GI Infections Flashcards
Common pathogens
E. coli Klebsiella Proteus Enterobater Sometimes strep and anaerobes
Primary Bacterial Peritonitis
SBP
Super painful
Secondary Bacterial Peritonitis
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
Intra-abdominal Abscess
Infection that gets covered up in a fibrous capsule.
Intra-abdominal Organ Infections
Appendicitis Cholecystitis Cholangitis Diverticulitis Pancreatitis
Primary Bacterial Peritonitis pathogens
Single organism
- E. coli
- Klebsiella
Secondary Bacterial Peritonitis pathogens
Polymicrobial
- anaerobes predominate
Abscess pathogens
Polymicrobial
Diagnosis of Primary Bacterial Peritonitis
PMN > 250
Cultures often negative
Diagnosis of Secondary Bacterial Peritonitis
WBC very high
May be dehydrated
Diagnosis of Abscess
WBC will be high, but not like Secondary
CT - find pocket
Culture the surgical drainage
General Treatment
Fluids
ABX - may hold until cultured
Surgical Source Control
Treatment: Primary Peritonitis
Cefotaxime
FQ
Amp + Gent
5-10 days
SBP Prophylaxis
Cipro 750mg weekly
Treatment of mild-moderate community acquired infections
Single agent: erta, ticarcillin-clavulanate
Combo: Cephalosporin or FQ both with Metronidazole
- no FQ if susceptibility < 90%
Treatment of severe community acquired infections
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%
Healthcare associated infections: definition and pathogens
> 48 after admission
Pathogens: the nasty ones, including Candida
Treatment of Healthcare associated infections
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
When and how to cover for VRE?
Liver transplant, history VRE infection
- Linezolid or Dapto
Treatment of mild Cholecystitis/Cholangitis
Cefazolin, Cefuroxime, Ceftriaxone
Treatment of moderate/severe Cholecystitis/Cholangitis
Big guns
General Monitoring
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
How to decide whether to cover Enterococcui or not
Bactermia - yup Immunocomprimised - yup Pure culture - probably yeah Only anaerobe cultured - maybe Mixed anaerobes in culture - nah
Never treat with cephalosporin!
C. diff
Spore and toxin producing gram positive anaerobic rod that colonizes the GI tract.
