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42 Cards in this Set
- Front
- Back
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3 most common G+ pathogens in peritonitis
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• Enteroccocus spp.
• Streptococcus spp. • Staphyloccoccus aureus |
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5 most common G- pathogens in peritonitis
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• Escherichia coli
• Enterobacteriaceae • Klebsiella spp. • Psuedumonas aeruginosa • Proteus spp. |
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2 most commone anerobes in peritonitis
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• Bacteroides spp.
• Clostridium spp. |
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define primary peritonitis
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aka spontaneous bacterial peritonitis (SBP)
No known intra-abdominal focus -hematogenous spread -lymphatic source -transmigration from intact bowel -peritoneal dialysis catheter single microbial cause |
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S/Sx of primary peritonitis is
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-acute fever
-abdominal pain -anorexia, N/V/D -↑HR, ↑RR |
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the pathogen most likely in children with peritonitis is
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streptococci
G+ |
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the pathogen most likely in cirrhosis with peritonitis is
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single enteric gram (-)
-E. coli -Klebsiella pneumoniae |
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the pathogen most likely in CAPD with peritonitis is
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staphylococcus (skin)
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treatment duration for primary peritonitis is
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5 v. 7-10 days
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3 empiric treatments for primary peritonitis is
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-3rd generation cephalosporins
-FQs -BL/BLI combos |
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which population should you prophylax for peritonitis?
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cirrhosis subgroups
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what is the Px regimen for peritonitis in cirrhotic patients?
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TMP/SMX
norfloxacin ciprofloxacin |
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define secondary peritonitis
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Focal intra-abdominal
-organ infection with spread -perforation of GI tract -ischemia -rupture of abscess -operative (leakage of GI flora) -trauma |
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S/Sx of secondary peritonitis
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-acutely ill
-abdominal pain -↑T, ↑HR, ↑RR -EMERGENCY: lack of bowel sounds or rigid abdomen -SEVERE: hypotension, shock |
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pathogens in secondary peritonitis
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-depends on location
-predominantely anaerobes |
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Tx duration for secondary peritonitis
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5 or 7-10 days
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2 Tx for mild-moderate 2' peritonitis
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cefoxitin
ampicillin/sulbactam |
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2 Tx for severe 2' peritonitis
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imipenem/cilastin
piperacillin/tazobactam |
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why would you use a combo Tx for 2' peritonitis?
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PCN allergy
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4 combination Tx for 2' peritonitis
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-AG + (clinda or metro)
-ceftriaxone + (clinda or metro) -aztreonam + clinda - *FQ + metronidazole |
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define intra-abdominal abscess
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-located within peritoneal cavity/retroperitoneal space or within visceral organs
-results from chronic inflammation -forms in days to years -fibrinous capsule -purulent collection of dead tissue, bacteria, WBC -separated by a defined wall (fibrin, WBC) -size varies (mL to L) -abscess can precipitate peritonitis |
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S/Sx of intra-abdominal abscess
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Inconsistent Sx
-+/- pain, fever, or abdominal distention |
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pathogens involved in intra-abdominal abscesses
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polymicrobial
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duration of Tx for intra-abdominal abscesses
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drained x 7 days
undrained x months |
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4 Tx for intraabdominal abscesses
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-carbapenems
-BL/BLI -aztreonam + clindamycin -FQ + metronidazole |
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define C. difficile-associated disease
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-Gram + anaerobic rod
-spore forming -toxin producing (A and B) -colonizes GI tract |
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4 risk factors for CDAD
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-Abx
-advanced age -immune suppression -prolonged hospitalization |
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which 3 Abx are most likely to cause CDAD?
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cephalosporins
clindamycin ampicillin |
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S/Sx of CDAD
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-mucoid, green, watery, foul-smelling stools
-crampy, abdominal pain -fevers -toxic megacolon or ileus may not be present with diarrhea |
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nonpharm Tx for CDAD
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-D/C offending agents
-fluids, electrolyte repletion |
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1st line therapy for CDAD
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-metronidazole 250-500 mg PO QID x 7-14 days
OR -metronidazole 500-750 mg PO TID x 7-14 days |
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2nd line therapy for CDAD
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-vancomycin 125-500 mg PO QD x 7-14 days
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Monitoring for GI infections
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-improvement in 2-3 days
-fever, WBC, VS, abdominal S/Sx |
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what to consider if patient fails to improve with Tx
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-resistant organisms
-recurrent or other infections |
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when is it mandatory that you cover enterococci
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bacteremia
immunocompromised patients |
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when is it reasonable that you cover enterococci
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isolated from pure culture
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when is it potentially useful that you cover enterococci
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isolated as only anaerobe
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when is it probably unecessary that you cover enterococci
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isolated as aerobic mixture
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NEVER TREAT ENTEROCOCCI WITH
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CEPHALOSPORINS
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3 Tx regimens that cover G- and anaerobes
(no G+) |
cefoxitin
cefotetan ampicillin sulbactam |
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3 Tx regimens that cover G-, G+, and anaerobes, but no P. aeruginosa
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imipenem
aminoglycoside/clindamycin clindamycin/aztreonam |
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3 Tx regimens that cover G-, G+, and anaerobes, AND P. aeruginosa
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piperacillin/tazobactam
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