MCQ Quiz: Management of Intra-abdominal Infections

The management of intra-abdominal infections (IAIs) is a critical area of inpatient care, encompassing a range of conditions from uncomplicated appendicitis to life-threatening, complicated peritonitis. As a pharmacist, understanding the principles of IAI management is essential for optimizing patient outcomes. The Patient Care 4 curriculum dedicates a specific module to this topic, emphasizing the cornerstones of therapy: timely and adequate source control combined with appropriate empiric antimicrobial therapy. This quiz will test your knowledge on the polymicrobial nature of these infections and the selection of evidence-based treatment regimens for both community- and healthcare-associated IAIs.

1. What is the most critical component in the successful management of a complicated intra-abdominal infection, such as an abscess?

• a. A 14-day course of oral antibiotics.
• b. Starting a probiotic.
• c. Adequate source control (e.g., percutaneous drainage or surgery).
• d. Administering an anti-motility agent.

Answer: c. Adequate source control (e.g., percutaneous drainage or surgery).

2. Intra-abdominal infections are typically polymicrobial. Empiric antibiotic regimens for community-acquired IAIs must reliably cover Gram-negative enteric flora and which other class of organisms?

• a. Atypical bacteria
• b. Viruses
• c. Anaerobic bacteria
• d. Fungi

Answer: c. Anaerobic bacteria

3. Which of the following is the most common anaerobic pathogen isolated from intra-abdominal infections?

• a. Clostridium perfringens
• b. Peptostreptococcus
• c. Bacteroides fragilis
• d. Actinomyces israelii

Answer: c. Bacteroides fragilis

4. A patient is diagnosed with mild-to-moderate, community-acquired complicated intra-abdominal infection. Which of the following would be an appropriate single-agent empiric antibiotic regimen?

• a. Ertapenem
• b. Vancomycin
• c. Ceftriaxone
• d. Metronidazole

Answer: a. Ertapenem

5. What is the key difference between an uncomplicated and a complicated intra-abdominal infection?

• a. Uncomplicated IAIs are always caused by Gram-positive bacteria.
• b. Complicated IAIs involve the extension of the infection beyond a single organ into the peritoneal space.
• c. Uncomplicated IAIs do not require antibiotics.
• d. Complicated IAIs are always healthcare-associated.

Answer: b. Complicated IAIs involve the extension of the infection beyond a single organ into the peritoneal space.

6. The “Management of Intra-abdominal Infections” is a specific learning module in which course?

• a. PHA5784C Patient Care 4
• b. PHA5104 Sterile Compounding
• c. PHA5703 Pharmacy Law and Ethics
• d. PHA5878C Patient Care 3

Answer: a. PHA5784C Patient Care 4

7. Which of the following antibiotic regimens provides excellent coverage for common community-acquired IAI pathogens, including both Gram-negatives and anaerobes?

• a. Levofloxacin alone
• b. Ceftriaxone plus metronidazole
• c. Vancomycin plus gentamicin
• d. Ampicillin alone

Answer: b. Ceftriaxone plus metronidazole

8. For a complicated IAI, what is the recommended duration of antibiotic therapy after adequate source control has been achieved?

• a. 24 hours
• b. 4-7 days
• c. 14 days
• d. At least 21 days

Answer: b. 4-7 days

9. Peritonitis is defined as:

• a. Inflammation of the gallbladder.
• b. Inflammation of the appendix.
• c. Inflammation of the peritoneum.
• d. Inflammation of the liver.

Answer: c. Inflammation of the peritoneum.

10. A patient with a healthcare-associated IAI is at higher risk for infection with which of the following resistant pathogens?

