Intra-abdominal Infections Flashcards
General Points
What will ID most pts with suspected infection?
Consider infection in those with unreliable PE, such as? & thosw with what?
If obvious peritonitis & undergoing immediate OR there is no need for what?
Imaging of choice if no immediate OR is what?
Begin fluid resuscitation when?
Hx, PE, & labs
elderly, immunocompromised, SCI, Obtundation; evidence of infection from undetermined source
no need for imaging (CT)
CT
ASAP
Begin empiric abx w/n how long?
Address what?
Microbiology eval: not routinely recommended in who?; culture intra-abdominal fluid if patients are what?
1hr
source control
lower-risk pts with CA-IAI
High-risk pts with CA-IAI & HA-IAI
IV abx
Cover what?
typical GNB, GPC, anaerobes
Anti-fungals
Consider what for candida albicans in non-critically ill patients?
Give what for empiric coverage, or what for Candida spps. in critically ill patients?
fluconazole pre-emptive, & pathogen directed
anidulafungin, caspofungin, or micafungin, or pathogen directed
Duration of abx
24 hrs if?
traumatic intestinal perforation if operated on w/n 12 hrs
gastroduodenal perforation if operated on w/n 24hrs
acute/gangrenous appendix or gallbladder without perforation
ischemic nonperforated bowel
Duration of abx
no > 4d if?
no > 5d if?
adequate source control
no source control
Microflora of GI Tract
Stomach
< 100bacteria/ml
Primarily oral flora
Streptococci
Lactobacilli
Microflora of GI Tract
Duodenum, Jejunum
Lactobacilli
Streptococci
Enterobacteriaceae (E.coli, Klebsiella, Enterobacter)
Microflora of GI Tract
Ileum
Enterobacteriaceae (E. coli, Klebsiella, Enterobacter)
Bacteroides
Microflora of GI Tract
Large Bowel
Lactobacilli (GP)
Streptococci (GP)
E. faecalis (GP)
E. coli (GP)
Klebsiella (GN)
Enterobacter (GN)
Bacteroides (anaerobe)
Pseudomonas (GN)
Candida (fungus)
