INTRA-ABDOMINAL INFECTIONS/ABSCESS Flashcards
TRUE OR FALSE: In adults, primary bacterial peritonitis (PBP) occurs most commonly in conjunction with cirrhosis of the liver
TRUE
The most common manifestation of primary peritonitis which is reported in up to 80% of patients.
* Abdominal pain, an acute onset of
FEVER
- Abdominal pain, an acute onset of symptoms, and peritoneal irritation during physical examination can be helpful diagnostically
What is the PMN cut-off that is diagnostic of PBP?
> 250 PMNs/μL
TRUE OR FALSE: In PBP, a single organism is typically isolated
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
Treatment regimen that may provide good initial coverage in moderately ill patients with PBP
Third-generation cephalosporins such as cefotaxime (2 g q8h, administered IV)
Treatment regimen that may be appropriate for nosocomially acquired PBP until culture results become available.
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)
TRUE OR FALSE: Secondary bacterial peritonitis develops when bacteria contaminate the peritoneum as a result of spillage from an intraabdominal viscus
TRUE
- mixed flora in which facultative gram-negative bacilli and anaerobes predominate
- Secondary peritonitis can result primarily from chemical irritation and/or bacterial contamination.
TRUE OR FALSE: CAPD-associated peritonitis is usually caused by multiple organism.
FALSE
* CAPD-associated peritonitis is usually caused by a single organism.
The most common organism in CAPD peritonitis
The most common organisms are Staphylococcus species
What is/are the drug/s of choice for CAPD peritonitis in areas with high rates of infection with methicillin-resistant S. aureus?
Vancomycin should be used and gram-negative coverage may need to be broadened—e.g., with an aminoglycoside, ceftazidime, cefepime, or a carbapenem
In fungal infections, the catheter should not be removed immediately
FALSE. The catheter should be removed immediately
The organ most subject to the development of abscesses
Liver
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
Bacteroides fragilis
The most common cause of liver abscess
associated disease of the biliary tract
most common presenting sign of liver abscess.
Fever
The single most reliable laboratory finding in liver abscess
an elevated serum concentration of alkaline phosphatase, which is documented in 70% of patients with liver abscesses
The mainstay of therapy for intraabdominal abscesses, including liver abscesses
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.
The treatment regimen for candidal liver abscess
liposomal amphotericin B (3–5 mg/kg IV daily) or an echinocandin, with subsequent fluconazole therapy
The most common route for the development of splenic abscess
hematogenous spread of infection is more common
the most common associated infection in the development of splenic abscess
bacterial endocarditis
The most common bacterial isolates from splenic abscesses
Streptococcal species
*followed by S. aureus—presumably reflecting the associated endocarditis
The standard treatment regimen and remains the best approach for complex, multilocular abscesses or multiple splenic abscesses
splenectomy with adjunctive antibiotics
The most common cause of perinephric and renal abscesses
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
The most important risk factor for the development of perinephric and renal abscesses
concomitant nephrolithiasis obstructing urinary flow
