Though patients present with a wide range of causes and various degrees of severity, the basic tenets of treatment remain source control, resuscitation, and antibiotic therapy. In the presence of any red zone criterion or two or more yellow zone criteria, gentamicin iv is to be added to the first or secondline regimen unless. Abdominal infection rate 30% if antibiotics administered post op. Intra abdominal infections are an important cause of morbidity and mortality that require treatment with antibiotic agents. The primary study outcome was a composite endpoint measuring occurrence of any one of the following.
Intraabdominal infection iai is a common disease pro cess managed by. The cornerstones of effective treatment of iais are early recognition, adequate source control, and appropriate antimicrobial therapy. Diagnosis and management of complicated intraabdominal infection in adults and children. Most intra abdominal infections develop from a source in the gastrointestinal tract. Abdominal infections are usually polymicrobial and result in an intra abdominal abscess or secondary peritonitis, which may be generalized or localized phlegmon. For patients with septic shock, antibiotics should be administered as soon as possible aiii. In this setting, short course gentamicin see appendix 2 is preferred because. Recent guidelines from the infectious diseases society of america suggest that a compli cated intraabdominal infection is an intraabdominal infection coupled with any one of the following indi. Sep 15, 2010 the surgical infection society and infectious diseases society of america recently updated recommendations for diagnosis and treatment of intra abdominal infections. Apr 28, 2016 intra abdominal candidiasis iac is the most common type of deepseated candidiasis, but remains poorly understood compared to candidemia. The most common source of infection in community acquired intraabdominal infections is the appendix, followed by the colon, and then the stomach. The anatomical extent of infection, the presumed pathogens involved, risk factors for. Infection develops in 3050% of patients with necrosis documented by ct scan or at the time of surgery.
Acsase medical student core curriculum intraabdominal and. Evidencebased guidelines for managing patients with intraabdominal infection were prepared by an expert panel of the surgical infection society and the infectious diseases society of america. Several factors should come into play once suspicion for an intra abdominal infection is entertained. Intraabdominal sepsis adult version number 1 april 2017 page 5 table 2 empirical treatment of intraabdominal infections n. The precise microbiological spectrum depends on the precise gastrointestinal source ie, small versus large bowel. Intraabdominal infections pharmacotherapy quick guide. The approach to antimicrobial selection and administration for intra abdominal infections in adults is discussed. The multifaceted nature of these infections has led to collaboration. Intraabdominal infection is a common problem worldwide. These updated guidelines replace those previously published in 2002 and 2003.
Less commonly, they can arise from the gynecologic or urinary tract. For patients with septic shock, antibiotics should be administered as soon as. Intraabdominal candidiasis iac is the most common type of deepseated candidiasis, but remains poorly understood compared to candidemia. Intraabdominal infection iai, also spelled intraabdominal is a group of infections that occur within the abdominal cavity. However, in the setting of acute perforation, antifungal therapy is generally unnecessary unless the patient is immunosuppressed, has. Prophylactic antibiotics have been associated with a change in the spectrum of pancreatic isolates from enteric gramnegatives to grampositive organisms and fungi. Diagnosis and manage ment of complicated intraabdominal infection in adults and children. Prompt resuscitation of patients with ongoing sepsis is of utmost. In the majority of cases, those masses remain undetected, until their often incidental discovery on abdominal imaging e. Systemic regimens reduce rate of prep as outlined above. Patients who potentially have an acute intraabdominal infection in association with systemic sepsis, satisfying either the red zone or yellow zone criteria above require addition of gentamicin iv to their antibiotic regimen. We performed a retrospective study of adults diagnosed with iac at our center in 201220.
