Infectious Disease: Gastrointestinal

Question 1

Intraabdominal Infections: Secondary Peritonitis
Microbiology

Answer 1

Polymicrobial!!
Aerobes: E. colis, Klebsiella, P.mirabilis, Enterobacter, Pseudomonas, Enterococcus, Staphylococcus
Anaerobes: Baceroides spss., Fusobacterium, Clostridium, Eubacterium

Question 2

Secondary Peritonitis Community Acquired

Answer 2

Not usually related to any surgical or medical intervention - usually the result of an underlying disease state
Typically mild-moderate infections

Question 3

Secondary Peritonitis Health-Care Associated

Answer 3

Usually r/t iatrogenic perforation or GI contamination during surgery or invasive procedures
Caused by more resistant organisms: P. aeruginosa, Enterobacter, Proteus, MRSA, Enterococci, & Candida

Question 4

Secondary Peritonitis High Risk Patients

Answer 4

APACHE II score > 15
Extremities of age (>65 yo)
Immunosuppression from medical therapy
*Transplantation
*Malignancy
*Inflammatory diseases
Immunocompromised states

Question 5

Secondary Peritonitis High-Severity Infections

Answer 5

Hypotension, Shock

Question 6

Secondary Peritonitis Treatment
Single Agent for Mild/Moderate Community Acquired

Answer 6

Cefoxitin
Ertapenem
Moxifloxacin
Tigecycline
Ticarcillin/Clavulanate

Question 7

Secondary Peritonitis Treatment
Single Agent for High-Risk/High Severity Community Acquired

Answer 7

Piperacillin/Tazobactam
Imipenem/Cilastatin
Doripenem
Meropenem

Question 8

Secondary Peritonitis Treatment
Combination Agents for Mild/Moderate Community Acquired

Answer 8

Cefazolin
Cefuroxime
Ceftriaxone
Ciprofloxacin
Levofloxacin
+
Metronidiazole

Question 9

Secondary Peritonitis Treatment
Combination Agents for High-Risk/High Severity Community Acquired

Answer 9

Ceftazidime
Cefepime
Ciprofloxacin
Levofloxacin
+
Metronidazole

Question 10

Secondary Peritonitis Treatment
Single Agent Health-care Associated

Answer 10

Piperacillin/Tazobactam
Imipenem/Cilastatin
Doripenem
Meropenem

Question 11

Secondary Peritonitis Treatment
Combination Agents Health-care Associated

Answer 11

Ceftazidime
Cefepime
Ciprofloxacin
Levofloxacin
+
Metronidazole

Question 12

Enterococcal Coverage for Health-care Associated Secondary Peritonitis if the patient has one of the following

Answer 12

Post-op infections
Previous therapy w/ cephalosporins w/n 90d
Immunocompromised pts
Valvular heart disease

Question 13

Secondary Peritonitis Duration of Therapy
Typical?
Will need to be longer if pts are what?

Answer 13

5-7d
in critical condition or slow to respond to therapy

Question 14

Abscesses - Treatment

Answer 14

Cover for anaerobic organisms - thrive in abscesses
Otherwise, treat as if a Health-care Associated infection

Question 15

C. difficile Associated Diarrhea
what type of organism is it?

Answer 15

Anaerobic, gram-positive, spore-forming rod

Question 16

C. difficile Associated Diarrhea
Abx thought/known to cause this?

Answer 16

Clindamycin
3rd gen cephalosporins
B-lactam/B-lactamase inhibitor combinations (Pip/Tazo, Amox/Clav, Amp/Subl)
Fluoroquinolones (Levo, moxi)
Carbapenems

Question 17

C. difficile Associated Diarrhea
Complications that make the infection severe are?

Answer 17

hypotension/shock
ileus
megacolon

Question 18

C. difficile Associated Diarrhea
Initial Episode Recommended Treatment
Preferred?
Alternative

Answer 18

Fidaxomicin 200mg PO BID x 10d

Vancomycin 125mg PO QID x 10d

Question 19

C. difficile Associated Diarrhea
First Recurrence Recommended Treatment
Preferred?
Alternative?
Adjunctive?

Answer 19

Fidaxomicin 200mg PO BID x 10d OR BID x 5d, followed by once every other day x 20d

Prolonged (6 or 8 week) PO vancomycin taper

Bezlotoxumab 10mg/kg IV given ONCE during SOC treatment

Question 20

C. difficile Associated Diarrhea
Second or Subsequent Recurrence Recommended Treatment
Preferred?
Alternative?
Alternative?
Adjunctive?

Answer 20

Fidazomicin 200mg PO BID x 10d OR BID x 5d, followed by once every other day x 20d

Prolonged (6 or 8 week PO vancomycin taper

Vancomycin 125mg PO QID x 10days, followed by rifaximin 400mg TID x 20d

Bezlotoxumab 10mg/kg IV given ONCE during SOC treatment

Question 21

C. difficile Associated Diarrhea
Initial Episode, fulminent

Answer 21

Vancomycin 500mg PO or NGT QID + Metrondiazole 500mg IV q8h

If ileus, consider vancomycin enemas