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53 Cards in this Set
- Front
- Back
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Organisms commonly found in Primary Peritonitis
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E.coli
Klebsiella sp Streptococci Bacteroides sp Pseudomonas Staphylococci Enterococci M. tuberculosis |
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Describe the clinical presentation of primary peritonitis
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Slow progression over days to weeks (N/V, diarrhea, tenderness)
1. worsening encephalopathy 2. cloudy dialysate fluid 3. Ascitic fluid leukocytes >250-300 cells/mm3 4. Protein <1g/dL 5. CT scan (-) for focal source |
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Describe the clinical presentation of secondary peritonitis
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Most commonly appendicitis
1. Acute distress; febrile; N/V 2. Generalized abdominal pain and guarding 3. Tachypnea; Tachycardia 4. Decreased urine output Labs: elevated WBC (>15k) Dehydration (increased HCT and BUN) Early alkalosis-> acidosis |
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Organisms usually found in Secondary Peritonitis
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Aerobic:
E. coli (32-61%) enterobacter Klebsiella Proteus Enterococci Streptococci Staphylococci Anaerobic: Bacteroides (25-80%) Clostridium Fusobacterium Prevotella Peptostreptococcus Fungal: Candida (<5%) |
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Organisms most common in community vs nosocomial
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Community:
E. coli Bacteroides Streptococci Nosocomial: E. coli Enterococci * Bacteroides Streptococci |
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Organisms associated with Tertiary Peritonitis
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Multiple Resistant Gram Negative Bacilli
Coagulase-negative and positive staph Enterococci (including VRE) Candida usually resembles nosocomial infections |
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What organisms are typically found in Hepatic abscesses
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Amebic:
Entamoeba histolytica Pyogenic: E. coli Klebsiella Streptococcus Enterococcus Bacteroides sp |
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What organisms are typically found in Splenic abscesses
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S. aureus
Streptococcus sp Salmonella sp. |
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What are the typical organisms found in Pelvic inflammatory disease
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Neisseria gonorrhoeae
Chlamydia trachomatis |
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What is used for Empiric coverage against G(-) pathogens in Spontaneous Bacterial Peritonitis (SBP)
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Ceftriaxone or Cefotaxime
Typically 5-10 days |
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Prevention of Spontaneous bacterial Peritonitis (SBP)
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SMX/TMP DS 1 tab 5x/week
Cipro 750mg Qweek Cipro 500mg daily |
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Empiric coverage for Peritoneal Dialysis (PD) Related Peritonitis
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Cefazolin or Vancomycin
PLUS 3rd/4th gen cephalosporin OR aminoglycoside Intraperitoneal (IP) > IV |
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Risk Factors for Treatment Failures (High Severity Infections)
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1. Delay in therapy >24 hrs
2. APACHE score > or = 15 3. Elderly 4. Co-morbidities 5. Organ dysfunction 6. Malnurished (albumin<2.4g/dL) 7. Extensive peritonitis 8. Cannot adequately control source 9. Malignancy |
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How to treat Lower Risk Community-Acquired Infections
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Empiric: gram negative bacilli and strep
Distal small bowel, appendiceal, and colonic-derived: obligate anaerobic bacteria Anti-pseudomonal activity: use narrower spectrum Treatment of Enterococcus and Candida is NOT necessary |
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How to treat Mild to moderate infections in Higher Risk Community-Acquired Infections
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Generally use agents effective against Enterococcus sp
Mild to Moderate Monotherapy: Cefoxitin Moxifloxacin Ticarcillin-clavulantate Ertapenem Tigecycline Combination: Cefazolin Cefotaxime Cefuroxime Ceftriaxone FQ PLUS Metronidazole |
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How to treat High severity infections in Higher risk Community-Acquired Infections
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Monotherapy:
Piperacillin-tazobactam Meropenem Imipenem/cilastatin Doripenem Combination: Ceftazidime Cefepime FQ Aztreoname PLUS metronidazole |
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Regimen for Mild-moderate acute cholecystitis
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Cefazolin
Cefurozime Ceftriaxone |
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Regimen for Acute cholestitis of severe physiologic disturbance, advanced age, or immunocompromised state
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Imipenem-cilastatin, meropenem, doripenem, piperacillin-tazobactam
OR cipro, levo, cefepime, each in combination with Metronidazole |
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Regimen for Acute cholangitis following bilioenteric anastamosis of any severity
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Imipenem-cilastatin, meropenem, doripenem, piperacillin-tazobactam
OR cipro, levo, cefepime, each in combination with Metronidazole |
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Health-care associated biliary infection of any severity
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Imipenem-cilastatin, meropenem, doripenem, piperacillin-tazobactam
OR cipro, levo, cefepime, each in combination with Metronidazole |
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When is Vancomycin recommended for HAI?