Antimicrobial therapy should be initiated once a patient receives a diagnosis of an intraabdominal infection or once such an infection is considered likely. Epidemiologic reports, antifungal treatment trials and diagnostic studies of invasive candidiasis have focused largely on candidemia. Metronidazole 750 mg may be substituted for erythromycin in sensitive patients. Peritonitis is subdivided into primary, secondary, and tertiary varieties. Acsase medical student core curriculum intraabdominal. Most intraabdominal infections are secondary infections that are polymicrobial and are caused by a defect in the gastrointestinal gi tract that must be treated by surgical drainage, resection, andor repair.
Intraabdominal infections iais are common surgical emergencies and have been reported as major contributors. The role of the intraabdominal view in complicated intraabdominal. Sepsis is a dynamic process that can evolve into conditions of varying severity 10, 11. The inflammatory response in patients with sepsis depends on the causative pathogen and. Trauma wound care and infection control mayo clinic. Most of the complicated intraabdominal infections treated by surgeons involve peritonitis or intraabdominal abscesses. Previous evidencebased guidelines on the management of intraabdominal infection iai were published by the surgical infection society sis in 1992, 2002, and 2010. Primary peritonitis is a monomicrobial infection in which the integrity of the gastrointestinal tract has not been violated. Secondary peritonitis is infection of the peritoneal cavity due to spillage of organisms into the peritoneum, usually associated with gi or genitourinary tract e. Abdominal infection rate 30% if antibiotics administered post op 70% abdominal infection rate in patients with colon injury modern combat steele dis col rec 2007, peterson ann surg 2007 43% infection rate with abdominal wounds 5. It can involve any intraabdominal organ or be located in between bowel loops, or be free within the peritoneal cavity itself. Risk factors for mortality were evaluated using multivariable logistic regression. The management of intraabdominal infections from a global. Pdf complicated intraabdominal infections are an important cause of morbidity and are frequently associated with poor prognosis.
Intraabdominal infections iais include many pathological conditions, ranging from uncomplicated appendicitis to faecal peritonitis. Abdominal infections are usually polymicrobial and result in an intraabdominal abscess or secondary peritonitis, which may be generalized or localized phlegmon. Patients who potentially have an acute intra abdominal infection in association with systemic sepsis, satisfying either the red zone or yellow zone criteria above require addition of gentamicin iv to their antibiotic regimen. Management generally involves an invasive procedure to control the source of the infection and antimicrobial therapy directed against the causative microorganisms. The cornerstones of effective treatment of iais are early recognition, adequate source control, and appropriate.
The inflammatory response in patients with sepsis depends on the causative pathogen and the host genetic characteris. When the infection extends into the peritoneal cavity or another normally sterile region of the abdominal cavity, the infection is described as a complicated intra abdominal infection. These include resuscitation, antibiotic usage, and source control itself. Updated guideline on diagnosis and treatment of intra. Vascular conditions by category, with tier class category. When the infection extends into the peritoneal cavity or another normally sterile region of the abdominal cavity, the infection is described as a complicated intraabdominal infection. Empiric antimicrobial therapy is nevertheless important in the overall management of intraabdominal infections. Intraabdominal infections usually arise after a breach in the intrinsic mucosal defense barrier that allows normal bowel flora to inoculate the abdominal cavity. Cure the infection reducing antimicrobial resistance reduces risk of clostridium difficile infection reduces risk of antimicrobialrelated organ toxicity reduces hospital costs and length of stay improves drug compliance file tm. Intraabdominal abscess is a sample topic from the johns hopkins abx guide. Abdominal sepsis represents the hostssystemic inflammatory response to intraabdominal infections. Intraabdominal sepsis is an iai that results in severe sepsis or septic shock2. Increased time to event with longer antibiotic therapy 10 vs 15 days infection with a resistant infection trended toward an increase with longer antibiotic therapy. At the time the most recent guideline was released, the plan was to update the guideline every.
Based on clinical features, niais and severe ciais presented significantly higher values in age, length of hospital stay, mortality, and the incidence of severe intraabdominal infection than mildmoderate ciais p infection develops in 3050% of patients with necrosis documented by ct scan or at the time of surgery. Pdf a focus on intraabdominal infection researchgate. Download fulltext pdf download fulltext pdf download fulltext pdf a focus on intraabdominal infection article pdf available in world journal of emergency surgery 51. The surgical infection society revised guidelines on the.
