Intraabdominal infections

Question 1

Stomach commonly found bacteria

Answer 1

Streptococcus, Lactobacillus

Question 2

Biliary tract commonly found bacteria

Answer 2

Normally sterile (E. coli, Klebsiella, or enterococci in patient >70 years, acute cholecystisis, jaundice, or common bile duct stones)

Question 3

Proximal small bowel commonly found organisms

Answer 3

Streptococcus, (including enterococci), E. coli, klebsiella, Lactobacillus, diphtheroids

Question 4

Distal Ileum commonly found organisms

Answer 4

E. coli, Klebsiella, Enterobacter, Bacteroides fragilis, Clostridium, peptostreptococci

Question 5

Colon commonly found organisms

Answer 5

Bacteroides spp., peptostreptococci, Clostridium, E. coli, Klebsiella, enterococci, Enterobacter, etc…

Question 6

Primary peritonitis classification

Answer 6

infections where the GI tract integrity has NOT been comprimised

Question 7

Secondary peritonitis classification

Answer 7

infection where the GI tract HAS been perferated

Question 8

Tertiary peritonitis classification

Answer 8

secondary infections that fail to respond to therapy

Question 9

CAPD

Answer 9

Chronic ambulatory peritoneal dyaliss - migration of organisms up the catheter

Question 10

SBP

Answer 10

Spontaneous bacterial peritonitis - translocation from the bloodstream (hematogenous); impared host defenses (ascitic fluid, shunting of blood around liver) (cirrhosis)

Question 11

CAPD organisms

Answer 11

S. aureus (most common), Pseudomonas, Streptococci

Question 12

SBP organisms

Answer 12

E. coli (most common), Klebsiella, S. Pneumoniae

Question 13

CAPD symptoms

Answer 13

mild symptoms, cloudy effluent

Question 14

SBP symptoms

Answer 14

altered mental status, already have liver disease

Question 15

CAPD diagnosis

Answer 15

> 50% PMNs/mm3

Question 16

SBP diagnosis

Answer 16

> /= 250 PMNs/m3

Question 17

secondary infections

Answer 17

1. fever
2. pain
3. decreased bowel sounds
4. shock

Question 18

CAPD drugs

Answer 18

gram + (cafazolin or Vanc) + gram - coverage (AG, caftazidime, carbapenem, cipro, levo). Can use intraperitoneal ABX

Question 19

SBP drugs

Answer 19

1. cefotaxime, ceftriaxone, flouroquinolones

2. secondary SBP prophylaxis - flouroquinolone or TMP/SMX

Question 20

secondary community acquired organisms (mild to moderate)

Answer 20

gram -, streptococci, and anaerobes

Question 21

secondary community acquired high risk, or healthcare acquired organisms

Answer 21

broaden to cover pseudomonas

Question 22

secondary community acquired drugs(mild to moderate)

Answer 22

1. Single agents - ticaricillin/clavulanate, cofoxitin, ertapenem
2. combo - metronydazole + cephalosporins OR quinolones

Question 23

secondary community acquired high risk, or healthcare acquired drugs

Answer 23

1. single agent - antipseudomonal carbapenems, PIP/TAZO

2. combo - cefepime, ceftazidime, cipro or levo + metronidazole