Choices: A. <20% Resistant P. aeruginosa, ESBL producing enterobacteriacea B. ESBL producing enterobacteriacea C. P. aeruginosa > 20% resistant to Ceftazidime D. MRSA |
MRSA
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When is AG recommended for HAI?
Choices: A. <20% Resistant P. aeruginosa, ESBL producing enterobacteriacea B. ESBL producing enterobacteriacea C. P. aeruginosa > 20% resistant to Ceftazidime D. MRSA |
ESBL producing enterobacteriacea
AND P. aeruginosa > 20% resistant to Ceftazidime |
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When is Piperacillin-Tazobactam recommended for HAI?
Choices: A. <20% Resistant P. aeruginosa, ESBL producing enterobacteriacea B. ESBL producing enterobacteriacea C. P. aeruginosa > 20% resistant to Ceftazidime D. MRSA |
A. <20% Resistant P. aeruginosa, ESBL producing enterobacteriacea
B. ESBL producing enterobacteriacea C. P. aeruginosa > 20% resistant to Ceftazidime |
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When is Carbapenems recommended for HAI?
A. <20% Resistant P. aeruginosa, ESBL producing enterobacteriacea B. ESBL producing enterobacteriacea C. P. aeruginosa > 20% resistant to Ceftazidime D. MRSA |
A. <20% Resistant P. aeruginosa, ESBL producing enterobacteriacea
B. ESBL producing enterobacteriacea C. P. aeruginosa > 20% resistant to Ceftazidime |
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When is Ceftazidime or Cefepime w/ Metronidazole recommended for HAI?
A. <20% Resistant P. aeruginosa, ESBL producing enterobacteriacea B. ESBL producing enterobacteriacea C. P. aeruginosa > 20% resistant to Ceftazidime D. MRSA |
<20% Resistant P. aeruginosa, ESBL producing enterobacteriacea
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What patients are at risk of enterococcal infections?
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1. Nosocomial
2. Recent use of antibiotics that select for Enterococcus sp. 3. Immunocompromised patients 4. Valvular heart disease 5. Prosthetic intravascular materials |
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Treatment for E. faecalis?
Treatment for E. faecium? |
E. Faecalis:
Piperacillin/tazobactam + or - Ampicillin E. Faecium: Vancomycin |
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Anti-MRSA therapy includes
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Vancomycin
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Patients at risk for fungal peritonitis include
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1. recurrent gastrointestinal perforations
2. surgically-treated acute pancreatitis 3. patients with positive stains of peritoneal fluid for yeast C. albicans and other fungi seen in 20% of acute GI perforations, but treatment may not be necessary |
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When are Antifungal Agents recommended? (2)
What antifungal is it NOt recommended? (1) |
1. higher risk patients whose cultures are positive for Candida
2. critically ill patients (use echinocandin NOT triazole) Echinocandins for Candida resistant to fluconazole Fluconazole for patients with isolated C. albicans Amphotericin B is NOT recommended for initial Rx |
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Name the most common organisms that cause Surgical Site Infections (SSI)- (6)
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1. S. aureus (MSSA or MRSA) (30%)
2. Coagulase-negative staph (13.7%) 3. Enterococcus sp (11.2%) 4. E. coli (9.6%) 5. P. aeruginosa (5.6%) 6. Enterobacter sp. (4.2%) |
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What type of surgical procedures have higher risk of surgical site infections?
