Term
| Primary peritonitis from peritoneal dialysis. what abx do you use? |
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Definition
Treatment: 14 DAYS (or longer if there is fungal infxn)
-Vancomycin OR Cefazolin] + [3rd gen Ceph OR Aminoglycoside]
-But she would never use cefazolin with 3rd gen ceph
-Try cefazolin with AG, or vanc and gent/AG, or vanc and 3rd gen ceph.
Don’t have to worry about systemic resistance because it doesn’t get into the blood, and can use smaller amounts bc goes right to site of infx, inflamm will help |
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Term
| Primary peritonitis from cirrhosis with cites. what abx do you use? |
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Definition
Treatment: 5 DAYS + prophylaxis indefinitely(?)
Primary: [Cefotaxime]
Alternatives:
Add Clinda or metronidazole if anaerobes are suspected OR
Other 3rd gen ceph, Extended spectrum pcn(resistant to amp so don’t use), Aztreonam, or Imipenem
Aminoglycoside with antipseudomonal pcn |
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Term
| Primary peritonitis from peritoneal dialysis. What bacteria commonly cause this? |
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Definition
Gram Positive skin infections
o S. Epidermidis, S. Aureus, Streptococci, Diptheroids |
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Term
| Primary peritonitis from cirrhosis with cites. What bacteria commonly cause this? |
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Definition
Gram negative
o E. coli (most common)
o Haemphilus pneumoniae
o Klebsiella
o Anaerobes
o S. Pneumonia, Pseudomonas |
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Term
| What bacteria commonly cause Secondary Peritonitis? |
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Definition
Usually polymicrobial
E. Coli, Bacterioides Fragilis, Enterococcus, Streptococci
Female genital tract: aerobic and anaerobic. Get to peritoneum through fallopian tubes.
Lactobacilli, eubacteria, clostridia, anaerobic strep, aerobic strep, staph epidermidis |
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Term
| Secondary Peritonitis: Community Acquired. How do you treat this ir Mild-Moderate and also if Severe?? |
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Definition
Antibiotics: 4-7 DAYS (unless difficult source control, still sick, feverish, etc)
Mild to Moderate (monotherapy-do not need to cover enterococcus faecalis!!!)
o Ticarcillin-Clavulanate
o Cefoxitin
o Ertapenem
o Moxifloxacin (not as good tho)
o Tigecycline
o Metronidazole + anyone of these to cover gram neg: Cefazolin, Cefuroxime, 3rd gen Ceph, Levo or Cipro
High Severity or risk (Combo therapy-must cover enterococcus faecalis!!!!)
o Imipenem-cilastatin, meropeneme, doripenem
o Piperacillin-tazobactam
o Metronidazole + Cefepime or Ceftazidime or Cipro or Levo |
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Term
| Secondary Peritonitis: Hospital Acquired. How do you treat this? |
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Definition
Treat as it was high severity community acquired
Add antifungal ONLY if Candida grows (it’s normal to have some in GIT)
MRSA coverage (if exposure to antibiotics previously or have MRSA) – Vancomycin
High Severity or risk (Combo therapy-must cover enterococcus faecalis!!!!)
o Imipenem-cilastatin, meropeneme, doripenem
o Piperacillin-tazobactam
o Metronidazole + Cefepime or Ceftazidime or Cipro or Levo |
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Term
| Describe Tertiary Peritonitis. |
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Definition
-Infection that persists or recurs at least 48 hours after apparently adequate management of primary or secondary peritonitis.
-More chronic and complicated |
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Term
| What are the predictors of antibiotic failure? |
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Definition
Delay in intervention
High severity (APACHE ≥15)
old age
comorbidity
degree of organ dysfunction
Low albumin level
Poor nutritional status
Degree of peritoneal involvement or diffuse peritonitis
Inability to achieve adequate debridement or control of drainage,
malignancy
transplant (may be immunosuppressed),
hospital stay prior to operation ≥5 days |
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Term
The following are indicative of _________ Peritonitis.
Presentation:
Indolent, N/V, abd tender, low fever, hypoactive bowel sounds, worsening encephalopathy in liver disease cloudy diasylate, fluid culture +, Bacterial on gram stain, inc WBC, Ascitic fluid >300 leukocytes/mm3, etc |
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Definition
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Term
The following are indicative of ______ Peritonitis:
Presentation:
Often acute (SUDDENLY HURTS, like appendicitis), Generalized abdominal pain
Tachypnea, Tachycardia
N/V, Fever
Hypotension & Shock
Dec urine output, Hypovolemia
Absent bowel sound, Board-like abdomen
Leukocytosis |
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Definition
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Term
The following are indicative of ______:
: Indolent, Fever often low grade, Leukocytosis, ileus, Abd pain, Abd distension |
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Definition
Abcess.
-Falls within category of secondary or tertiary peritonitis
-May occur without preceding generalized peritonitis
-Causes overlap with peritonitis: Appendicitis, Pancreatitis, Pelvic Inflammatory Disease. |
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Term
| what drugs do you use for primary and secondary propylaxis? |
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Definition
ciprofloxacin, norfloxacin, and bactrim!
prophylaxis is specifically for liver dz pts |
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