Intraabdominal infections

Question 1

What are the types of intra-abdominal infections

Answer 1

Peritonitis, Abscesses, Complicated intra-abdominal infection (CIAI) (secondary peritonitis), Cholecystitis and cholangitis, appendicitis

Question 2

What are the main types of enterics bacteria, common GI anaerobes

Answer 2

E. coli and Klebsiella/bacteroides species

Question 3

What gram positive bacteria needs to be accounted for more when the infection is healthcare associated

Answer 3

Pseudomonas

Question 4

What antibiotics work best against enterobacteriaceae

Answer 4

Ceftriaxone, Pip/Taz, Cefepime

Question 5

What antibiotic types work best against GI anaerobes (bacteriodes, clostridium peptostreptococcus)

Answer 5

Pip/Taz, carbapenems, metronidazole

Question 6

What antibiotic types work best against pseudomonas

Answer 6

Pip/taz, carbapenems EXCEPT ertapenem, cefipme

Question 7

What resistance mechanisms would Carbapenems be used for

Answer 7

Extended Spectrum Beta-lactamases (ESBL)

Question 8

What antibiotics are enterococcus faecalis susceptible to

Answer 8

Ampicillin, ampicillin/sulbactam, Pip/Taz, imipenem, vancomycin, linezolid, daptomycin

Question 9

What antibiotics are used for Vancomycin resistant Enterococcus faecium (VRE)

Answer 9

Daptomycin or linezolid

Question 10

What is peritonitis, what is the difference between primary and secondary

Answer 10

Inflammatory response of peritoneum secondary to bacteria, primary has an unknown cause and is spontaneous while secondary is due to known cause

Question 11

What is peritoneal dialysis-associated, what orgamism is common for causing this

Answer 11

Flora following the catheter to the peritoneium causes inflammation, Staph aureus

Question 12

What patients are more likely to experience Spnetaneous bacterial peritonitis (SBP/ primary peritonitis)

Answer 12

patients with liver failure and alcoholic cirrhosis

Question 13

What medication increase the risk for SBP

Answer 13

PPIs

Question 14

What are presentation symptoms someone with SBP should have

Answer 14

fever, abdominal distention, abdominal pain, worsening altered mental status, N/V, hypovolemic hypotension

Question 15

How is SBP diagnosed

Answer 15

Ascitic fluid has PMN greater than 250 cells/mm3

Question 16

What organisms usually cause SBP

Answer 16

Stretococcus species, enterics, NO ANAEROBES

Question 17

What are the treatment options for SBP, how long is the duration of therapy and when should patients feel better

Answer 17

Ceftriaxone and cefotaxime, 5 days, 24-48 hours

Question 18

When would a patient get prophylaxis for SBP, what are the prophylactic drugs

Answer 18

If they get SBP at all they need prophylaxis/ Levofloxacin, Ciprofloxacin or Bactrim

Question 19

T/F: SBP can have positive gram-stain culture but could also be negative as well while also just being monomicrobial

Answer 19

True

Question 20

What is an abscesses, how are they usually treated

Answer 20

focal collection of necrotic tissue, bacteria, inflammatory cells and my preceded peritonitis

Question 21

What causes a complicated intra-abodominal infection, symptoms

Answer 21

anatomical disruption and extend beyond a single organ/ peritoneal space, abdominal distension, hypovolemia, organ failure

Question 22

What are the classifications of CIAI

Answer 22

mild/moderate community acquired, high-risk community-acquired, healthcare associated

Question 23

What are the bacteria associated with CIAI

Answer 23

Enterics, anaerobes, pseudomonas

Question 24

What antibiotics are used to treat mild/moderate infection treatment CIAI

Answer 24

Cefoxitin, Metronidazol PLUS Ceftriaxone or ceftotaxime

Question 25

What antibiotic is used to treat severe and healthcare associated CIAI

Answer 25

Pip/Taz

Question 26

What last resort antibiotics would be used for mild to moderate CIAI, community acquired/high risk

Answer 26

ertapenem/ imipenem/cilastatin, meropenem, doripenem

Question 27

What is cholecystitis, cholangitis, usuall cause

Answer 27

inflammation of the gallbladder, inflammation of bile ducts/ obstruction of normal bile flow due to gallstones or possibly tumor or stricutres

Question 28

T/F: Cholecystitis usually needs antibiotics while cholangitis does not usually need antibiotics

Answer 28

False: Cholangitis usually needs antibiotics while cholecystitis usually does not need antibiotics

Question 29

What is a key presentation for cholecystitis or cholangitis, what may separate the two

Answer 29

jaundice, Murphy sign positive in cholecystitis

Question 30

What are bacteria that may cause cholecystitis and cholangitis

Answer 30

enterics, enterococcus and usually not anaerobes unless there was biliary enteric anastamosis

Question 31

What antibiotic treats mild to moderate cholecystitis/ cholangitis, high risk or healthcare associated

Answer 31

Ceftriaxone, pip/taz

Question 32

What is appendicitis

Answer 32

Inflammation of the appendix and usually occurs in younger patients

Question 33

What are the ways to deal with Appendicitis, what antibiotics

Answer 33

Surgery and antibiotics (antibiotics preffered first), cefotxin or Metronidazole PLUS ceftriaxone or ceftotaxime

Question 34

When should Daptomycin or linezolid should be strongly considered emperically

Answer 34

a liver transplant or the hospital is known to be colonized with VRE

Question 35

T/F: Anaerobes grow in culture

Answer 35

False: Anaerobes do not grow in culture

Question 36

For CIAI how long should treatment be

Answer 36

4 days if there is surgery