treatment for intra-abdominal infections?

A
  • source control (remove or drain if possible)
  • resuscitation and fluids (management of sepsis)
  • antimicrobial therapy
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6
Q

Intra-abdominal infections

What is the treatment for low-risk community acquired intra-abdominal infections?

A

monotherapy:
- ertapenem
- moxifloxacin
combo therapy + metronidazole:
- cefotaxime
- ceftriaxone
- ciprofloxacin
- levofloxacin

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7
Q

Intra-abdominal infections

What is the treatment for high-risk community acquired intra-abdominal infections?

A

monotherapy:
- piperacillin/tazobactam
- carbapenems (except ertapenem)
- eravacycline (reserve for pt with history of multidrug resistant organisms)
- imipenem/cilastatin/relebactam (reserve for pt with history of multidrug resistant organisms)
combo therapy + metronidazole
- cefepime
- ceftazidime
- aztreonam (+ vancomycin)
- ceftolozane/tazobactam
- ceftazidime/avibactam

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8
Q

Intra-abdominal infections

What factors would warrant MRSA coverage for a healthcare associated intra-abdominal infection?

A
  • advanced age
  • co-morbid medical conditions
  • previous hospitalization or surgery
  • recent exposure to broad spectrum antibiotics
  • known history of MRSA
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9
Q

Intra-abdominal infections

What factors would warrant fungal coverage for a healthcare associated intra-abdominal infection?

A
  • upper GI perforation
  • recurrent bowel perforation
  • surgically treated pancreatitis
  • multiple invasive interventions
  • broad spectrum antibiotic use
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10
Q

Intra-abdominal infections

What is the treatment for healthcare associated intra-abdominal infections?

A

monotherapy:
- piperacillin/tazobactam
- carbapenems (except ertapenem)
- eravacycline (reserve for pt with history of multidrug resistant organisms)
- imipenem/cilastatin/relebactam (reserve for pt with history of multidrug resistant organisms)
combo therapy + metronidazole
- cefepime
- ceftazidime
- aztreonam (+ vancomycin)
- ceftolozane/tazobactam
- ceftazidime/avibactam

if post-op= + vancomycin +/- antifungal

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11
Q

C. diff

How can antibiotic use aid in the development of C. diff?

A
  • long duration of antibiotic use
  • multiple antibiotics
  • broad spectrum antibiotics
  • specific antibiotics: clindamycin, 3/4 gen cephalosporins, carbapenems, fluroquinolones
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12
Q

C. diff

What is the criteria for a C. diff infection to be categorized as non-severe?

A

< 15000 WBC, SCr <1.5 mg/dL, no systemic signs

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13
Q

C. diff

What is the criteria for a C. diff infection to be categorized as severe?

A

15000 + WBC, SCr 1.5mg/dL+, no systemic signs

only need WBC or SCr to meet criteria

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14
Q

C. diff

What is the criteria for a C. diff infection to be categorized as fulminant?

A

systemic signs or systems of infection

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15
Q

C. diff

What is the duration of treatment for C. diff?

A

10 days

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16
Q

Intra-abdominal infections

What is the duration of treatment for intra-abdominal infections?

A

4-7 days, 4 days max with source control (surgery), 5-7 days if no surgical management

17
Q

Intra-abdominal infections

What are the PO treatment options for intra-abdominal infections?

A
  • amoxicillin/clavulanic acid
  • ciprofloxacin + metronidazole
  • moxifloxacin

may use 2/3 gen cephalosporin + metronidazole

18
Q

C. diff

What drugs can be used for the treatment of C. diff?

A
  • metronidazole
  • vancomycin
  • fidaxamicin
  • rifaximin
  • bezlotoxumab
  • fecal microbiota spores
19
Q

C. diff

What is the first line treatment for a first episode of C. diff that is non-severe or severe?

A
  • fidaxomicin 200 mg PO BID
  • vancomycin 125mg PO Q6H
20
Q

C. diff

When would the use of Bezlotoxumab be indicated for C. diff?

A

pt with high risk of recurrence

21
Q

C. diff

What risk factors predispose a patient to C. diff recurrance?

A
  • age 65+
  • immunocompromised
  • first episode is severe or fulminant
  • additional antibiotics
22
Q

C. diff

What is the treatment for a recurrent C. diff infection?

A

choose a different antibiotic than choosen from previous course

23
Q

C. diff

What is the treatment for fulminant C. diff infection?

A

vancomycin 500mg PO Q6H + metronidazole 500 mg IV Q8H