Term
| intra-abdominal infection |
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Definition
| contained w/in peritoneal cavity, which extends from undersurface of diaphragm to floor of pelvis |
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Term
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Definition
| inflammation of biliary ductal system |
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Term
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Definition
| inflammation of gallbladder |
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Term
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Definition
| inflammation of peritoneal lining |
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Term
| primary peritonitis - aka "SBP or spontaneous bacterial peritonitis" |
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Definition
develops in peritoneal cavity without an apparent connection or bacterial source within abdomen; bacteria enter abdomen via bloodstream or lymphatic system;
- caused by SINGLE organism
Primary Cause: ALCOHOLIC CIRRHOSIS;
- occurs in up to 30% of pts w/ chronic liver dx;
- also associated w/ ASCITES (post-necrotic liver dx, CHF, peritoneal dialysis) |
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Term
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Definition
focal contamination within abdomen caused by perforation, postoperative peritonitis, or trauma; bacteria enter as a result of GI perforation caused by diseases or traumatic injuries;
- commonly POLYMICROBIAL |
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Term
| tertiary or persistent peritonitis |
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Definition
| infection associated w/ a higher morbidity & mortality; persists or recurs at least 48 hrs after initial treatment |
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Term
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Definition
collections of necrotic tissue, bacteria, & WBCs that form over a period of days to years;
- result of chronic inflammation;
Frequently caused by APPENDICITIS |
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Term
| Pathogens found in Intra-Abdominal Infections - Alcoholic Cirrhosis & Ascites |
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Definition
Aerobic:
- E.coli, Klebsiella, H. pneumoniae, Pseudomonas, Acinetobacter;
Anaerobic:
- Bacteroides, Peptostreptococcus, Fusobacteria, Clostridium |
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Term
| Common Pathogens of IA Infections - Community-acquired Peritoneal Dialysis (CAPD) |
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Definition
Aerobic:
- Streptococcus, Enterococcus, Staphylococcus;
Anaerobic:
- none |
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Term
| Clinical Presentation of Primary Peritonitis |
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Definition
- not acute distress;
Sx: some N/V, abdominal tenderness;
S (more mild):
- mild temp., hypoactive bowel sounds, worsening encephalopathy (cirrhosis), cloudy dialysate fluid (if PD);
Labs:
- WBC mildly elevated
- Ascitic fluid (leukocytes & bacteria);
Diagnostic Tests:
- PD culture or ascitic fluid culture (+) |
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Term
| Clinical Presentation of Secondary Peritonitis |
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Definition
- may be more acute distress;
Sx:
- N/V, abdominal tenderness, ABDOMINAL GUARDING;
S (more severe):
- tachypnea, tachycardia, elevated temp., hypotension, shock, decreased UO, faint bowel sounds that cease;
Lab Tests:
- high WBC w/ neutrophils & bands;
- Hct & BUN are increased (dehydration);
Diagnostic Tests:
- abdominal radiographs --> free air in abdomen (intestinal perforation) |
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Term
| Clinical Presentation of Abscess |
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Definition
often unrecognized for long periods of time;
- abdominal pain/tenderness;
- low-grade or spiking pattern fever;
- paralytic ileus or abdominal distension;
- mass may be palpated;
- ruptures --> peritonitis;
Lab tests: NOT helpful |
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Term
| Goals of Therapy for Treating IA Infections |
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Definition
correction of underlying cause;
resolve infection without major organ complications;
return pt to baseline status |
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Term
| General Approach to Treatment of IA infections |
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Definition
1) prompt drainage of purulent material
2) support of vital organs;
3) appropriate antimicrobial therapy |
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Term
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Definition
critical for management of abscesses;
Goal: to prevent further bacterial contamination;
Perform Gram Stain IMMEDIATELY & send for culture |
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Term
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Definition
aggressive management & repletion are required;
- maintains intravascular volume;
- ensures adequate UO;
- corrects acidosis |
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Term
| General Empiric Therapy for IAIs |
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Definition
Initiate as soon as IAI is suspected & before identification occurs;
Base on LIKELY pathogens;
Include coverage for Staph & Strep;
- use IP administration instead of IV;
Cirrhotic pts: cover Gram-Pos & Gram (-) aerobes;
2ndary IAIs: cover both aerobic & anaerobic bacteria from GI tract |
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Term
| Recommended SINGLE Agent Therapy for MILD-to-MODERATE Community Acquired IAIs |
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Definition
Cephalosporin:
- cefoxitin (Mefoxin) --> 2nd gen, covers (+), (-), & anaerobes, NOT PSA;
Beta-Lactam/Beta-Lactamase inhibitor:
- ticarcillin/clavulanic acid (Timentin)--> covers (+) [less than pip/tazo], (-), anaerobes, PSA;
Carbapenems:
- ertapenem (Invanz) --> covers (+), (-), anaerobes, NOT PSA;
FQN:
moxifloxacin (Avelox) --> covers (+), (-), anaerobes, NOT PSA;
Glycylcycline:
- tigecycline (Tygacil) --> covers (+), (-), anaerobes, NOT PSA; |
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Term
| Recommended Single Agent Therapy for HIGH-SEVERITY Community Acquired IAIs |
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Definition
Beta-lactam/Beta-lactamase inhibitor:
- piperacillin/tazobactam (Zosyn) --> covers (+), (-), anaerobes, PSA;
Carbapenems:
- imipenem/cilastatin (Primaxin), meropenem (Merrem), doripenem (Doribax) --> covers (+), (-), anaerobes, PSA; |
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Term
| Recommended COMBO Therapy for MILD-to-MODERATE Community Acquired IAIs |
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Definition
Cephalosporin based:
- cefazolin (Ancef), ceftriaxone (Rocephin), cefotaxime (Claforan), or cefuroxime (Ceftin) --> covers (+), (-), NO PSA OR anaerobes
PLUS
metronidazole (Flagyl) --> anaerobes;
FQN based:
- ciprofloxacin (Cipro, [covers (-) & PSA, less (+)]) or levofloxacin (Levaquin, [covers (+), (-), NO PSA])
PLUS
metronidazole (Flagyl) --> anaerobes |
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Term
| Recommended COMBO Therapy for HIGH-SEVERITY Community Acquired IAIs |
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Definition
Cephalosporin based:
- ceftazidime (Fortaz, 3rd gen) or cefepime (Maxipime, 4th gen) --> covers (+), (-), both PSA!!
