Intra-Abdominal Infections Flashcards
Primary Peritonitis Causes
- Peritoneal Dialysis
- Liver disease
- Typically monomicrobial
Most common pathogen in cirrhotic ascites
- Gram negative bugs
- E. coli
- Klebsiella pneumoniae
Most common pathogens in primary peritonitis with peritoneal dialysis
- Gram positive bugs
- CoN staph
- S. aureus
Clinical presentation and diagnosis
- Ascitic fluid in cirrhosis > 250PMNs
- Ascitic fluid in PD > 50% PMNs, WBCs > 100 cells/mm3
- Culture from ascitic fluid often comes back negative
Empiric Treatment of Primary Peritonitis in Cirrhosis
- Cefotaxime 2g IV
- Ceftriaxone 2g IV
- Duration 5 to 10 days
When to treat prophlylactically in cirrhotic pts
-Pts with > 1 episode of SBP Treat with -Bactrim DS qd for 5 days/week -Ciprofloxacin 750mg/ week -Ciprofloxacin 500mg qd
Empiric Treatment of Primary Peritonitis in PD
- Vancomycin + Cefepime
- Vancomycin + Ceftazidime
- Duration 14 to 21 days
Secondary Peritonitis
- Disease process originates from within the abdomen
- Typically polymicrobial
- Surgery is usually needed
Secondary Peritonitis Common pathogens
- E. coli
- Strep
- Bacteroides spp
Treatment of Secondary Peritonitis
- Correction of the disease processes or injuries
- Surgical intervention “source control”
- Fluids
- Empiric abx
Mild to Moderate Infection Secondary Peritonitis Criteria
- APACHE II score < 15
- Perforated or abscessed appendicitis
- Acute diverticulitis
Severe Infection Secondary Peritonitis Criteria
- APACHE II score > 15
- Advanced age
- Immunocompromised pt
- Nosocomial infections (post-op)
Secondary Peritonitis Empiric Treatment for mild to moderate infections
-Single agent
ex. Cefoxitin, ertapenem, moxifloxacin
-Combination Thererapy
ex. Metronidazole
plus
Cefazolin, Ceftriaxone, Cipro/Levo
Secondary Peritonitis Empiric Treatment for Severe Infections
-Single agent
ex. Zosyn, meropenem, imipenem-cilastatin, doripenem
-Combination therapy
ex. Metronidazole
plus
Cipro/Levo, Cefepime, Ceftazadime
When to cover for MRSA
- Surgical history
- Dialysis
- Resident of LTC in last 12mo
- Add Vanco onto treatment regiment