• a. Streptococcus pyogenes
• b. Haemophilus influenzae
• c. Pseudomonas aeruginosa
• d. Moraxella catarrhalis

Answer: c. Pseudomonas aeruginosa

11. The treatment of appendicitis and diverticulitis is covered in the lecture on intra-abdominal infections.

• a. True
• b. False

Answer: a. True

12. Why is metronidazole often added to other antibiotics like cephalosporins for treating IAIs?

• a. It provides excellent coverage against aerobic Gram-negative bacteria.
• b. It provides excellent coverage against anaerobic bacteria.
• c. It covers MRSA.
• d. It covers atypical pathogens.

Answer: b. It provides excellent coverage against anaerobic bacteria.

13. Which of the following is NOT considered adequate monotherapy for a mixed intra-abdominal infection?

• a. Piperacillin-tazobactam
• b. Meropenem
• c. Ciprofloxacin
• d. Moxifloxacin (for mild-moderate CA-IAI)

Answer: c. Ciprofloxacin

14. A patient has uncomplicated acute diverticulitis. According to recent guidelines, what is the most appropriate management?

• a. Immediate surgery is required.
• b. A 14-day course of IV piperacillin-tazobactam.
• c. Supportive care with a clear liquid diet; antibiotics may be reserved for select patients.
• d. A high-dose statin.

Answer: c. Supportive care with a clear liquid diet; antibiotics may be reserved for select patients.

15. Spontaneous Bacterial Peritonitis (SBP) is a type of primary peritonitis that occurs most commonly in patients with what underlying condition?

• a. Diabetes
• b. Heart failure
• c. Cirrhosis and ascites
• d. Chronic kidney disease

Answer: c. Cirrhosis and ascites

16. The primary pathogens in Spontaneous Bacterial Peritonitis are typically:

• a. Anaerobic bacteria
• b. Fungi
• c. Enteric Gram-negative bacilli like E. coli and Klebsiella.
• d. MRSA

Answer: c. Enteric Gram-negative bacilli like E. coli and Klebsiella.

17. What is the first-line treatment for SBP?

• a. An IV third-generation cephalosporin like ceftriaxone.
• b. Oral ciprofloxacin.
• c. IV vancomycin.
• d. Oral metronidazole.

Answer: a. An IV third-generation cephalosporin like ceftriaxone.

18. Which carbapenem has a narrower spectrum of activity that does NOT reliably cover Pseudomonas or Acinetobacter, making it suitable for CA-IAI but not always for HA-IAI?

• a. Meropenem
• b. Imipenem-cilastatin
• c. Doripenem
• d. Ertapenem

Answer: d. Ertapenem

19. A patient develops a surgical site infection after a colon resection. The empiric antibiotic regimen should cover:

• a. Gram-positives only.
• b. Gram-negatives only.
• c. Anaerobes only.
• d. Gram-positives, Gram-negatives, and anaerobes.

Answer: d. Gram-positives, Gram-negatives, and anaerobes.

20. The curriculum includes a required reading on Intra-Abdominal Infections from DiPiro’s Pharmacotherapy.

• a. True
• b. False

Answer: a. True

21. A patient with a severe penicillin allergy (anaphylaxis) needs coverage for a complicated IAI. Which regimen would be most appropriate?

• a. Piperacillin-tazobactam
• b. Meropenem
• c. Ciprofloxacin plus metronidazole
• d. Cefepime plus metronidazole

Answer: c. Ciprofloxacin plus metronidazole

22. “Source control” could involve which of the following procedures?

• a. Drainage of an abscess.
• b. Debridement of necrotic tissue.
• c. Surgical repair of a bowel perforation.
• d. All of the above.

Answer: d. All of the above.

23. Why is empiric coverage for Enterococcus not routinely recommended for community-acquired IAIs?

• a. Enterococcus is not found in the gut.
• b. It is generally considered a low-virulence organism in this setting, and standard regimens are often sufficient.
• c. It is always resistant to standard therapies.
• d. It is not a bacterium.

Answer: b. It is generally considered a low-virulence organism in this setting, and standard regimens are often sufficient.

