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PT2 ID 7-9 > Surgical prophylaxis and C.diff therapeutics > Flashcards

Surgical prophylaxis and C.diff therapeutics Flashcards

1
Q

patients at high risk for surgical infection

A
  • obese
  • extremes of age
  • smoking history
  • malnutrition
  • underlying illness
  • bacterial colonization
  • immunosuppressive therapy
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2
Q

primary prophylaxis agent

A

cefazolin

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3
Q

drug to use for prophylaxis if PCN allergy is present in pts at risk of GPC or MRSA

A

vancomycin

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4
Q

general prophylaxis treatment strategy

A
  • start Abx w/in 1 hr of incision
  • if surgery is > 2 half lives then redose
  • no more than 24 hr prophylaxis
  • CDI risks
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5
Q

clean surgeries

A
  • cardio-thoracic cavity
  • vascular
  • orthopedic
  • neurosurgery
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6
Q

drugs to use in clean prophylaxis

A
  • cefazolin 1-2g IV q8h
  • cefuroxime 1.5 IV q12h for CABG
  • vancomycin 15 mg/kg IV q12h
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7
Q

clean-contaminated surgeries

A
  • head/neck
  • gastroduodenal
  • colorectal
  • appendectomy
  • biliary
  • high risk genitourinary
  • OB/GYN
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8
Q

anaerobes in which clean-contaminated

A
  • head/neck
  • appendectomy
  • OB/GYN
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9
Q

drugs for clean-contaminated prophylaxis

A
  • cefazolin (anaerobes in upper airway and GNB)

- cefoxitin (anaerobes in GI)

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10
Q

contaminated wounds

A
  • bullet wound
  • surgical mishap
  • GI spillage
  • trauma <4h before*
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11
Q

signs of a dirty wound

A
  • purulence
  • abscess
  • tissue perforation
  • trauma >4h before*
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12
Q

empiric treatment for contaminated wound

A

Vanco +

  • Zosyn
  • cefotasime + metronidazole
  • ertapenem
  • imipenem
  • cipro +metronidazole
  • levo+metronidazole
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13
Q

complications of C.diff

A
  • pseudomembranous colitis
  • toxic megacolon (friable colon)
  • sepsis
  • death
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14
Q

risks for C.difficile

A
  • antibiotic use in past month

- contamination on health care workers hands

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15
Q

antibiotic that causes the most C.diff

A

clindamycin

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16
Q

strain name of C.diff

A

NAP

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17
Q

C.diff is resistant to what abx

A

fluoroquinolones

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18
Q

symptoms of C.diff

A
  • nausea
  • abdominal distention
  • profuse watery diarrhea
  • possible bloody streaks
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19
Q

lab signs of C.diff

A
  • WBC > 15,000

- fever > 100 F

20
Q

initial treatment for mild-moderate CDI

A

metronidazole 500 mg PO TID x 10-14

<15,000 WBC and stable SCr

21
Q

initial treatment episode of severe CDI

A

vanco 125 mg PO QID x 10-14

>15,000 WBC and 50% increase in SCr

22
Q

initial treatment episode for severe CDI with toxic megacolon

A

-vanco 500 mg PO QID
+ vanco retention enema 500 mg in 100 mL NS PR q6h
+/- metronidazole 500 mg IV q6h

23
Q

treatment for 2nd episode of C.diff

A
  • initial regimen x 14
  • for severe symptoms PO vanco
  • may still use metronidazole
24
Q

treatment of 3rd episode of C.diff

A
  • vanco 125 PO QID x 10-14d
  • vanco taper over 6 weeks
  • NO METRONIDAZOLE
25
Q

vancomycin taper

A
  • all doses 125 mg
  • 1st week QID
  • 2nd week BID
  • 3rd week q24h
  • 4th week every other day
  • 5th-6th week q72h
26
Q

options when vancomycin is ineffective

A
  • rifaximin
  • fidaxomicin
  • fecal transplant
27
Q

avoid drugs that do what when treating C.diff

A

inhibit peristalsis

28
Q

role of probiotics in preventing CDI

A

unclear, need larger trials

29
Q

normal mouth flora

A
  • anaerobic strep (peptococcus)

- strep

30
Q

normal stomach flora

A
  • oral flora
  • strep
  • lactobacillus
31
Q

normal small intestine duodenum, jejunum flora

A
  • lacatobacillus
  • strep
  • enterobacteriaceae (E.coli, klebsiella, enterbacter)
32
Q

normal Ileum flora

A
  • enterobacteriaceae

- anaerobes (bacteroides)

33
Q

normal large intestine flora

A
  • lactobacilli
  • strep
  • enterococcus
34
Q

why does fidaxomicin work well for C.diff

A

it has minimal systemic absorption so it stays in gut

35
Q

most common bacteria in biliary tract

A

enterobacteriaceae

36
Q

monotherapy treatment options for mild-mod abdominal infections outside biliary tract

A
  • cefoxitin 2g IV q6h
  • ertapenem 1g IV q24h
  • moxifloxacin 400 mg IV q24h
  • tigecycline 100 mg IV load then 50 mg q12h
  • ticarcillin/clavulanate 3.1 g q6h
37
Q

combos to use in mild-moderate intraabdominal infection

A

metronidazole 500 mg q8h +

  • cefazolin 1-2g q8h
  • cefuroxime 1.5g q12h
  • ceftriaxone 1-2g q12-24h
  • levofloxacin 750mg q24h
  • ciprofloxacin 400 mg q12h
38
Q

examples of higher severity intraabdominal infection

A
  • severely ill
  • advanced age
  • immunocompromised pts.
39
Q

monotherapies for severe intraabdominal infection

A
  • imipenem-cilastatin 500 mg q6h
  • meropenem 1g q8h
  • piperacillin/tazobactam 3.375g q6h
40
Q

combination therapies for severe intraabdominal infections

A

metronidazole +

  • cefepime
  • ceftazidime
  • ciprofloxacin
  • levofloxacin
41
Q

treatment for biliary infections

A

normal severe intraabdominal infection drugs PLUS vancomycin

42
Q

use of metronidazole and carbapenems

A

probably don’t do it since carbapenems do have anaerobic activity

43
Q

duration of therapy for intraabdominal infection

A

4-7 days unless it can’t be controlled

44
Q

duration of therapy for intraabdominal infection if bacteremia is present

A

14 days

45
Q

how long to treat following cholecystectomy

A

24 hours unless infection is beyond gallbladder wall

46
Q

oral options for oral antibiotics in intraabdominal infections when no resistance noted

A
  • moxi
  • cipro + metro
  • levo + metro
  • cephalosporin + metro
  • augmentin
47
Q

resistance of bacteroides

A
  • cefoxitin 5-30%
  • cefotetan 17-87%
  • clindamycin 19-35%

PT2 ID 7-9 (3 decks)

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