Management of Intra-Abdominal Infections
Intra-abdominal infections are common problem in the practice of the acute care surgeon. Evidence based guidelines have been developed to aid clinicians in the diagnosis and management of this common and potentially complex clinical problem (Solomkin et a
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Laura J. Moore
Intra-abdominal infections are common problem in the practice of the acute care surgeon. Evidence based guidelines have been developed to aid clinicians in the diagnosis and management of this common and potentially complex clinical problem [1]. The management of patients with intra-abdominal infections consumes considerable hospital resources and spans multiple areas of the hospital including the emergency department, operating room, and intensive care unit. Intra-abdominal infections can be categorized as either uncomplicated or complicated. Uncomplicated intra-abdominal infections involve a single organ and do not spread to the peritoneum. The mainstay of management of uncomplicated intra-abdominal infections is antimicrobial therapy. Complicated intra-abdominal infections extend beyond a single organ and present with focal or diffuse peritonitis necessitating surgical intervention in addition to antimicrobial therapy. Patient outcomes are strongly influenced by the initial clinical decision making, including rapidity of diagnosis, timely operative intervention to obtain source control, and antibiotic selection. This text will provide a concise but comprehensive review of the key diagnostic and management strategies for the management of patients with intraabdominal infections. Recommendations for surgical intervention for specific disease processes (e.g., appendicitis, diverticulitis) are beyond the scope of this chapter and will be discussed in subsequent areas of the textbook.
not spread to the peritoneum. Typically patients with uncomplicated IAIs can be managed with either surgical intervention OR antibiotics. Examples of uncomplicated IAIs include nonperforated appendicitis, acute cholecystitis, and acute diverticulitis. Complicated IAIs occur when the infectious process spreads beyond the single organ, resulting in either localized or diffuse peritonitis. The treatment of patients with complicated IAIs involves BOTH surgery and antibiotic therapy. Patients with IAIs can be further categorized based upon their overall health status into low-risk and high-risk populations. Categorization into low-risk and highrisk categories takes into account the patient’s history, the type of infection, and the patient’s physiologic status at the time of diagnosis. Low-risk patients present with community acquired IAIs without physiologic derangements. High-risk patients (Table 15.1) typically present with underlying comorbid conditions often in a delayed fashion. This combination of factors increases the complexity of the decision making process for the optimal management of these patients. Finally, it is also important to recognize the difference in potential pathogens associated with community acquired vs. hospital acquired IAIs. The major clinical difference between community acquired and hospital acquired IAIs is that patients with hospital acquired IAIs typically have a higher severity of illness at the time of presentation.
Background
Initial Diagnostic Evaluation
Intra-abdominal infections (I
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