Lecture 10 - Intra-abdominal Infections Flashcards
Biliary Tract infection common causes
Gram - and +
Non-modifiable risk factors for gallstones
advanced age, 40+
female
FH & genetics
Underlying disease = HIV, Cirrhosis, Crohn’s Disease
Modifiable risk factors for gallstones
Obesity, hyperlipidemia, metabolic syndrome, diabetes
Rapid Weight loss
Meds
Risk factors for Lack of source control?
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
Community Acquired Mild-moderate Biliary Tract infection
Cefazolin 2g
cefuroxime 1.5g
Ceftriaxone 1.5g = most reliable
dont need anaerobe coverage
Community Acquired Severe BTI or High risk
&
Healthcare-associated BTI
Pip/tazo
Imipenem/cilastatin
Meropenem
Doripenem
Cefepime + metronidazole
cipro/levo + metronidazole
How long should you treat for gallbladder infection
4-7 days = just abx
if remove it, then < 24hrs
can switch to oral therapy once stable
Appendicitis Treatment
Generally managed with removal
most ppl treated with abx had to come back to get it removed
duration of appendicitis treatment
< 24 hrs = if appendectomy with no rupture
4-7 days for ruptured/perforated
7-10 days if medically managed (abx)
Diverticulitis risk factors
Diet = low fiber/high fat foods
Lack of physical activity
Obesity
Age
smoking
Meds = NSAIDs, Opioids, Corticosteroids
Uncomplicated Diverticulitis Txm
May not require abx
If given, 4-7days of gram -/anaerobic coverage…should respond in 48-72hrs
If treated outpatient, can use oral
Complicated Diverticulitis txm Moderate-Severe
1st-3rd gen cep + metronidazole
Cipro/lev + metro
Complicated Diverticulitis txm Severe or high risk
Pip/tazo
Mero-, imip-, doripenem
Cefepime or ceftazidime + metronidazole
Primary Peritonitis
infection of peritoneal fluid without surgically treatable source
Secondary peritonitis
infection of peritoneal cavity usually due to rupture/perforation of GI tract
more common
Tertiary peritonitis
Primary/secondary peritonitis that persist for > 48hrs or recurs despite treatment or source control attempts
Peritonitis diagnosis what to look for
> 250 PMN for SBP
100 PMN for peritoneal dialysis peritonitis
SBP Treatment
ceftriaxone 2g or cefotaxime 2g
Levo 750mg
Treat for 5-7 days
SBP prophylaxis/prevention
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
Peritoneal Dialysis Peritonitis Treatment
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
Secondary Peritonitis etiology
usually polymicobial unlike Primary
Secondary Peritonitis Treatments, community acquired mild to moderate
1st-3rd gen cephalosproin + metronidazole
Cipro/levo + metronidazole
Moxi
Cefoxitin
Ertapenem
Tigecycline
Secondary Peritonitis Treatment, community acquired severe or high risk or healthcare associated w/ any severity
Pip/tazo
Mero, imip, doripenem
Cefepime or ceftazidime + metro
Cipro/levo + metro
What’s most important in 2ndary Peritonitis
source control is key, ABX 4-7 days after control
When to consider MRSA for 2ndary Peritonitis
Heathcare associated
Colonized
Grown in cultures
When to consider Candida coverage for 2ndary peritonitis?
if yeast on gram stain or grown in cultures
When to consider enterococcal coverage for 2ndary peritonitis
previously received cephlosporins
immunocompromised
valvular heart disease or prosthetic intravascular materials
