intra-abdominal inf Flashcards
what is primary peritonitis? and who does it occur in?
peritonitis that occurs without an evident source.
Occurs in patients with ascites
who gets acites? 6
Cirrhosis Chronic active and acute viral hepatitis Congestive heart failure Metastatic malignant disease Systemic lupus erythematosus Lymphedema
what is secondary peritonitis?
is usually caused by spillage of GI or genitourinary microorganisms into the peritoneal cavity owing to loss of the integrity of the mucosal barrier.
what may cause spillage of GI or GU leading to secondary peritonitis? 6
Penetrating abdominal trauma Ruptured appendix Perforated peptic ulcer Perforated diverticular disease Perforated cholecystitis Postsurgical complications following abdominal procedures
what bug is the # 1 cause of Primary Bacterial Peritonitis? what about #2?
Enterobacteriaceae 63% (Escherichia coli, Klebsiella spp., etc.)
S. pneumoniae 15%
what bug causes Secondary Bacterial Peritonitis
Often polymicrobial (Enterobacteriaceae, Bacteroides sp., enterococci, P. aeruginosa (3-15%))
what are the most commonly isolated microorganisms in intraabdominal infections.
Escherichia coli (1) and Bacteroides (2)
what are S&S of intraabd inf
Acute abdominal pain Faint or absent bowel sounds Fever N/V Elevated WBCs, BUN
what does intraabd inf from perforation show on xray?
free air
Empiric treatment of a patient diagnosed with primary peritonitis should include which of the following pathogen(s)?
enterobact, strep pneumo, enterococci, and bacteriodes (less than 1%) but still cover for
what bact are associated with peritoneal dialysis?
Skin flora (S. epidermidis, S. aureus, Streptococci, Diphtheroids)
what is the best empiric option for a patient diagnosed with primary peritonitis
Ampicillin 2 g IV Q4H + Gentamicin 5 mg/kg IV QDay + Metronidazole 500 mg PO Q8H
what do you use for primary peritonitis if Extended Spectrum Beta Lactamase
imipenem or meropenem or ertapenem
what is used in prevention of 1 peritonitis in cirrhosis and ascites?
TMP/SMX
what is used for prevention of 1 peritonitis caused by cirrhosis and UGI bleed
cipro
is empiric tx usually necessary for 2 peritonitis?
yes
what is C.Diff
Anaerobic, Gram-positive spore-forming rod shaped bacteria
what is Known cause of colitis and Pseudomembranous colitis
c.diff
what are 4 risk factors for c.diff?
Antibiotic use (broad spectrum)
Manipulation of the GI tract (sgx, enemas, NG tubes)
Cytotoxic drugs
Age
what is c.diff colitis? 3 steos
-Overgrowth of C. difficile Normal flora Newly acquired -Toxin release Toxin A: enterotoxin which is responsible for most symptoms – hemorrhage/fluid secretion Toxin B: cytotoxin -Ulceration caused by toxins released
what are complications of c.diff colitis?
Toxic megacolon
Colonic perforation
Death
what are symptoms of c.diff?
Typically > 5 loose stools per day over 2 days min
Cramping, abdominal pain, dehydration
Presence of systemic signs of infection
Fever, leukocytosis
what is the characteristics of stool in c.diff
Watery, green, foul smelling, small volume, mucus or blood
Presence of stool leukocytes in 50% of patients
how do you treat C.diff? 4
-Antibiotics Metronidazole Vancomycin Bacitracin (Lack evidence, promising) -Immunomodulation Vaccine (decrease replapse) IVIG Hyperimmune bovine colostrum (prevent CDAD, relapse) -Probiotics Saccharomyces boulardii (prevents relapse,1 study) -Surgery Total colectomy (severe CDAD)
what is adjuvant therapy for c.dif?
Prebiotic: oral oligofructose (increase bifidobacteria, decrease relapse)
fecal flora transplantation
what does clindamycin treat?
Bacteroides Fragilis
what does metronidazole treat?
Bacteroides Fragilis
what does aminoglycosides treat?
E.coli
what does aztreonam treat?
E.coli
what does cipro treat?
E.coli
what does cefoxtitin treat?
E.coli and bacteroides
what does cefotetan treat
E.coli and bacteroides
what does amp/sulbactam treat?
E.coli and bacteroides
what does piperacillin/tazobactam treat?
E.coli and bacteroides
what does ticarcillin/calvulanate treat?
E.coli and bacteroides
what does imipenem treat?
E.coli and bacteroides
what does meropenem treat?
E.coli and bacteroides
what does ertapenem treat?
E.coli and bacteroides
if in secodary peritonitis anaerobe is not isolated how do you treat?
still treat as if anaerobe was there
what are choices of treatment of mild to moderate secondary peritonitis - inpt nonICU
ampicillin/sulbactam, piperacillin/tazo, ticarcillin/clavulnate, ertapenem, cefoxitin, cefotetan, cipro + metronidazole
what are choices of treatment of mild to moderate secondary peritonitis - ICU pt
Imipenem, meropenem, amp + metronid + genta or tobra, amp+ metro + cipro
