Lecture 10 - Intra-abdominal Infections

Question 1

Biliary Tract infection common causes

Answer 1

Gram - and +

Question 2

Non-modifiable risk factors for gallstones

Answer 2

advanced age, 40+
female
FH & genetics
Underlying disease = HIV, Cirrhosis, Crohn’s Disease

Question 3

Modifiable risk factors for gallstones

Answer 3

Obesity, hyperlipidemia, metabolic syndrome, diabetes
Rapid Weight loss
Meds

Question 4

Risk factors for Lack of source control?

Answer 4

High risk:
Severe disease = sepsis
Age 70+
Immunosuppresion
Malignancy

Other:
Low albumin
poor nutritional status
Delay in initial intervention > 24hrs
High degree of peritoneal involvement

Question 5

Community Acquired Mild-moderate Biliary Tract infection

Answer 5

Cefazolin 2g
cefuroxime 1.5g
Ceftriaxone 1.5g = most reliable

dont need anaerobe coverage

Question 6

Community Acquired Severe BTI or High risk
&
Healthcare-associated BTI

Answer 6

Pip/tazo
Imipenem/cilastatin
Meropenem
Doripenem
Cefepime + metronidazole
cipro/levo + metronidazole

Question 7

How long should you treat for gallbladder infection

Answer 7

4-7 days = just abx

if remove it, then < 24hrs

can switch to oral therapy once stable

Question 8

Appendicitis Treatment

Answer 8

Generally managed with removal

most ppl treated with abx had to come back to get it removed

Question 9

duration of appendicitis treatment

Answer 9

< 24 hrs = if appendectomy with no rupture
4-7 days for ruptured/perforated
7-10 days if medically managed (abx)

Question 10

Diverticulitis risk factors

Answer 10

Diet = low fiber/high fat foods
Lack of physical activity
Obesity
Age
smoking
Meds = NSAIDs, Opioids, Corticosteroids

Question 11

Uncomplicated Diverticulitis Txm

Answer 11

May not require abx
If given, 4-7days of gram -/anaerobic coverage…should respond in 48-72hrs

If treated outpatient, can use oral

Question 12

Complicated Diverticulitis txm Moderate-Severe

Answer 12

1st-3rd gen cep + metronidazole
Cipro/lev + metro

Question 13

Complicated Diverticulitis txm Severe or high risk

Answer 13

Pip/tazo
Mero-, imip-, doripenem
Cefepime or ceftazidime + metronidazole

Question 14

Primary Peritonitis

Answer 14

infection of peritoneal fluid without surgically treatable source

Question 15

Secondary peritonitis

Answer 15

infection of peritoneal cavity usually due to rupture/perforation of GI tract

more common

Question 16

Tertiary peritonitis

Answer 16

Primary/secondary peritonitis that persist for > 48hrs or recurs despite treatment or source control attempts

Question 17

Peritonitis diagnosis what to look for

Answer 17

> 250 PMN for SBP
100 PMN for peritoneal dialysis peritonitis

Question 18

SBP Treatment

Answer 18

ceftriaxone 2g or cefotaxime 2g
Levo 750mg

Treat for 5-7 days

Question 19

SBP prophylaxis/prevention

Answer 19

Hx of SBP:
Cipro 500 QD > 1yr
Bactrim QD > 1yr

If Cirrhosis + current GI bleed or ascitic protein < 1.5g/dl = ceftriaxone X 7 days

Diuresis - furosemide/spirono 40:100 ratio
Decrease PPI use

Question 20

Peritoneal Dialysis Peritonitis Treatment

Answer 20

Start broad Gram + (Vanco/cefazolin) & Gram - (Cefepime, Ceftazidome, AGs)

Tailor therapy based on peritoneal fluid culture results

Treat for at least 14 days, effluent should be clear by day 5

Intraperitoneal route preferred unless signs of sepsis

Question 21

Secondary Peritonitis etiology

Answer 21

usually polymicobial unlike Primary

Question 22

Secondary Peritonitis Treatments, community acquired mild to moderate

Answer 22

1st-3rd gen cephalosproin + metronidazole
Cipro/levo + metronidazole

Moxi
Cefoxitin
Ertapenem
Tigecycline

Question 23

Secondary Peritonitis Treatment, community acquired severe or high risk or healthcare associated w/ any severity

Answer 23

Pip/tazo
Mero, imip, doripenem
Cefepime or ceftazidime + metro
Cipro/levo + metro

Question 24

What’s most important in 2ndary Peritonitis

Answer 24

source control is key, ABX 4-7 days after control

Question 25

When to consider MRSA for 2ndary Peritonitis

Answer 25

Heathcare associated
Colonized
Grown in cultures

Question 26

When to consider Candida coverage for 2ndary peritonitis?

Answer 26

if yeast on gram stain or grown in cultures

Question 27

When to consider enterococcal coverage for 2ndary peritonitis

Answer 27

previously received cephlosporins
immunocompromised
valvular heart disease or prosthetic intravascular materials