Intra-Abdominal Infections Flashcards
where are lactobacilli found?
Upper, stomach
What is found in the small intestines?
streptococci
lactobacilli
enterobacteriaceae
what is found in the large intestines?
Aerobic + anaerobic microbial populations
who does primary periotonitis typically occur in?
patients with cirrhosis, hepatitis CHF metastatic malignant dz systemic lupus erythematosus lymphedema
caused by spillage of GI or genitourinary microorganisms into the peritoneal cavity owing to loss of the integrity of the mucosal barrier.
Secondary peritonitis
what mostly cuases primary bacterial peritonitis?
Enterobacteriaceae (E. coli, Kelbsiella)
what is the common anaerobe in primary peritonitis?
Bacteroides (but still <1% of primary infections)
what often causes secondary bacterial peritonitis
polymicrobial (Enterobacteriaceae, Bacteroides sp., enterococci, P. aeruginosa
Empiric treatments for primary peritonitis.
Cefotaxime
Ceftriaxone
Piperacillin/ tazobactam
Ticacillin/ clavulanic acid or amp/ sulbactam
If a primary peritonitis bacteria is ESBL then what should you use?
Imipnem
meropenem
ertapenem
Drugs to prevent primary peritonitis with cirrhosis and ascities.
TMP/SMX
Drugs to prevent primary peritonitis w/ cirrhosis and UGI bleed.
Cipro
Ways to treat secondary peritonitis (mild- moderate)
ampicillin/ sulbactam piperacillin/ tazo ticacillin/ clavulanate ertapenem cefoxitin cefotetan cipro + metronidazole
Ways to treat severe, life threatening dz with an ICU patient.
imipenem
meropenem
ampicillin + metronidazole + gentamicin or tobramycin
Amipicillin + metronidazole + ciprofloxacin
Classify C. Diff
Anaerobie, gram positive
why is c. diff so bad?
forms spores
what does C. diff cause?
Colitis and pseudomembranous colitis
what are risk factors for C. diff
antibiotic use (broad spectrum)
manipulation of GI tract (sgx, enema, NG tubes)
cytotoxic drugs
age
What is the toxin that enterotoxin which is responsible for most symptoms – hemorrhage/fluid secretion in C. Diff
Toxin A
What is the cytotoxin with C. Diff.
Toxin B
what are 3 complications of C. Diff.
toxic megacolon
colonic perforation
death
what are symptoms of C. Diff
>5 loose stools per day Over at least 2 days watery, green, foul, small volume feces 1/2 of patients have leukocytes in stool cramping, abdominal pain, dehydration fever, leukocytosis
Tx for C Diff (abx)
Metronidazole
Vanco (oral)
Bacitracin (lack of evidence, promising) (oral)
Immunomodulation for C. Diff (for people at high risk)
Vaccine (decrease relapse)
IVIG
Hyperimmune bovine colostrum
What are probiotics to give for C. Diff
Saccharomyces boulardii (prevents relapse,1 study)
what is surgery for C. Diff?
total colectomy (severe CDAD)
what are some adjunctive therapies for C. Diff?
Prebiotic: oral oligofructose
cholestyramine (lack of evidence, ADRs)
Fecal flora transplant
