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Guidelines
Pathogens
Antimicrobials
Perforation of the stomach or duodenum, usually due to peptic ulcer disease, but can include iatrogenic or non-iatrogenic trauma, ingested foreign bodies or cancer
Diagnostic Pearls
Rapid surgical consultation for repair
Test for H. pylori in all patients with peptic ulcer disease and gastric cancer
Assess NSAID use history
Source control within 24 hours
Including those on PPIs or with malignancy
Complicated
Delayed repair
Extends beyond source organ causing peritonitis or abscess
Upper GI Bleed with Cirrhosis
Usual Organisms
Helicobacter pylori
Oral Streptococci
Enterobacteriaceae (E. coli, Klebsiella spp.)
Less Common Ogranisms
Enterococci
Enteric Anaerobes (B. fragilis, Clostridium spp.)
Organisms of Interest in IAI
ESBLs in IAI
AmpC producing organisms or "SPICE" bacteria in IAI
Enterococci, particularly E. faecium and VRE in IAI
MRSA in IAI
Candida in IAI
