INTRA-ABDOMINAL INFECTIONS/ABSCESS

Question 1

TRUE OR FALSE: In adults, primary bacterial peritonitis (PBP) occurs most commonly in conjunction with cirrhosis of the liver

Answer 1

TRUE

Question 2

The most common manifestation of primary peritonitis which is reported in up to 80% of patients.
* Abdominal pain, an acute onset of

Answer 2

FEVER

• Abdominal pain, an acute onset of symptoms, and peritoneal irritation during physical examination can be helpful diagnostically

Question 3

What is the PMN cut-off that is diagnostic of PBP?

Answer 3

> 250 PMNs/μL

Question 4

TRUE OR FALSE: In PBP, a single organism is typically isolated

Answer 4

TRUE

• if PBP is suspected and multiple organisms including anaerobes are recovered from the peritoneal fluid, the diagnosis must be reconsidered and a source of secondary peritonitis sought

Question 5

Treatment regimen that may provide good initial coverage in moderately ill patients with PBP

Answer 5

Third-generation cephalosporins such as cefotaxime (2 g q8h, administered IV)

Question 6

Treatment regimen that may be appropriate for nosocomially acquired PBP until culture results become available.

Answer 6

Broader empirical coverage aimed at resistant hospital-acquired gram-negative bacteria (e.g., treatment with a carbapenem or newer agents, such as ceftolozane-tazobactam or ceftazidime-avibactam)

Question 7

TRUE OR FALSE: Secondary bacterial peritonitis develops when bacteria contaminate the peritoneum as a result of spillage from an intraabdominal viscus

Answer 7

TRUE

• mixed flora in which facultative gram-negative bacilli and anaerobes predominate
• Secondary peritonitis can result primarily from chemical irritation and/or bacterial contamination.

Question 8

TRUE OR FALSE: CAPD-associated peritonitis is usually caused by multiple organism.

Answer 8

FALSE
* CAPD-associated peritonitis is usually caused by a single organism.

Question 9

The most common organism in CAPD peritonitis

Answer 9

The most common organisms are Staphylococcus species

Question 10

What is/are the drug/s of choice for CAPD peritonitis in areas with high rates of infection with methicillin-resistant S. aureus?

Answer 10

Vancomycin should be used and gram-negative coverage may need to be broadened—e.g., with an aminoglycoside, ceftazidime, cefepime, or a carbapenem

Question 11

In fungal infections, the catheter should not be removed immediately

Answer 11

FALSE. The catheter should be removed immediately

Question 12

The organ most subject to the development of abscesses

Answer 12

Liver

Question 12

This organism accounts for only 0.5% of the normal colonic flora, is the anaerobe most frequently isolated from intraabdominal infections, is especially prominent in abscesses, and is the most common anaerobic bloodstream isolate

Answer 12

Bacteroides fragilis

Question 13

The most common cause of liver abscess

Answer 13

associated disease of the biliary tract

Question 14

most common presenting sign of liver abscess.

Answer 14

Fever

Question 15

The single most reliable laboratory finding in liver abscess

Answer 15

an elevated serum concentration of alkaline phosphatase, which is documented in 70% of patients with liver abscesses

Question 16

The mainstay of therapy for intraabdominal abscesses, including liver abscesses

Answer 16

Drainage

• percutaneous (with a pigtail catheter kept in place or possibly with a device that can perform pulse lavage to fragment and evacuate the semisolid contents of a liver abscess), transluminal (with endoscopic ultrasound guidance), or surgical.

Question 17

The treatment regimen for candidal liver abscess

Answer 17

liposomal amphotericin B (3–5 mg/kg IV daily) or an echinocandin, with subsequent fluconazole therapy

Question 18

The most common route for the development of splenic abscess

Answer 18

hematogenous spread of infection is more common

Question 19

the most common associated infection in the development of splenic abscess

Answer 19

bacterial endocarditis

Question 20

The most common bacterial isolates from splenic abscesses

Answer 20

Streptococcal species

*followed by S. aureus—presumably reflecting the associated endocarditis

Question 21

The standard treatment regimen and remains the best approach for complex, multilocular abscesses or multiple splenic abscesses

Answer 21

splenectomy with adjunctive antibiotics

Question 22

The most common cause of perinephric and renal abscesses

Answer 22

urinary tract infection

• > 75% of perinephric and renal abscesses arise from a urinary tract infection
• Infection ascends from the bladder to the kidney, with pyelonephritis preceding abscess development

Question 23

The most important risk factor for the development of perinephric and renal abscesses

Answer 23

concomitant nephrolithiasis obstructing urinary flow