Intrabdominal Infection

Question 0

Most common pathogens - community-acquired intra-abdominal infection

Answer 0

Enterobacteria (esp. E.coli)
Anaerobes (esp. Bacteroides)
Gr+ (esp. Strep)

Question 1

Imaging to determine presence/source if intra-abdominal infection (if no immediate laparotomy)

Answer 1

CT scan

Question 2

Interventions (general elements) - inta-abd infections

Answer 2

1. Source control (drainage, diversion, resection)
2. Fluid resuscitation (maintain MAP >65)
3. Microbiologic evaluation (cultures and susceptibility testing)
4. Timing of abx therapy

Question 4

Timing of abx therapy - intra-abd infection

Answer 4

Within 8 hours (ASAP if sepsis/septic shock…within 1 hr)

Delay is associated with worse outcomes

Question 5

Appendicitis (mild/mod: perforated or abscessed)

Answer 5

carbapenem (erta only if no pseudo) or ticarcillin

Alt. cefoxitin, moxi, tigecycline

Question 6

Appendicitis (high risk: severe, immunocompromised, adv. age)

Answer 6

carbapenem (not erta) or piperacillin

Question 7

Appendicitis - Peds

Answer 7

carbapenem, piperacillin or ticarcillin

Question 8

Appendicitis - combo therapy if concerned about anaerobes

Answer 8

FQ (Cipro or Levo) or Ceph (cefepime or ceftazidime)

Plus Metronidazole

Question 9

Appendicitis - combo therapy if concerned about anaerobes (Peds)

Answer 9

Rocephin + Metronidazole

Question 10

Cholecystitis - mild to moderate

Answer 10

Rocephin

Question 11

Cholecystitis - severe

Answer 11

Ertapenem (no pseudo) or Piperacillin

Plus Metronidazole

Question 12

Health care acquired biliary infection

Answer 12

same empiric + Vanc