PLUS
metronidazole (Flagyl) --> anaerobes;
FQN based:
- ciprofloxacin (Cipro, [covers (-) & PSA, less (+)]) or levofloxacin (Levaquin, [covers (+), (-), NO PSA])
PLUS
metronidazole (Flagyl) --> anaerobes;
Monobactam based:
- aztreonam (Azactam) --> (-) ONLY, PSA
PLUS
- metronidazole (Flagyl) --> anaerobes
**Vancomycin is effective against Gram-Pos cocci
- add ONLY when pt has hx of MRSA
- NOT RECOMMENDED in normal therapy |
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Term
| Recommended SINGLE Agent Therapy for HEALTH CARE IAIs |
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Definition
Beta-lactam/Beta-lactamase inhibitor:
- piperacillin/tazobactam (Zosyn) --> covers (+), (-), anaerobes, PSA;
Carbapenems:
- imipenem/cilastatin (Primaxin), meropenem (Merrem), doripenem (Doribax) --> covers (+), (-), anaerobes, PSA; |
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Term
| Recommended COMBO Therapy for HEALTH CARE IAIs |
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Definition
Cephalosporin based:
- ceftazidime (Fortaz, 3rd gen) or cefepime (Maxipime, 4th gen) --> covers (+), (-), both PSA!!
PLUS
metronidazole (Flagyl) --> anaerobes;
FQN based:
- ciprofloxacin (Cipro, [covers (-) & PSA, less (+)])
PLUS
metronidazole (Flagyl) --> anaerobes;
Monobactam based:
- aztreonam (Azactam) --> (-) ONLY, PSA
PLUS
- metronidazole (Flagyl) --> anaerobes
**Vancomycin is effective against Gram-Pos cocci
- add ONLY when pt has hx of MRSA
- NOT RECOMMENDED in normal therapy |
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Term
| ertapenem, doripenem, imipenem/cilastatin |
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Definition
| carbapenems used in Tx of IAIs with ESBLs (Extended-Spectrum Beta-Lactamases) |
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Term
| Anti-Enterococcal Therapy: E. faecalis for IAIs |
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Definition
Initial therapy vs. E. faecalis:
- ampicillin (1st choice) |
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Term
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Definition
| 1st line therapy for fungal IAI caused by C. albicans |
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Term
| echinocandins (Caspofungin, micafungin, or anidulafungin) |
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Definition
| Tx of IAIs caused by resistant Candida spp. |
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Term
| echinocandins (caspofungin, micafungin, anidulafungin) |
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Definition
| initial therapy in critically ill pts w/ fungal IAI |
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Term
| Ampicillin/sulbactam (Unasyn) |
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Definition
| Beta-lactam/beta-lactamase inhibitor combo that is NOT RECOMMENDED for tx of IAIs due to E.coli resistance |
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Term
| cefotetan (Cefotan), clindamycin (Biaxin) |
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Definition
| 2nd gen. cephalosporin & macrolide that are NOT RECOMMENDED for tx of IAIs due to high resistance to Bacteroides fragilis |
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Term
| aminoglycosides (gentamicin, tobramycin, amikacin) |
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Definition
| NOT RECOMMENDED for routine use in CA-IAIs b/c availability of less toxic agents that are equally efficacious |
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Term
| Health Care-Associated IAIs |
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Definition
| routine use of COMBO therapy for Gram-Negs is NOT RECOMMENDED |
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Term
| Duration of Antibiotic Therapy for most IAIs |
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Definition
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Term
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Definition
Begin Antimicrobial therapy prior to appendectomy:
- antianaerobic cephalosporins (cefoxitin);
- Seriously Ill: carbapenem or Beta-lactam/Beta-Lactamase inhibitor;
Post-Op Abx NOT REQUIRED if appendix was normal or just inflamed at time of operation;
- If RUPTURED, Abx therapy is REQUIRED |
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