ID: Intra-Abdominal Infections

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ID: Intra-Abdominal Infections
2011-03-07 18:05:14
Intra Abdominal Infections

ID: Intra-Abdominal Infections
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  1. Why does stomach have fewer bacteria?
    • gastric motility
    • bactericidal activity (acidic pH 1-2)
  2. What kind of flora do duodenum and jejunum harbor?
    • oral flora
    • (streptococcus, lactobacillus)
  3. For lower small intestine, what kind of bacteria does ileum harbor?
    how about distal ileum?
    • ileum: facultative GN, GP, obligate anaerobes
    • distal ileum: anaerobe
  4. bacteria in large bowel? distal colon?
    • anaerobic
    • mainly bacteroides
  5. 2 kinds of biliary tract infection
    • cholecystitis
    • cholangitis
    • presence of cholelithiasis
  6. biliary tract infection is mostly ___ infection.
    aerobic GN
  7. S&S of biliary tract infection
    2 BTIs are cholecystitis adn cholangitis

    • RUQ pain, abdominal distention
    • anorexia, NV
    • fever, shaking chils
    • jaundice
  8. labs of bilirary tract infection
    • leukocytosis
    • inc bilirubin, alk phos, aminotransferase
  9. cholecystitis is inflam of __
    gall bladder
  10. gallstone in cholecystitis can result in...
    • increased intraluminal pressure
    • gallbladder distention
    • edema
  11. abx for community acquired mild-mod cholecystitis
    • cefazolin (1st)
    • cefuroxime (2nd)
    • ceftriaxone (3rd)
    • no need to cover anaerobe
  12. abx for nosocomial or community-severe, adv age, immunocompromised cholecystitis?
    • imi, mero, dori (not erta)
    • Zosyn
    • cipro, levo, or cefepime + metronidazole
    • (unlike comm-acq mild-mod, need to consider anaerobe)
  13. cholangitis is inflam of ___
    common bile duct
  14. important difference btwn cholestitis vs. cholangitis
    cholangitis has bloodstream infection
  15. microbiology of biliary tract
    • GN (e coli, kleb)
    • GP (streptococc)
  16. how to treat biliary tract?
    • ultrasonography if suspected
    • early surgical
    • no PO intake
    • NG suction
    • IV fluids & electrolytes
  17. do you need anaerobic therapy for biliary tract?
    no, unless bilirary enteric anastamosis (benign stricture)
  18. should i cover enterococcus for bilirary tract?
    • not required
    • except immunosuppressed pts
  19. do i need AG for biliary tract infection?
    for diabetics or others with signs of GN sepsis
  20. what should i do with the abx if cholecystectomy for bilirary tract?
    d/c abx within 24h unless infection outside of gallbladder
  21. if there is complication with bilirary tract infxn, how long should be the therapy?
    7-14 d
  22. tx options for bilirary tract infection
    • zosyn, timentin, unasyn
    • ertapenem
    • or
    • 3rd cephalo + metro
    • aztreonam + metro
    • cipro + metro
    • moxi
  23. tx for life threatening bilirary tract infxn
    • mero, imi, dori
    • (all carbapenems cept erta)
  24. pathophys of peritonitis?
    • bacterial contamination
    • release of humoral inflamm mediators
    • recruit macrophage, PML
  25. spontaneous bacterial peritonitis is also known as ___.
    primary peritonitis
  26. primary peritonitis is freq in those with ___.
    • cirrhosis
    • ascites
    • hepatitis
    • CHF
    • metastiatic malignancy
    • SLE
  27. does primary peritonitis have intra-abd abnormality?
  28. pathophys of primary peritonitis?
    • bacterial translocation
    • bacterial overgrowth
    • dec motility
    • sturctural damage
    • dec host defense mechanism
  29. do you need to cover for GN in primary peritonitis?
    • GN aerobic
    • e.coli
  30. do you need to cover for GP in primary peritonitis?
    • yes
    • GM cocci
    • strep, pneumo, entero
  31. do you need to cover anaerobe in primary peritonitis?
  32. which two abx would you not need in primary peritonitis? why
    • no AG: nephrotox
