bomkamp

Question 1

types of intra-abdominal infections

Answer 1

intraperitoneal
retroperitoneal

Question 2

types of peritonitis

Answer 2

primary peritonitis
secondary peritonitis

Question 3

what is primary peritonitis

Answer 3

spontaneous bacterial peritonitis
sometimes also due to peritoneal dialysis

Question 4

what is secondary peritonitis

Answer 4

due to another cause
- diverticulitis
- appendicitis
- abscess

Question 5

what is an uncomplicated infection for peritonitis

Answer 5

confined in one organ and not extending past peritoneum

Question 6

what is a complicated infection for peritonitis

Answer 6

extending to multiple organs and into peritoneal space

Question 7

which patients are at highest risk for spontaneous bacterial peritonitis and why

Answer 7

hepatic failure and ascites
alcoholic cirrhosis
- kinda immunocompromised bc liver not functioning and body not making proteins

Question 8

most common pathogen spontaneous bacterial peritonitis (primary)

Answer 8

e. coli

Question 9

is spontaneous bacterial peritonitis monomicrobial or polymicrobial

Answer 9

monomicrobial

Question 10

symptoms of spontaneous bacterial peritontis

Answer 10

abdominal pain
N/V/D
fevers/chills
reduced bowels

Question 11

diagnosis of SBP

Answer 11

ANC > 250

Question 12

how to calculate ANC

Answer 12

TNC body fluid x band/neutrophils (%)

Question 13

treatments for SBP

Answer 13

ceftriaxone primarily

could add MRSA coverage:
vanc
dapto
linezolid

could add anaerobic coverage:
beta lactam/beta lactamase inhib
carbapenem
add metronidazole

Question 14

treatment duration in SBP

Answer 14

5-7 days

Question 15

most common pathogens for secondary peritonitis

Answer 15

e. coli
bacteoides
enterobacter
enterococcus

Question 16

which pathogens not common in secondary peritonitis

Answer 16

pseudomonas
staph

Question 17

is secondary peritonitis monomicrobial or polymicrobial

Answer 17

polymicrobial

Question 18

presentation of secondary peritonitis

Answer 18

abdom pain
fever/chills
cant poop
tachypnea
hypotension

Question 19

diagnosis of secondary peritonitis

Answer 19

imaging + symptoms
(CT scan or XRay)

Question 20

pillars of treatments for intraabdominal infections

Answer 20

source control
antimicrobial therapy

Question 21

how do we select empiric therapy for secondary peritonitis

Answer 21

look at antibiogram
if severe, recent cephalo use, immunocomp then get enterococci covered
antifungal if on culture

Question 22

if candida albicans found what do we use

Answer 22

fluconazole

Question 23

mild to moderate treatment of secondary peritonitis

Answer 23

ceftriaxone
cefazolin
+ metro

Question 24

moderate to severe treatment of secondary peritonitis

Answer 24

pip/tazo
meropenem
cefepime

Question 25

which agent not recommended empirically in secondary peritonitis

Answer 25

amp/sulbactam

Question 26

length of treatment for secondary peritonitis

Answer 26

4-7 days 5-10 days if diverticulitis 24 hours if surgery

Question 27

oral antibiotic options for secondary peritonitis

Answer 27

amox/clav q8-12h hr

Question 28

how is c diff transmitted

Answer 28

person to person via fecal oral route

Question 29

which strains of c. diff are associated with higher severity of infection

Answer 29

BI NAP1 027

Question 30

which antibiotics associated with highest risk of c. diff infections

Answer 30

fluroquinolones clindamycin ceftriaxone carbapenems

Question 31

symptoms of c. diff infection

Answer 31

profuse watery foul smelling diarrhea abdominal pain

Question 32

when do we test for c. diff

Answer 32

3+ profuse watery green foul smelling stools in 24 h

Question 33

imgaing finding leading us to believe C. diff

Answer 33

evidence of colitis

Question 34

testing methods for c. diff

Answer 34

NAAT testing antigen test (GDH) + toxin A/B NAAT + toxin A/B test

Question 35

if toxin test is negative what might that mean

Answer 35

has c. diff but not colonized/ infection

Question 36

is repeat testing recommended in c. diff

Answer 36

no repeat testing within 7 days

Question 37

can we use loperamide in c. diff

Answer 37

no dont use

Question 38

classifications of c. diff

Answer 38

non severe WBC < 15 K SCr < 1.5 severe WBC > 15 k SCr > 1.5 fulminant hypotension or shock ileus toxic megacolon

Question 39

treatment options for c. diff

Answer 39

oral vancomycin fidaxomicin metronidazole (IV or PO)

Question 40

considerations of oral vancomycin

Answer 40

its cheap kills everything

Question 41

considerations of fidaxomicin

Answer 41

expensive sustained response and lower recurrence rates kills weeds only

Question 42

when do we use metronidazole

Answer 42

only in fulminant in combo with another agent

Question 43

treatment examples

Answer 43

fidaxomicin first then vanc key is to just keep switching up and can do tapered vanc or fidax

Question 44

risk factors for c. diff reurrence

Answer 44

65+ severe infection immunocompromised

Question 45

what is Rebyota

Answer 45

fecal microbiota suspension administered via rectal tubule given following antibiotic therapy (rolling out new grass)

Question 46

what is Vowst

Answer 46

bacterial spore suspension given after completion of antibiotic treatment oral option but expens (planting new seeeds)

Question 47

what is bezlotuxumab

Answer 47

MAB targeting c. diff toxin to neutralize its effect given during course of CDI treatment (reduces weed damage)