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What bacteria types are common un the upper GI?
What bacteria types are common in the mid-GI?
What bacteria types are common in the lower GI?
What are the common bacteria of Peritonitis?
- E. coli
- Streptococcus pneumonia
How is Peritonitis diagnosed?
Presence of ascites, bacteria in ascitic fluid
What are the S/S of Spontaneous peritonitis?
- fever & chills
- abdominal pain, distention, vomiting
- cloudy peritoneal fluid
- Usually in chronic alcoholics with acites
What is the treatment for Spontanteous peritonitis?
- empiric: 3rd generation cephalosporin (ceftriaxone, ceftazadime, cefotaxime) or cefepime
- Add an anaerobic agent (clindamycin or metronidazole) if no response
- Continue for 10-14 day
What bacteria often bacterial etiology of Secondary peritonitis?
- Usually Gram –
- Lactobaccilli, streptococcus and oral anaerobes - peptostreptococcus, fusobacterium, bacteroides
- biliary tract: E. coli, Klebsiella, enterococci
- large bowel: anaerobes
What are the S/S of Secondary Peritonitis?
- abdominal pain, nausea, vomiting
- involuntary abdominal guarding
- hypoactive bowel sounds
- tense, rigid, board-like abdomen
- diminished urine output
What is the treatment for Secondary bacterial peritonitis?
- clindamycin or metronidazole + an antipseudomonal fluoroquinalone (ciprofloxacin) or aminoglycoside
- any of the following alone:
- (All have G- and anerobic coverage)
- Probably wanto to add Cipro to ertapenem and ampicillin/sulbactam to cover pseudomonas, as neither have that)
- Add a quinolone for persistent infection
Continuous Ambulatory Peritoneal Dialysis-Associated Peritonitis is usually what organism and what drug is usually used to treat it?
What are the treatments available for Continuous Ambulatory Peritoneal Dialysis-Associated Peritonitis?
- vancomycin if gram positive organisms
- aminoglycosides or ciprofloxacin for gram negatives
- either above may be give IV or intraperitoneal
- Dosages significantly less than IV
- Gentamicin or tobramycin 8 mg/L
- Vancomycin 30 mg/L
What are the potential bacterial etiologies of Continuous Ambulatory Peritoneal Dialysis-Associated Peritonitis?
- coagulase negative staphylococci
- Staphylococcus aureus (MRSA)
- gram negatives
What bacteria usually cause Cholecystitis and Cholangitis?
- G + more common because higher up in GI tract, though G- still significant
- E. coli,
- Klebsiella spp.
What are the S/S of Acute Cholecystitis and Cholangitis?
- fever, jaundice & abdominal pain (Charcot’s triad)
- right upper quadrant pain
- nausea & vomiting
- leukocytosis, hyperbilirubinemia, elevated liver enzymes
What are the treatment options for Cholecystitis and Cholangitis?
- piperacillin/tazobactam or aminoglycoside + clindamycin or metronidazole
- or ceftazadime or cefepime + metrondiazole or clindamycin
- Carbapenem – imipenem/cilastin or meropenem or doripenem