    • no need to cover anaerobes so exclude these abx
  33. tx for primary peritonitis?
    • cefotaxime, ceftriaxone (3rd gen)
    • zosyn, timentin, unasyn
    • erta
    • no AG or anaerobe abx needed
  34. when will abx respond for primary peritonitis?
    within 72 h
  35. how long should be the tx for primary peritonitis?
    5d - 2wk
  36. pathophys of secondary peritonitis?
    • fecal contamination of peritoneal cavity
    • perforation of GI tract
    • intraperitoneal or visceral absecess
  37. how to treat secondary peritonitis?
    • surgery
    • abx
  38. what bacteria to target for secondary peritonitis?
    • aerobic GN bacilli (e.coli, kleb, proteus, enterobacter)
    • anaerobes (b.fragilis) (unlike primary perito)
  39. tx for mild-mod secondary peritonitis?
    • zosyn, unasyn, timentin
    • erta
    • cipro, levo, moxi + metro
    • tige
    • cefepime + metro
  40. tx for severe secondary peritonitis?
    all carba except erta
  41. S&S of tertiary perito?
    • sepsis
    • multiorgan dysfunct
  42. CAPD stands for...
    continuous ambulatory peritoneal dialysis
  43. microbiology of CAPD?
    • coag negative staph
    • GN bacilli - e.coli
    • s. epi, s. aur, streptococc, diphteroids
  44. tx for CAPD?
    vanco + ceftazidime or gentamycin IV
  45. what to do if no response for abx for CAPD in 48 h?
    remove catheter
  46. is gram stain recommended for intra-abd? when?
    • not routinely recomm; no need if community acquired
    • use if clinically toxic, immunocompromised, significant resistance, health care infxn (yeast)
  47. bugs for community acquired mild-mod?
    • enteric GN aerobe bacilli
    • enteric GP streptococci
    • anaerobes (distal small bowel, appendiceal, colon-derived)
  48. tx for comm acq mild-mod intra abd?
    • for pseudo: zosyn; levo or cipro + metro
    • cefazolin, cefuroxime, or ceftriaxone + metro
    • moxi
    • GP, GN: erta, tige
    • anaerobe: cefoxitin, erta
  49. to cover anaerobe in comm acq mild-mod IAI, what cephamycin to use?
    • cefoxitin
    • (resistance with cefotetan)
  50. erta covers what bacteria?
    GN, GP, anaerobe
  51. which FQ has the best anaerobic coverage? can you use this solely for anaerobe?
    • moxifloxacin
    • cannot rely alone, need flagyl
  52. does tige cover anaerobe?
  53. does tige cover pseudo?
  54. which abx is great for intra-abd surgery? why? any SE?
    • tigecycline
    • goes to liver
    • great if renal issue or sepsis
    • SE of NV (common in young b/c serotonin release)
  55. bugs for high risk comm acq IAI?
    broad GN
  56. tx for comm acq high risk IAI?
    • pseudo: all carba except erta; zosyn; ceftazidime or cefepime + metro
    • cipro or levo + metro
  57. bugs for health care assoc IAI?
    • GN aerobic bacilli
    • acinetobacter!
  58. drugs for health care assoc IAI?
    • all carba cept erta
    • zosyn
    • ceftazidime or cefepime + metro
    • acinetobacter: aminoglycosides, colistin
  59. when do you use antifungal tx for IAI?
    • high risk comm acq
    • health care assoc
  60. what to give if candida IAI? what if resistance?
    • fluconazole
    • if resistant, critical pt or immunocompromised: echinocandin (fungin)
  61. when to give anti-enterococcal tx? what is the tx?
    • health care assoc: previous abx, immunocompromised, valvular heart disease
    • target e. faecalis
    • ampicillin, zosyn, vanco, lin, dapto
  62. when to initiate anti-MRSA tx?
    what is the tx?
    • health care assoc: known to be colonized, prior tx fail, significant abx exposure
    • vanco
  63. how long should IAI abx tx be?
    limit to 4-7d
  64. regimen and duration of therapy for surgical?
    • postpone to give 24h of ppx
    • bactrim or cipro
  65. what are oral therapy for IAI to complete the abx course?
    • moxi, cipro or levo + metro
    • cephalo + metro
    • augmentin
  66. cholangitis has ___ left shift and ___ jaundice than cholecystitis.
    • more left shift
    • less jaundice