Confined to visceral structures and peritoneal cavity
Anatomical disruption, extends past single organ, or abscess is formed
Purulent collection of walled off fluids, separated from a surrounding tissue, filled with necrotic debris, bacteria, and inflammatory and immune cells
Abscesses typically occur adjacent to the site of primary diseases?
Another name for primary peritonitis:
Spontaneous bacterial peritonitis
SBP has an evident source in the abdomen?
10-30% of patients with alcoholic cirrhosis, ascites
Typically a slower process to manifest symptoms
Involves perforation of the GI tract, visceral perforation by a peptic ulcer, IBD, Appendicitis (CA-IAI)
Occurs in critically ill patients- persistent/recurrent peritonitis at least 48 hours after management of primary or secondary peritonitis
Organisms found in the stomach:
Organisms found in the small bowel
Streptococcus, enterococcus, E.coli, klebsiella, lactobacillus, diphtheroids
Organisms found in biliary tract
E. coli, klebsiella, or enterococci
Organisms found in distal ileum
E. coli, klebsiella, enterobacter, enterococci, B. fragilis, Clostridium, peptostreptococci
Organisms found in colon
E. coli, klebsiella, enterobacter, enterococci, B. fragilis, Clostridium, peptostreptococci, candida
Two cardinal symptoms of IAI?
Leukocytosis and fever
LLQ abdominal pain with constipation
Sudden onset of epigastric pain, shifting to RLQ
Treatment goal of IAI:
Approach to treatment for IAI:
1. Prompt surgical intervention and drainage of infected site
2. Hemodynamic resuscitation
3. Early administration of appropriate antimicrobial therapy
Antimicrobial therapy is curative for IAI?
What is the duration of therapy for IAI?
FOUR DAYS AFTER ADEQUATE SOURCE CONTROL
When should anti-microbial therapy be started?
As soon as IAI is suspected
What coverage do you need in IAI's?
Broadly cover aerobic and anaerobic organisms
Enterococcal coverage should be given in mild to moderate CA-IAI?
False- should only be given in sever CA-IAI or HA-infections
Which TWO candida species have to be treated with echinocandins?
Krusei and auris
What is the diagnostic criteria for SBP?
PMNs >250 cells/mm3
- Need to cover e.coli and streptococcus
What is the duration of therapy for SBP?