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Phar 761 > GI Infections > Flashcards

GI Infections Flashcards

1
Q

Common pathogens

A 
E. coli
Klebsiella
Proteus
Enterobater
Sometimes strep and anaerobes
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2
Q

Primary Bacterial Peritonitis

A

SBP

Super painful

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3
Q

Secondary Bacterial Peritonitis

A

Focal intra-abdominal site involved allow bacteria to come in contact with peritoneum.
Surgery if absent bowel sounds or rigid abdomen.
Severe: hypotension and shock

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4
Q

Intra-abdominal Abscess

A

Infection that gets covered up in a fibrous capsule.

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5
Q

Intra-abdominal Organ Infections

A 
Appendicitis
Cholecystitis
Cholangitis
Diverticulitis
Pancreatitis
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6
Q

Primary Bacterial Peritonitis pathogens

A

Single organism

  • E. coli
  • Klebsiella
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7
Q

Secondary Bacterial Peritonitis pathogens

A

Polymicrobial

- anaerobes predominate

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8
Q

Abscess pathogens

A

Polymicrobial

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9
Q

Diagnosis of Primary Bacterial Peritonitis

A

PMN > 250

Cultures often negative

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10
Q

Diagnosis of Secondary Bacterial Peritonitis

A

WBC very high

May be dehydrated

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11
Q

Diagnosis of Abscess

A

WBC will be high, but not like Secondary
CT - find pocket
Culture the surgical drainage

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12
Q

General Treatment

A

Fluids
ABX - may hold until cultured
Surgical Source Control

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13
Q

Treatment: Primary Peritonitis

A

Cefotaxime
FQ
Amp + Gent
5-10 days

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14
Q

SBP Prophylaxis

A

Cipro 750mg weekly

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15
Q

Treatment of mild-moderate community acquired infections

A

Single agent: erta, ticarcillin-clavulanate
Combo: Cephalosporin or FQ both with Metronidazole
- no FQ if susceptibility < 90%

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16
Q

Treatment of severe community acquired infections

A

Cultures important for de-escalation.
Usually patients that are in and out of healthcare system.
Single agent: carbapenems or pip/tazo
Combo: cefepime, ceftazidime, or FQ all with Metro
- no FQ if susceptibility < 90%

17
Q

Healthcare associated infections: definition and pathogens

A

> 48 after admission

Pathogens: the nasty ones, including Candida

18
Q

Treatment of Healthcare associated infections

A

Carbapenems safe choice

Known colonization with ESBL producing E.coli/Klebsiella, resistant Pseudomonas/gram - :
- Aminoglycoside, colistin

MRSA - Vanco

C. albicans - Fluconazole

Non C. albicans - Echinocandin

Cover for Enterococcus: amp, vanco, pip/tazo

19
Q

When and how to cover for VRE?

A

Liver transplant, history VRE infection

- Linezolid or Dapto

20
Q

Treatment of mild Cholecystitis/Cholangitis

A

Cefazolin, Cefuroxime, Ceftriaxone

21
Q

Treatment of moderate/severe Cholecystitis/Cholangitis

A

Big guns

22
Q

General Monitoring

A

Should improve in 2-3 days and become stable
- If not, consider resistance or other infections

If empirically covering for anaerobes, continue for entirety of duration, even if changing therapy based on culture results

Good source control: 4-7 days of treatment
- If not, clinical decision

Prophylaxis of abdominal surgery: < 24hrs

23
Q

How to decide whether to cover Enterococcui or not

A 
Bactermia - yup
Immunocomprimised - yup
Pure culture - probably yeah
Only anaerobe cultured - maybe
Mixed anaerobes in culture - nah

Never treat with cephalosporin!

24
Q

C. diff

A

Spore and toxin producing gram positive anaerobic rod that colonizes the GI tract.

25
Q

C. diff commonly comes up after:

A

Cephalosporins
Clindamycin
Ampicillin

Can show up as late as 8 weeks afterwards…

26
Q

Worry about C. diff if:

A

3 or more unformed stools within 24 hours
Unformed stool test positive for toxins
Seen upon inspection

27
Q

C. diff diagnosis

A

First - Enzyme Immunoassay (EIA)

Then - PCR b/c expensive

28
Q

Mild-Moderate C.diff definition

A

WBC < 15,000

SCr < 1.5 x baseline

29
Q

Severe C.diff definition

A

WBC > 15,000

SCr > 1.5 x baseline

30
Q

Severe and complicated C.diff definition

A

Hyptoension, shock, ileus, megacolon

31
Q

General C.diff treatment

A

Begin Empiric while awaiting test results
DC inciting ABX if possible
- If not, finish course, continue C.diff treatment x 7 days
Give fluids and electrolytes - diarrhea
Contact precautions

32
Q

Mild-Moderate C.diff Treatment

A

Metronidazole 500mg PO TID
Vanco 125mg PO q6 if necessary
10-14 days

33
Q

Severe C.diff Treatment

A

Vanco 125 PO q6
Up to 500mg if needed
10-14 days

34
Q

Severe and Complicated C.diff Treatment

A

Vanco 500mg PO Q6 PLUS Metro 500mg IV q8

If Ileus; Vanco enema

35
Q

Treatment of C.diff recurrence

A

1st recurrence: same med
- more severe: vanco

2nd recurrence: Vanco taper 2 months

Phar 761 (5 decks)

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