Intra-Abdominal Infections (IAI)

Define uncomplicated IAI

confined within visceral peritoneum and does not extend past that

Define complicated IAI

extends beyond a single organ into peritoneal space

list people who are at a high risk for SBP

those with hepatic failure and ascites which is alcholic cirrhosis and continuous peritoneal dialysis (CAPD)

explain how SBP is diagnosed

s/s of infection, ANC >250, and ascitic fluid protein <2.5

empiric treatment of SBP

ceftriaxone, cefepime, pip/tazo, or meropenem

how is SBP treated if S. aureus/coag (-) staph (and MRSA) is a concern

vanc, linezolid, or dapto

explain how SBP is treated if anaerobic coverage is needed

beta lactam/beta lactam inhibitor, carbapenem, or add metronidazole to empiric

the treatment duration for SBP for patients with cirrhosis and ascites is _____

5-7 days

explain the use of secondary prophylaxis for SBP for patients with cirrhosis and ascites

po bactrim or cipro qd

the treatment duration for SBP for patients undergoing CAPD is _____. What else should be considered?

14-21 days and should consider removing catheter and transition to hemodialysis

intraperitoneal admin preferred in SBP patients that ____

are undergoing CAPD

secondary peritonitis is typically _____microbial

poly

list imaging used for secondary peritonitis

CT or X-ray

for empiric secondary peritonitis therapy, explain when enterococci coverage is NOT needed

If mild to mod community acquired secondary peritonitis

for empiric secondary peritonitis therapy, explain when enterococci coverage is needed

high severity IAI, history of cephalosporin use, immunocompromised, biliary source of infection, history of valvular heart disease, prosthetic valve

list empiric therapy options for community acquired mild-mod secondary peritonitis

ceftriaxone +metro, cefazolin + metro, cipro + metro, levo + metro, cefoxitin, ertapenem, or tigecycline

list empiric therapy options for community acquired severe and HC associated secondary peritonitis

cefepime + metro, cipro + metro, levo + metro, pip/tazo, meropenem

list therapy if candida albicans is found on culture for secondary peritonitis

fluconazole

list therapy if candida species (NOT albicans) is found on culture for secondary peritonitis

micafungin

list empiric therapies for secondary peritonitis that are avoided due to E. coli resistance

amp/sulbactam and cipro/levo + metro

what is important to keep in mind with pathogen directed therapy for secondary peritonitis

keep anaerobic coverage even if culture is negative

in general, secondary peritonitis is treated for a duration of

4-7 days after source control (hard to determine)

diverticulitis is treated for a duration of

if uncomplicated, don’t use antibiotics. If mod-severe: 5-10 days

appendicitis w/o perforation, abscess, or peritonitis is treated for a duration of

24 hours

cholecystitis w/o perforation is treated for a duration of

24 hours

bowel injuries repaired w/in 12 hrs are treated for a duration of

24 hours

What organisms in IAIs are possible but less common…therefore don’t usually need to be covered?

Staph Aureus and PsA