Intra-Abdominal Infections

Question 1

where are lactobacilli found?

Answer 1

Upper, stomach

Question 2

What is found in the small intestines?

Answer 2

streptococci
lactobacilli
enterobacteriaceae

Question 3

what is found in the large intestines?

Answer 3

Aerobic + anaerobic microbial populations

Question 4

who does primary periotonitis typically occur in?

Answer 4

patients with cirrhosis, hepatitis
CHF
metastatic malignant dz
systemic lupus erythematosus
lymphedema

Question 5

caused by spillage of GI or genitourinary microorganisms into the peritoneal cavity owing to loss of the integrity of the mucosal barrier.

Answer 5

Secondary peritonitis

Question 6

what mostly cuases primary bacterial peritonitis?

Answer 6

Enterobacteriaceae (E. coli, Kelbsiella)

Question 7

what is the common anaerobe in primary peritonitis?

Answer 7

Bacteroides (but still <1% of primary infections)

Question 8

what often causes secondary bacterial peritonitis

Answer 8

polymicrobial (Enterobacteriaceae, Bacteroides sp., enterococci, P. aeruginosa

Question 9

Empiric treatments for primary peritonitis.

Answer 9

Cefotaxime
Ceftriaxone
Piperacillin/ tazobactam
Ticacillin/ clavulanic acid or amp/ sulbactam

Question 10

If a primary peritonitis bacteria is ESBL then what should you use?

Answer 10

Imipnem
meropenem
ertapenem

Question 11

Drugs to prevent primary peritonitis with cirrhosis and ascities.

Answer 11

TMP/SMX

Question 12

Drugs to prevent primary peritonitis w/ cirrhosis and UGI bleed.

Answer 12

Cipro

Question 13

Ways to treat secondary peritonitis (mild- moderate)

Answer 13

ampicillin/ sulbactam
piperacillin/ tazo
ticacillin/ clavulanate
ertapenem
cefoxitin
cefotetan
cipro + metronidazole

Question 14

Ways to treat severe, life threatening dz with an ICU patient.

Answer 14

imipenem
meropenem
ampicillin + metronidazole + gentamicin or tobramycin
Amipicillin + metronidazole + ciprofloxacin

Question 15

Classify C. Diff

Answer 15

Anaerobie, gram positive

Question 16

why is c. diff so bad?

Answer 16

forms spores

Question 17

what does C. diff cause?

Answer 17

Colitis and pseudomembranous colitis

Question 18

what are risk factors for C. diff

Answer 18

antibiotic use (broad spectrum)
manipulation of GI tract (sgx, enema, NG tubes)
cytotoxic drugs
age

Question 19

What is the toxin that enterotoxin which is responsible for most symptoms – hemorrhage/fluid secretion in C. Diff

Answer 19

Toxin A

Question 20

What is the cytotoxin with C. Diff.

Answer 20

Toxin B

Question 21

what are 3 complications of C. Diff.

Answer 21

toxic megacolon
colonic perforation
death

Question 22

what are symptoms of C. Diff

Answer 22

>5 loose stools per day
Over at least 2 days
watery, green, foul, small volume feces
1/2 of patients have leukocytes in stool 
cramping, abdominal pain, dehydration 
fever, leukocytosis

Question 23

Tx for C Diff (abx)

Answer 23

Metronidazole
Vanco (oral)
Bacitracin (lack of evidence, promising) (oral)

Question 24

Immunomodulation for C. Diff (for people at high risk)

Answer 24

Vaccine (decrease relapse)
IVIG
Hyperimmune bovine colostrum

Question 25

What are probiotics to give for C. Diff

Answer 25

Saccharomyces boulardii (prevents relapse,1 study)

Question 26

what is surgery for C. Diff?

Answer 26

total colectomy (severe CDAD)

Question 27

what are some adjunctive therapies for C. Diff?

Answer 27

Prebiotic: oral oligofructose
cholestyramine (lack of evidence, ADRs)
Fecal flora transplant