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Colon> Vascular> Cholecystectomy> Organ transplant
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Name the 3 Core measures of Surgical Care Improvement Project
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1. Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision
2. Prophylactic Antibiotic Selection for Surgical Patients 3. Prophylactic Antibiotics Discontinued with 24 hrs After Surgery End Time |
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Common Gram(-) pathogens of:
Thoracic, GI, GU, OB/GYN, Head and Neck, ophthalmic, vascular |
E. coli
P. aeruginosa Enterobacter sp. Klebsiella sp. |
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Common anaerobic pathogens of:
GI, Head and Neck, OB/GYN |
Bacteroides sp
Clostridium sp. |
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Common Gram (+) pathogens of:
Cardiothoracic, Head and neck, neurosurgery orthopedic, ophthalmic, vascular |
S. aureus (MSSA/MRSA)
Coagulase negative staph |
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Common Gram (+) pathogens of:
GI, Head and Neck, OB/GYN |
Streptococcus
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Agents that have to be re-dosed at 3-5 hrs
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Cefazolin
Cefotetan Clindamycin |
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Agent that has to be re-dosed every 2-3 hrs
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Cefoxitin (shorted half life)
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Agent that has to be re-dosed every 6-12 hrs
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Vancomycin (half life of 4-6 hrs)
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Half life and re-dose of Ciproflaxacin
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half life: 3.5-5
re-dose: 4-10 hr |
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Half life and re-dose of Metronidazole
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half life: 6-14 hr
re-dose: 6-8 hr |
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Drug and Dose for Antimicrobial Prophylaxis of surgery in:
Cardiothoracic |
Cefazolin 1-2g IV
1g= <80kg 2g= >80kg Alternative: Vancomycin +-Gentamicin |
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Drug and Dose for Antimicrobial Prophylaxis of surgery in:
Gastro-duodenal |
Cefazolin 1-2g IV
1g= <80kg 2g= >80kg Alternative: Gentamicin + Metronidazole |
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Drug and Dose for Antimicrobial Prophylaxis of surgery in:
Biliary |
Cefazolin 1-2 g OR (Gentamicin + metronidazole)
Cefoxitin 1-2g OR (Gentamicin + Clindamycin) Cefotetan 1-2g OR (Aztreonam + Metronidazole) Cefuroxime 1.5 g IV*** Different dose than others |
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Drug and Dose for Antimicrobial Prophylaxis of surgery in:
OB/GYN |
Cefazolin 1-2 g OR (Gentamicin + - Clindamycin)
Cefoxitin 1-2 g Cefotetan 1-2 g OR (Gentamicin + - Metronidazole) |
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Drug and Dose for Antimicrobial Prophylaxis of surgery in:
Orthopedic |
Cefazolin 1-2 g IV
alternative: Vancomycin |
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Drug and Dose for Antimicrobial Prophylaxis of surgery in:
Urologic |
Ciprofloxacin 400mg IV
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Drug and Dose for Antimicrobial Prophylaxis of surgery in:
Vascular |
Cefazolin 1-2g IV
Alternative: Vancomycin + - Gentamicin |
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Drug and Dose for Antimicrobial Prophylaxis of surgery in:
Colorectal Appendectomy |
Cefazolin 1-2 g IV + Metronidazole 500mg Iv
Alternative: Gentamicin IV + Metronidazole IV Cefoxitin 1-2 g IV Alternative: Clindamycin IV + Gentamicin Cefotetan 1-2 g IV Alternative: Aztreonam IV + Metronidazole IV |
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Drug and Dose for Antimicrobial Prophylaxis of surgery in:
Neurosurgical |
Cefazolin 1-2 g
Alternatives: Vancomycin IV OR Clindamycin IV |
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Most ABX should be given 60 min prior to incision... which two drugs are the exception? Should be given 120 min before
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FQ and Vancomycin
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Anaerobic Bacteria Susceptibilities
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Metronidazole (100%)
Piperacillin/tazobactam (>99%)- also Pseudomonas Imipenem/cilastatin (>99%) Ampicillin/sulbactam (97%) Tigecycline (95%) |