24. The management of GI Infections is an active learning session in the Patient Care 4 course.

• a. True
• b. False

Answer: a. True

25. A patient has cholecystitis (inflammation of the gallbladder). The most common causative organisms are:

• a. Similar to those in other biliary tract and intra-abdominal infections (E. coli, Klebsiella, Enterococcus).
• b. Primarily Staphylococcus aureus.
• c. Primarily anaerobic bacteria.
• d. Viruses.

Answer: a. Similar to those in other biliary tract and intra-abdominal infections (E. coli, Klebsiella, Enterococcus).

26. What is the role of a pharmacist in managing IAIs?

• a. Recommending appropriate, guideline-concordant antimicrobial therapy.
• b. Adjusting doses for renal dysfunction.
• c. Monitoring for efficacy and adverse effects.
• d. All of the above.

Answer: d. All of the above.

27. A patient with a healthcare-associated IAI who is at high risk for MRSA should have what agent added to their empiric regimen?

• a. Metronidazole
• b. Ciprofloxacin
• c. Vancomycin
• d. Gentamicin

Answer: c. Vancomycin

28. What is the primary difference between primary and secondary peritonitis?

• a. Primary peritonitis has an evident intra-abdominal source, while secondary does not.
• b. Secondary peritonitis has an evident intra-abdominal source (like a perforation), while primary does not.
• c. Primary peritonitis is always caused by fungi.
• d. Secondary peritonitis is always community-acquired.

Answer: b. Secondary peritonitis has an evident intra-abdominal source (like a perforation), while primary does not.

29. For how long should antibiotics be continued if a patient with a complicated IAI does not have adequate source control?

• a. 4-7 days
• b. The duration is undefined and therapy is often continued until the source is controlled and the infection resolves.
• c. For 24 hours only.
• d. Antibiotics should be stopped immediately.

Answer: b. The duration is undefined and therapy is often continued until the source is controlled and the infection resolves.

30. The pharmacology of antimicrobials used for IAIs is covered in the Patient Care 2 curriculum.

• a. True
• b. False

Answer: a. True

31. Which of the following is NOT a goal of IAI management?

• a. Resolve the infection.
• b. Prevent mortality.
• c. Use the broadest possible antibiotic coverage for the longest possible duration in all cases.
• d. Minimize antibiotic-related toxicities.

Answer: c. Use the broadest possible antibiotic coverage for the longest possible duration in all cases.

32. Moxifloxacin is a fluoroquinolone with what unique spectrum feature that gives it a role in mild CA-IAI?

• a. It has activity against Pseudomonas aeruginosa.
• b. It has reliable activity against anaerobic bacteria.
• c. It has activity against MRSA.
• d. It covers fungi.

Answer: b. It has reliable activity against anaerobic bacteria.

33. The main reason for the polymicrobial nature of most IAIs is:

• a. Contamination from the skin during surgery.
• b. Seeding from a distant site of infection.
• a. A breach in the gastrointestinal tract, leading to spillage of endogenous gut flora.
• d. A hospital-wide outbreak.

Answer: c. A breach in the gastrointestinal tract, leading to spillage of endogenous gut flora.

34. A patient is diagnosed with uncomplicated appendicitis and undergoes an appendectomy. Post-operative antibiotics are:

• a. Required for 14 days.
• b. Not usually necessary.
• c. Required for 7 days.
• d. Always include coverage for MRSA.

Answer: b. Not usually necessary.

35. A patient has perforated appendicitis found during surgery. Post-operative antibiotics should be continued for:

• a. 24 hours
• b. 4-7 days
• c. 1 month
• d. No post-operative antibiotics are needed.

Answer: b. 4-7 days

36. Tigecycline has a broad spectrum of activity but its use in severe IAIs is limited due to:

• a. Its lack of anaerobic coverage.
• b. Its high cost.
• c. Poor clinical outcomes in severe infections, possibly due to low serum concentrations.
• d. Its narrow spectrum.

Answer: c. Poor clinical outcomes in severe infections, possibly due to low serum concentrations.

