Intraabdominal infections and abscesses Flashcards
Most common manifestation of Primary spontaneous bacterial peritonitis
Fever
Common cell count finding in ascitic fluid in PBP
> 250 PMNs/uL is diagnostic for PBP
Treatment for PBP
should cover gram-negative aerobic bacilli and gram-positive cocci
3rd gen cephalosporin (cefotaxime 2g IV q8h or ceftriaxone 2 gm q24) or penicillin/B lactamase inhibitor combinations (Piptazo 3.375 gm IV q6h
develops when bacteria contaminate the peritoneum as a result of spillage from an intraabdominal viscus
Secondary peritonitis
Treatment of secondary bacterial peritonitis
includes early administration of antibiotics aimed particularly at aerobic gram-negative bacilli and anaerobes
Etiologic agent of Continuous ambulatory peritoneal dialysis (CAPD) peritonitis
skin organisms
Characteristics of dialysate in patients with CAPD peritonitis
cloudy and contains > 100 WBC/uL, >50% of which are neutrophils
Most common causative agent for CAPD peritonitis
Staphylococcus aureus
Empirical treatment for CAPD peritonitis
directed at S. aureus, ConS, and gram-negative bacilli until the results of cultures become available
Options
Cefazolin and a fluoroquinolone or a 3rd generation cephalosporin
Empirical treatment for CAPD peritonitis
directed at S. aureus, ConS, and gram-negative bacilli until the results of cultures become available
Options
Cefazolin and a fluoroquinolone or a 3rd generation cephalosporin
MRSA - vancomycin + gram negative coverage with an aminoglycoside, ceftazidime, cefepime or a carbapenem
Indication for immediate removal of CAPD catheter
Fungal infection
forms in untreated peritonitis if overt gram-negative sepsis either does not develop or develops but is not fatal
Intraabdominal abscess
imaging with highest yield for intrabadominal abscess
Abdominal CT
Algorithm for the management of patients with intraabdominal abscess by percutaneous drainage
Principle of treatment of intraabdominal infections
involves determination of the initial focus of infection, adminsitration of broad-spectrum antibiotics targeting the organisms involved and performance of a drainage procedure if one or more definitive abscesses have formed
Most common associated disease with liver abscess
diseases of the biliary tract
Most common presenting sign of liver abscess
Fever
Single most reliable laboratory finding of liver abscess
Elevated serum concentration of alkaline phosphatase (seen in >70% of patients)
Imaging studies for liver abscesss
Ultrasonography, CT scan, indium-labeled WBC or gallium scan, and MRI
Mainstay of therapy for intrabdominal abscesses
Drainage
Factors predicting the failure of percutaneous drainage and therefore may favor primary surgical intervention
- multiple sizable abscesses
- viscous abscess contents that tend to plug the catheter
- associated disease (disease of the biliary tract) requiring surgery
- presence of yeast
- communication with an unteated obstructed biliary tree
- lack of a clinical response to percutaneous drainage in 4-7 days
Treatment of candidal liver abscess
initial administration of liposomal amphotericin B (3-5 mg/kg IV daily) or an echinocandin with subsequent fluconazole therapy
-clinically stable: may use fluconazole alone (6 mg/kg daily)
Most common associated infection for splenic abscess
Bacterial endocarditis
Most sensitive diagnostic tool for splenic abscess
CT scan of the abdomen
Most common bacterial isolate from splenic abscess
Streptococcal sp
Standard of treatment for splenic abscess
Splenectomy with adjunctive antibiotics
Most important factor in successful treatment of splenic abcess
Early diagnosis
Organisms that need to be covered through vaccination in patients who will undergo splenectomy
Encapsulated organisms
- Streptococcus pneumoniae, Haemophilus influenza, Neisseria meningitidis
Most common cause of perinephric and renal abscesses
Urinary tract infection (>75%)
Most important risk factor associated with the development of perinephric abscess
Concomitant nephrolithiasis obstructive urinary flow
Most frequently encountered organisms in perinephric and renal abscess
E. coli, Proteus sp, and Klebsiella sp
Hallmark of candidal renal abscess caused by ascension from the baldder
Ureteral obstruction with large fungal balls
Most useful diagnostic modalities for renal abscess
Renal ultrasonography and abdominal CT
Treatment for perinephric and renal abscess
Includes drainage of pus and antibiotic therapy directed at the organisms recovered
Treatment of Psoas abscess
surgical drainage and administration of an antibiotic regimen directed at the inciting organisms
Treatment of Psoas abscess
surgical drainage and administration of an antibiotic regimen directed at the inciting organisms
