Abdominal infections

Question 1

What organisms should be considered in health-care associated IAI?

Answer 1

Candida, Enterococcus, and MRSA

Question 2

What risk factors are there for healthcare association IAI?

Answer 2

Invasive device
History of MRSA or colonization
history of surgery
Hospitalization
Dialysis
Residence in long term care facility in last year

Question 3

What risk factors there are for community acquired IAI with high severity?

Answer 3

Age > 70
Immunosuppression
Malignancy
Liver/Renal Disease

Question 4

Which anatomical area for IAI should anaerobic coverage be included in?

Answer 4

Distal ileum/colon - Bacteroides fragilis, Clostridium spp., Enterobacter spp, E. coli, Klebsiella spp., Peptostreptococcus spp.

Question 5

How would you treat mild-mod or high risk (also healthcare associated) IAI?

Answer 5

Mild-Moderate: Cefoxitin, ertapenem, moxifloxacin, tigecycline OR 1st/2nd/3rd gen cephalosporin, cipro/levo + metronidazole

High risk/Healthcare associated: Carbapenem or P/T or anti-pseudomonal cephalosporin or cipro/levo + metronidazole

Question 6

When should anti-enterococcal therapy be added in HA IAI?

Answer 6

Post-op infection,
Previous use of of cephalosporin (select for enterococcus)
Valvular Heart Dx

*VRE in liver transplant or VRE colonization

Question 7

How should pancreatitis be treated?

Answer 7

Per American College of Gastroenterology,

Aggressive hydration (250-500 mL/hr) first 12-24 hr, LR preferred

Only use antibiotic in EXTRApancreatic infection (e.g. cholangitis, bloodstream infection) or infected necrotic pancreatitis

Question 8

What is the preferred treatment for SBP per AASLD?

Answer 8

Community acquired: Cefotaxime 2 g IV Q8H or CTX 1 g IV BID; PCN allergy: Levofloxacin 500 mg QD

HA: P/T 3.375 g IV Q6H + Vancomycin

Duration: 5 days

Question 9

When should enterococcal coverage be added for acute cholangitis?

Answer 9

Hepatic disease or severely immunocompromised

Question 10

What are the treatment regimens for H. pylori?

Answer 10

FDA approved: PPI + Clarithromycin + Amoxicillin (or metronidazole in PCN allergic) x 14 days

Non-FDA approved: PPI + bismuth subsalicylate + tetracycline + metronidazole x 10-14 days

Alternate: Levo + PPI + amox

Question 11

What is the treatment regimen for Campylobacter?

Answer 11

Preferred: Azithromycin

Ciprofloxacin

Question 12

What is the treatment regimen for Nontyphoidal Salmonella enterica?

Answer 12

Treatment not necessary

Question 13

What is the treatment regimen for Salmonella enterica, Typhi or Paratyphi?

Answer 13

CTX

Cipro

Question 14

What is the treatment regimen for Shigella?

Answer 14

Azithromycin
Ciprofloxacin
CTX

Question 15

What is the treatment for Vibrio cholerae?

Answer 15

Doxycycline

Ciprofloxacin

Question 16

What is the treatment for Non-Vibrio cholera?

Answer 16

Non-invasive: no treatment

Invasive disease: CTX + doxycycline

Question 17

What is the treatment regimen for Yersinia enterocolitica?

Answer 17

TMP/SMX

Question 18

What are the antiparasitic therapy for Cryptosporidium?

Answer 18

Nitazoxanide

Question 19

What are the anti-parasitic therapy for cyclospora?

Answer 19

TMP-SMX

Question 20

What is the anti-parasitic therapy for giardia?

Answer 20

Tinidazole or nitaxoxanide

Question 21

What is the anti-parasitic therapy for cystoisospora?

Answer 21

TMP-SMX

Question 22

What is the anti-parasitic therapy for Trichinella?

Answer 22

Albendazole

Question 23

How is initial episodie, non-severe Cdiff definited? How is it treated?

Answer 23

WBC < 15K, SCr < 1.5 mg/dL

Vanc 125 mg PO QID x 10 days
FDX 200 mg PO BID x 10 days

Only use metronidazole 500 mg TID x 10 days if no alternative agents

Question 24

How is initial episode, severe Cdiff defined? How is it treated?

Answer 24

Vanco 125 mg QID x 10 days

FDX 200 mg PO BID x 10 days

Question 25

How is initial episode, fulminant defined? How is it treated?

Answer 25

Hypotension or shock, ileus, megacolon Vancomycin 500 mg PO QID If ileus, consider rectal instillation of vancomycin. *Add metronidazole 500 mg IV TID for ileus

Question 26

How do you treat first recurrence of Cdiff?

Answer 26

Vancomycin 125 mg PO QID if metronidazole was used first time Prolonged tapered and pulsed vancomycin if vancomycin 125 mg PO QID was used initially FDX 200 mg PO BID if vancomycin was used initially

Question 27

How do you treat second or subsequent recurrences for Cdiff?

Answer 27

Vanc in a tapered/pulsed Vancomycin 125 mg PO QID + rifaximin 400 mg TID x 10 days FDX 200 mg PO BID FMT

Question 28

What is the minimal period that repeat testing of Cdiff should be avoided?

Answer 28

7 days during the same episode of diarrhea