37. Which of the following is a risk factor for infection with resistant pathogens in a healthcare-associated IAI?

• a. Recent hospitalization
• b. Prior antibiotic use
• c. High local prevalence of resistant organisms
• d. All of the above

Answer: d. All of the above

38. The primary management of acute appendicitis is:

• a. A 10-day course of oral antibiotics.
• b. A watch-and-wait approach.
• c. Surgical appendectomy.
• d. A clear liquid diet for one week.

Answer: c. Surgical appendectomy.

39. Antifungal coverage for Candida should be considered in which patients with IAI?

• a. All patients with community-acquired IAI.
• b. Critically ill patients with recent surgery for a recurrent intestinal perforation.
• c. Patients with uncomplicated diverticulitis.
• d. It is never necessary.

Answer: b. Critically ill patients with recent surgery for a recurrent intestinal perforation.

40. The curriculum includes an active learning session on managing complicated intra-abdominal infections.

• a. True
• b. False

Answer: a. True

41. The most common organisms causing community-acquired IAIs are derived from:

• a. The patient’s skin flora.
• b. The patient’s oral flora.
• c. The patient’s colonic flora.
• d. The hospital environment.

Answer: c. The patient’s colonic flora.

42. Which of the following is NOT an appropriate single-agent therapy for a healthcare-associated IAI with risk for Pseudomonas?

• a. Piperacillin-tazobactam
• b. Meropenem
• c. Cefepime
• d. Imipenem-cilastatin

Answer: c. Cefepime

43. The first step in managing any IAI is:

• a. Starting antibiotics.
• b. Obtaining imaging to confirm the diagnosis and location.
• c. Resuscitation and stabilization of the patient.
• d. Calling a surgical consult.

Answer: c. Resuscitation and stabilization of the patient.

44. A patient develops cholangitis, an infection of the biliary tract. What is the most common cause?

• a. A viral infection
• b. An autoimmune process
• c. An obstruction of the common bile duct, often by a gallstone.
• d. A medication side effect.

Answer: c. An obstruction of the common bile duct, often by a gallstone.

45. After source control is achieved, antibiotic therapy can often be narrowed based on:

• a. The patient’s preference.
• b. The cost of the antibiotics.
• c. Intra-operative culture and sensitivity results.
• d. The pharmacist’s favorite drug.

Answer: c. Intra-operative culture and sensitivity results.

46. What is the key difference in microbiology between a stomach perforation and a colon perforation?

• a. A stomach perforation will have more anaerobes.
• b. A colon perforation will have a much higher bacterial load and a greater prevalence of anaerobes.
• c. There is no difference.
• d. A stomach perforation will involve more fungi.

Answer: b. A colon perforation will have a much higher bacterial load and a greater prevalence of anaerobes.

47. A “left-sided” IAI (e.g., sigmoid diverticulitis) is more likely to involve anaerobes than a “right-sided” IAI (e.g., appendicitis).

• a. True
• b. False

Answer: a. True

48. De-escalation of antibiotics in IAI management is an example of:

• a. Poor clinical practice.
• b. Antimicrobial stewardship.
• c. A medication error.
• d. A therapeutic failure.

Answer: b. Antimicrobial stewardship.

49. An active learning session on intra-abdominal infections is part of which course?

• a. PHA5784C Patient Care 4
• b. PHA5163L Professional Skills Lab 3
• c. PHA5781 Patient Care I
• d. PHA5782C Patient Care 2

Answer: a. PHA5784C Patient Care 4

50. The ultimate goal of managing a patient with a complicated IAI is to:

• a. Ensure the patient receives the broadest spectrum antibiotic for the longest duration.
• b. Resolve the infection with appropriate source control and targeted antimicrobial therapy while minimizing complications and mortality.
• c. Avoid surgery at all costs.
• d. Discharge the patient from the hospital as quickly as possible, regardless of their clinical status.

Answer: b. Resolve the infection with appropriate source control and targeted antimicrobial therapy while minimizing complications and mortality.