Gastrointestinal Infections Flashcards
Intra-abdominal infections
What is the criteria for high-risk community acquired intra-abdominal infection?
- APACHE II > 10
- septic shock/severe sepsis
- 2 of the following: age > 70, poor nutritional status, diffuse peritonitis, precense of maligancy, immunocompromised
Intra-abdominal infections
What pathogens are associated with community acquired low-risk intra-abdominal infections?
- E. coli
- bacteroides fragllis
- streptococcus spp.
- enterococcus spp.
- klebsiella spp.
- clostridium spp.
NOT pseudomonas aeruginosa (SPACE)
Intra-abdominal infections
What pathogens are associated with community acquired high-risk intra-abdominal infections?
- E. coli
- bacteroides fragllis
- streptococcus spp.
- enterococcus spp.
- klebsiella spp.
- clostridium spp.
- INCLUDING pseudomonas aeruginosa
Intra-abdominal infections
What pathogens are associated with healthcare associated intra-abdominal infections?
- E. coli
- bacteroides fragllis
- streptococcus spp.
- enterococcus spp.
- klebsiella spp.
- clostridium spp.
- pseudomonas aeruginosa
Intra-abdominal infections
What are the 3 components of treatment for intra-abdominal infections?
- source control (remove or drain if possible)
- resuscitation and fluids (management of sepsis)
- antimicrobial therapy
Intra-abdominal infections
What is the treatment for low-risk community acquired intra-abdominal infections?
monotherapy:
- ertapenem
- moxifloxacin
combo therapy + metronidazole:
- cefotaxime
- ceftriaxone
- ciprofloxacin
- levofloxacin
Intra-abdominal infections
What is the treatment for high-risk community acquired intra-abdominal infections?
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
Intra-abdominal infections
What factors would warrant MRSA coverage for a healthcare associated intra-abdominal infection?
- advanced age
- co-morbid medical conditions
- previous hospitalization or surgery
- recent exposure to broad spectrum antibiotics
- known history of MRSA
Intra-abdominal infections
What factors would warrant fungal coverage for a healthcare associated intra-abdominal infection?
- upper GI perforation
- recurrent bowel perforation
- surgically treated pancreatitis
- multiple invasive interventions
- broad spectrum antibiotic use
Intra-abdominal infections
What is the treatment for healthcare associated intra-abdominal infections?
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
C. diff
How can antibiotic use aid in the development of C. diff?
- long duration of antibiotic use
- multiple antibiotics
- broad spectrum antibiotics
- specific antibiotics: clindamycin, 3/4 gen cephalosporins, carbapenems, fluroquinolones
C. diff
What is the criteria for a C. diff infection to be categorized as non-severe?
< 15000 WBC, SCr <1.5 mg/dL, no systemic signs
C. diff
What is the criteria for a C. diff infection to be categorized as severe?
15000 + WBC, SCr 1.5mg/dL+, no systemic signs
only need WBC or SCr to meet criteria
C. diff
What is the criteria for a C. diff infection to be categorized as fulminant?
systemic signs or systems of infection
C. diff
What is the duration of treatment for C. diff?
10 days
Intra-abdominal infections
What is the duration of treatment for intra-abdominal infections?
4-7 days, 4 days max with source control (surgery), 5-7 days if no surgical management
Intra-abdominal infections
What are the PO treatment options for intra-abdominal infections?
- amoxicillin/clavulanic acid
- ciprofloxacin + metronidazole
- moxifloxacin
may use 2/3 gen cephalosporin + metronidazole
C. diff
What drugs can be used for the treatment of C. diff?
- metronidazole
- vancomycin
- fidaxamicin
- rifaximin
- bezlotoxumab
- fecal microbiota spores
C. diff
What is the first line treatment for a first episode of C. diff that is non-severe or severe?
- fidaxomicin 200 mg PO BID
- vancomycin 125mg PO Q6H
C. diff
When would the use of Bezlotoxumab be indicated for C. diff?
pt with high risk of recurrence
C. diff
What risk factors predispose a patient to C. diff recurrance?
- age 65+
- immunocompromised
- first episode is severe or fulminant
- additional antibiotics
C. diff
What is the treatment for a recurrent C. diff infection?
choose a different antibiotic than choosen from previous course
C. diff
What is the treatment for fulminant C. diff infection?
vancomycin 500mg PO Q6H + metronidazole 500 mg IV Q8H