When peritonitis results from peritoneal dialysis, skin surface flora are introduced via the peritoneal catheter. They are usually caused by aerobic and anaerobic enteric bacteria. Intraabdominal infections are an important cause of morbidity and mortality that require treatment with antibiotic agents. A term severe complicated intraabdominal sepsis scias to. Dehiscences complicate 510% of intraabdominal bowel anastomoses, and are associated with a mortality increase 3. It can involve any intra abdominal organ or be located in between bowel loops, or be free within the peritoneal cavity itself. Appendicitis is the most frequent cause of abscess. Diagnosis and management of complicated intraabdominal. Antibiotic therapy for intraabdominal infections mcgovern medical.
Intra abdominal infections iais are common surgical emergencies and have been reported as major contributors to nontrauma deaths in the emergency departments worldwide. In the critically ill patients there is some evidence that the prevention of gut mucosal acidosis improves outcome. Uncomplicated infection, which involves intramural inflammation of the gastrointesti nal tract, may progress to complicated infection if left untreated. Mar 19, 2010 the most common source of infection in community acquired intra abdominal infections is the appendix, followed by the colon, and then the stomach. We described the clinical characteristics, microbiology, treatment and outcomes of iac, and identified risk factors for mortality. Patients who present with either a suspected or diagnosed intra abdominal infection should have some form of volume resuscitation. Diagnosis and manage ment of complicated intra abdominal infection in adults and children. Hepatic masses one of the principal organs where intra abdominal masses occur is the liver.
Intra abdominal abscess answers are found in the johns hopkins abx guide powered by unbound medicine. Psapvii infectious diseases 181 intraabdominal infections agreed on clinically. Antifungal therapy is recommended if candida is cultured from intraabdominal fluid cultures in patients with severe community acquired or healthcare associated infection. Lecture 24 intraabdominal infections lalji intraabdominal. Intraabdominal infection results from entry of bacteria into the peritoneal or retroperitoneal spaces or from bacterial collections within intraabdominal organs. Several factors should come into play once suspicion for an intraabdominal infection is entertained. Intraabdominal collection of pus or infected material, usually due to a localised infection inside the peritoneal cavity. Intraabdominal infections iais represent a most frequent. Peak incidence of infection occurs in the 3rd week of disease. Patients who present with either a suspected or diagnosed intraabdominal infection should have some form of volume resuscitation. Dehiscences complicate 510% of intra abdominal bowel anastomoses, and are associated with a mortality increase 3.
Intraabdominal collection of pus or infected material, usually due to a localized infection inside the peritoneal cavity. Intra abdominal sepsis adult version number 1 april 2017 page 5 table 2 empirical treatment of intra abdominal infections n. Management of intraabdominal infections free online. Epidemiological study of community and hospitalacquired.
Recent guidelines from the infectious diseases society of america suggest that a complicated intraabdominal infection is an intraabdominal infection coupled with any one of the following indicators of severe illness. Complicated intraabdominal infection, which extends into the peritoneal space, is associated with abscess for mation and peritonitis. Intraabdominal infections request pdf researchgate. Clinicians manual on intraabdominal infections pdf if you found this book helpful then please like, subscribe and share. Intra abdominal infections in adults solomkin js, mazuski je, bradley js, et al. Though patients present with a wide range of causes and various degrees of severity, the basic. Intra abdominal infection iai, also spelled intraabdominal is a group of infections that occur within the abdominal cavity. The approach to antimicrobial selection and administration for intraabdominal infections in adults is discussed. Antibiotic therapy for intraabdominal infections mcgovern. Intraabdominal infections in adults solomkin js, mazuski je, bradley js, et al. Intraabdominal candidiasis iac is poorly understood compared to candidemia.
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