Intraabdominal infections-Table 1 Flashcards
What is considered a left shift?
> 70%neutrophils
What is an important thing to remember about diverticulitis and lab findings?
They will NOT always have an elevated white count!! Don’t assume they aren’t sick because the WBC are WNL
What causes the early alkalosis in secondary and tertiary peritonitis?
Hyperventilation and vomiting
Which microbes can survive in the stomach?
H pylori and C diff spores
What is the predominant in the large bowel?
B frag
What abx covers B frag?
Pip/taz
What are the bacteria that predominate intra-abdominal infections?
Aerobic bacteria: ecoli, kleb, enterococcus, pseudomonas( mainly health care
Anaerobic bacteria: b frag
What should you suspect if you find staph a in the abdomen?
Introduction from a surgical procedure
Why is amp/sulb not recommended in mild-mod intra abdominal infection?
Too much e coli resistance
Why are cefotetan and clindamycin not recommended in mild-mod intraab infections?
There is too much b frag involved and way too much resistance! Don’t ever use these
Is empiric coverage of enterococcus recommended in mild-mod intra ab infections?
No, this isn’t necessary for community acquired
What is the tx for community associated mild-mod intra ab infection?
•Cipro plus metronidazole OR •Cefazolin plus metronidazole OR Ceftriaxone plus metronidazole
What is the tx for community associated severe intra ab infections?
•Cipro plus metronidazole OR •Cefepime plus metronidazole OR •Piperacillin/tazobactam OR •Meropenem (severe PCN allergy/high suspicion of ESBL)
How is health care associated tx?
Severe as above
In a non-septic pt presenting to the health care setting, how much time do you have as a provider before your pts needs to receive abx?
8 hours maximum
How long do you have before you need to admin abx to a pt presenting in sepsis?
Tx within an hour
If a pt has a perfed appendix and the c/s is showing more than one organism, what should you prescribe coverage for?
Anaerobes- even if none grew!
What is the duration of abx therapy in an established mild-mod intraab infection?
4-7 days, unless no source control
What broadspec abx have near 100% coverage for B frag?
Pip/tazo
Amp/sulb
Carbapenems
Do the above drugs need metro as a companion to cover anaerobes?
NO
What are PO options for mild-mod intraab infections?
•Cipro + metronidazole •Levofloxacin + metronidazole •Moxifloxacin + metronidazole •Cephalexin + metronidazole •Cefuroxime + metronidazole (improved E coli coverage)– preferred Amoxicillin/clavulanic acid*
What is the duration of therapy for an abscess if it is drained? Undrained?
- 3-7 days after the drainage
- weeks based
What is the duration of therapy for non perf appendicitis? perfed?
- periop prophylaxis single dose to 24 hours
- 4-7 days
How long is the duration of therapy for cholecystitis if nonoperative? What is the duration of therapy for cholecystitis with non perf and perf?
- 5-10 days
- up to 24 hrs hours
- 4-7 days
What is the duration of therapy for uncomplicated diverticulitis? Mod-severe divertic?
- none
- 4-7 days
What is the duration of therapy for early intervention gastro duodenal perf ( 24hrs)?
- perioperative prophylaxis
- 4- 7 days
What is the duration of therapy for non-necrotic pancreatitis without pancreatitis? For necrotic with infection?
- none
- 4-7
What is the duration of therapy for peritonitis?
4-7 days
What is primary peritonitis?
spontaneous, monomicrobial infection of ascitic fluid and peritoneal membrane in pts w/ESLD
What is secondary peritonitis?
related to pathological process in visceral organ. Peritoneal infections that arise from hollow viscus inflammation and/or perforation (contained/tx by source control procedure and antibiotics)
What is the clinical presentation of acute cholecystitis?
abd pain, usu RUQ or epigastric. Pain usu steady and severe, N/V/anorexia. Fatty food intake prior to attack.
What are the common bugs that infect the bile?
E coli (41%) , Enterococcus (12%) , Klebsiella, Enterobacter
How is acute cholecystitis diagnosed?
Clinical picture +gallstones on imaging
What lab values are associated with acute cholecystitis?
•↑WBC, TBili, AlkPhos often normal.
What are the imaging modalities for acute cholescytitis?
- US (+ stones, thickened GB wall)
- HIDA (cholescintigraphy)—IV radionuclide taken up by liver, excreted into bile
- MRCP (magnetic resonance)—noninvasive method to eval bile ducts
What is the tx for acute chole?
Urgery and abx to decrease wound infection for 24-48hrs postop
What are the most common bugs in necrotizing pancreatitis?
E coli, Pseudomonas, Klebsiella, Enterococcus
When would you tx necrotizing pancreatitis prophylactically?
If there is extensive necrosis tx with abx 7-10 days
What is the potential harm in tx prophylactically? What is really the best way to tx?
Potential for superimposed fungal infection
Wait until you know what is causing the infection BEFORE starting abx
How if infected necrosis diagnosed?
CT guided percut aspiration
What is the tx of choice for necro pancreatitis?
Surgical debridement then abx based on C/S
