Intraabdominal and SSTI Flashcards
Peritonitis
K
Inflammation of the peritoneum (serous membrane lining the abdominal
cavity)
O
Types
L
Primary
L
Secondary
L
Spontaneous or idiopathic, no primary focus of infection
O
Occurs secondary to an abdominal process
O
Causes of Secondary Peritonitis
O
Peptic ulcer perforation
L
Perforation of a GI organ
K
Appendicitis
L
Endometritis secondary to intrauterine
device
K
Bile peritonitis
L
Pancreatitis
P
Operative contamination
P
Diverticulitis
-
Intestinal neoplasms
O
GI normal flora
S
Peritonitis: Microbiology
D
Stomach and proximal small intestine:
O
Aerobic and facultative gram-positive and gram-negative organisms
K
Ileum
O
E. coli, Enterococcus, anaerobes
O
Large intestine:
L
Anaerobes (i.e., Bacteroides, Clostridium perfringens)
K
Aerobic and facultative gram-positive and gram-negative organisms (i.e., E. coli,
Streptococcus, Enterococcus, Klebsiella, Proteus, Enterobacter)
O
Peritonitis: Clinical presentation
L
Abdominal pain aggravated by motion, rebound tenderness
L
Bowel paralysis
L
Pain with breathing
L
Decreased renal perfusion
O
Ascitic fluid
K
Protein
K
WBCs
K
more than 3 g/dL
K
Therapy or prophylaxis should be limited in
K
Bowel injuries caused by trauma that are repaired within 12 hours (treat for less
than 24 hours)
K
Intraoperative contamination by enteric contents (treat for less than 24 hours)
L
Perforations of the stomach, duodenum, and proximal jejunum (unless patient is
on antacid therapy or has malignancy) (prophylactic antibiotics for less than 24
hours)
K
Acute appendicitis without evidence of perforation, abscess, or peritonitis (treat
for less than 24 hours)
,
Mild to moderate community-acquired infection
K
Cefoxitin
M
Cefazolin, cefuroxime, ceftriaxone, or cefotaxime plus metronidazole
L
Ertapenem
K
Moxifloxacin
L
Ciprofloxacin or levofloxacin plus metronidazole
L
Tigecycline
K
High-risk or severe* community-acquired or health
care–acquired infection
L
Piperacillin/tazobactam •
L
Comorbidities and organ dysfunction
Ceftazidime plus metronidazole or cefepime plus
,
Inability to achieve adequate source control
metronidazole
,k
Presence of malignancy
K
Imipenem/cilastatin or meropenem
K
Severe physiologic disturbance
I
Ciprofloxacin plus metronidazole or levofloxacin plus
metronidazole (not for health care–acquired infections)
K
Immunosuppression
K
High-risk or severe:
I
APACHE II score >15
I
Advanced age
J
Poor nutritional status/low albumin concentration
J
Comorbidities and organ dysfunction
K
Inability to achieve adequate source control
K
Presence of malignancy
J
Severe physiologic disturbance
J
Immunosuppression
K
Therapy duration:
K
4 days (when source control is complete)
J
Cellulitis
K
Acute spreading skin infection that involves primarily the deep
dermis and subcutaneous fat
J
Poorly defined margins
K
Warmth, pain, erythema and edema, and tender lymphadenopathy
J
Malaise, fever, and chills
J
Cellulitis: Microorganism
K
Mostly Streptococcus pyogenes and occasionally S. aureus (rarely
other organisms)
K
Blood cultures are rarely positive and not routinely recommended
unless severe systemic symptoms are present or if the patient is
immunosuppressed
N
Necrotizing Fasciitis
K
Significant systemic symptoms, including shock and organ failure
J
Necrotizing Fasciitis: Microbiology
N
Mixed infection with facultative and anaerobic bacteria (Type 1)
G
S. pyogenes (Type 2)
F
Clostridial myonecrosis (Type 3)
G
perianal abscess,
J
abdominal surgery
J
trauma
J
injection sites in persons who inject drugs
M
varicella
J
minor trauma (cuts, burns, and
splinters),
J
surgical procedures
J
Involves the skeletal muscle.
G
Gas production and muscle necrosis are prominent features of this infection, is
commonly referred to as gas gangrene.
G
Surgical debridement: Most important therapy and often repeated
debridement is necessary
V
Antibiotics are not curative; given in addition to surgery (if used early,
may be effective alone)
G
Non purulent cellulitis
Mild
Moderate
Sever
C
Purulent cellulitis
Mild
Moderate
Sever
Df
Oral antibiotic to cover streptococcus
Penicillin
Cephalexin
Dicloxacillin
Clindamycin
F
Oral antibiotic to cover both MRSA and streptococcus
TMP-SMXor doxycycline + pencillin or amoxicillin or cephalexin
C
Iv antibiotic to cover streptococcus
Pencillin
Cefazolin
Ceftrixone
Clindamycin
F
Iv antibiotic to cover both MRSA and streptococcus
Vancomycin
Daptomycin
Linezolid
Telvancin
Ceftaroline
F
Incision and drainage of abscess, antibiotic not required
D
Incision and drainage of abscess, no antibiotic
F
Incision and drainage , oral antibiotic to cover MRSA
TMP-SMX
Doxycycline
D
Vancomycin + Piperacillin tazobactam or imipenem /cilastatinor meropenem
V
Vancomycin or linezolid + Piperacillin tazobactam or impenem/ cilastain or meropenem or ertapenem or ceftrixone + metronidazole
M
Duration 5 days
F
K
Duration 1-2 week
F
Associated with penetrating trauma
D
Purpulent drainage
C
Nasal continuation with MRSA
D
Concurrent evidence of MRSA infection elsewhere
Cd
Systemic inflammatory response syndrome ( SIRS ) criteria
K
Primary peritonitis in patient with cirrhosis non sever infection
N
Primary peritonitis in patient with cirrhosis sever infection
L
Perforated peptic ulcer
D
Cholangitis
D
Ceftrixone, cefotaxime
,
E.coli, klebsilla, penumococcci
C
Piperacillin /tazobactam , carbapenm
S
Aztreonam + vancomycin
D
Aztreonam + levofloxacin
D
Aztreonam + moxifloxacin
D
Ceftrixone or cefotaxime with or without metronidazole
D
Streptococcus, E.coli
D
E.coli, klebsiella , proteus
D
First generation cephalosporin
D
What is Normal floral of skin
K
Coagulase negative staphylococcus
D
Micrococci
D
Corynebacterium
D
Propiobacterium
D
Acinetbacter
D
Non pharmacology for cellulitis
L
What is the role of clindamycin in necrotizing soft tissue infection
D
