Term
| How is successful patient outcomes determined for IAIs? |
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Definition
- Early diagnosis
- Rapid surgical intervention
- Selection of appropriate antibiotic |
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Term
| What areas are IAIs located? |
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Definition
- Peritoneal cavity - base of diaphragm to pelvis
- Retroperitoneal cavity - pancreas, kidneys, adrenals, duodenum, aorta/vena cava |
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Term
| What are the 3 types of peritonitis? |
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Definition
- Primary - Intact GI, no barrier disruption. Caused by cirrhosis, dialysis, nephrotic syndrome
- 2ndary - inflammation and barrier disruption. Caused by diverticulitis, appendix, neoplasms, OPERATIONS
- tertiary - persistent infection |
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Term
| What is an abscess in IAI? |
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Definition
| purulent collection of fluid - walls off necrotic debris, bacteria, and inflammatory cells |
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Term
| What are the 2 types of IAIs? |
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Definition
- Uncomplicated - inflammatory process in a SINGLE organ. May progress to complicated. Appendicitis, cholecyst
- Complicated - Inflammatory process in the peritoneal or other sterile region. Need source control! |
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Term
| What 3 components determine therapy in IAIs? |
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Definition
- Presence of barrier disruption
- Severity of disease expression
- Likelihood of resistance |
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Term
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Definition
Systemic inflammatory response syndrome: 2+ of:
- Temp > 38 or < 36
- WBC >12 or < 4
- HR > 90, RR > 20
**Sepsis - Infection + SIRS
** Severe Sepsis - Sepsis + organ dysfunction
** Septic shock - Sepsis + hypotension |
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Term
| What is Source control for IAIs? |
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Definition
In a stabilized patient - drain infected foci, control contamination, and restore function
**Failure the more sick the person is, Incr age, low albumin |
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Term
| When are fluids indicated for IAIs? |
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Definition
| Even in the absence of severe sepsis - an early goal |
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Term
| What kind of coverage is needed in IAIs? |
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Definition
Gram(+), gram(-) and anaerobes
Special considerations for:
- Resistant enterobactereciae
- MRSA
- Enterococci
- Candida |
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Term
| What is the difference between community and hospital acquired IAIs? |
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Definition
- Community - no hospital or hospital < 7 days
- Hospital - Hospital > 7 days |
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Term
| What are special considerations for IAIs? |
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Definition
- Resistant gram(-) - FQN resistant or ESBL
- Enterococci - source control not achieved. Vanc, Zosyn, Penems
- E. faecium - Tigecyclin, linezolid. VRE or liver transplant
- MRSA - Vanc for known colonization, treatment failure,
- Candida - Fluconazole, Echocandin - Immunosuppression, transplant, recurrent IAI |
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Term
| How do you cover classification #'s in IAIs? |
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Definition
1 - baseline coverage - Augmentin, or a Cef + metronidazole
2 - everything but candida - Zosyn or carbipenem/ +/- Vanc
3 - EVERYTHING. In severe septic shock and severe sepsis of HA-diffuse peritonitis. Never just one agent. Zosyn + Vanc + AG + fluconazole/echocandin |
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