Sandbox/intraabdominal: Difference between revisions
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Revision as of 13:48, 13 June 2014
Overview
From a clinical view, intra-abdominal infections can be classified in:[1][2] 1) uncomplicated, in which the infectious process involves only a single organ and there is no anatomical disruption, and 2) complicated, in which the infectious process extends beyond the hollow viscus into the peritoneal space and is associated with abscess formation or peritonitits. Patients with uncomplicated intra-abdominal infections usually do not need antimicrobial therapy besides perioperative prophylaxis and can be managed with surgery alone (i.e. appendicitis).
Principles of Therapy for Complicated Intra-abdominal Infection
- Clinical factors for high risk patients:[3]
- Delay in the initial intervention (>24) h)
- APACHE II score of 15 or more.
- Advanced age (>70 years)
- Comorbidity and degree of organ dysfunction
- Low albumin level
- Poor nutrition status
- Degree of peritoneal involvement or diffuse peritonitis
- Inability to achieve adequate debridement or control of drainage
- Presence of malignancy
- All patients should undergo a source control procedure to drain infected foci, control ongoing peritoneal contamination by diversion or resection, and restore anatomic and physiological function.
- Patients should undergo rapid fluid resuscitation and other measures in order to promote physiological stability.FOr patienst with septic shock or organ failure, follow THe Surviving Sepsis Campaign guidelines for managing septic shock.[4]
- Antibiotics should be initiated once the diagnosis of intra-abdominal infection is established or once such infection is considered highly likely.
- Patients without septic shock should receive antimicrobial therapy in the emergency department.
- For patients with lower-risk with co community-acquired infection, cultures are optional. For higher-risk patients, cultures from the site of infection should be obtained.
- Susceptibility testing for Pseudomonas, Proteus, Acinetobacter, Staphylococcus aureus, and Enterobacteriaceae should be performed.
- Lower-risk patients with community-acquired intra-abdominal infection do not require modification of therapy if they show a satisfactory clinical response to source control and medical therapy.
- Use of susceptibility results to determine antibiotic therapy in high-severity community-acquired or health care-associated infection should be based on pathogenic potential and density of identified organisms.
- The duration of therapy should be limited to 4-7 days.
Initial Empiric Treatment of Extra-biliary Community-acquired Complicated Intra-abdominal Infection
▸ Click on the following categories to expand treatment regimens.
Pediatric patients ▸ Single agent ▸ Combination Adults, mild-to-moderate severity ▸ Single agent ▸ Combination Adults, high risk or severity ▸ Single agent ▸ Combination |
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Empiric Antimicrobial Therapy for Health Care-Associated Complicated Intra-abdominal Infection
▸ Click on the following categories to expand treatment regimens.
Multidrug resistant gram-negative bacilli ▸ Recommended Regimen ESBL-Enterobacteriaceae ▸ Recommended Regimen Pseudomonas aeruginosa >20% resistant to ceftazidime ▸ Recommended Regimen MRSA ▸ Recommended Regimen |
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Initial Empiric Treatment of Biliary Infection in Adults
▸ Click on the following categories to expand treatment regimens.
Community-acquired acute cholecystitis of mild-to-moderate severity ▸ Recommended Regimen Community-acquired acute cholecystitis of severe physiologic disturbance, advanced age, or immunocompromised state ▸ Recommended Regimen Acute cholangitis following bilio-enteric anastamosis of any severity ▸ Recommended Regimen Health care–associated biliary infection of any severity ▸ Recommended Regimen |
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References
- ↑ Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ; et al. (2010). "Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America". Clin Infect Dis. 50 (2): 133–64. doi:10.1086/649554. PMID 20034345.
- ↑ Blot S, De Waele JJ (2005). "Critical issues in the clinical management of complicated intra-abdominal infections". Drugs. 65 (12): 1611–20. PMID 16060697.
- ↑ Koperna T, Schulz F (1996). "Prognosis and treatment of peritonitis. Do we need new scoring systems?". Arch Surg. 131 (2): 180–6. PMID 8611076.
- ↑ Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM; et al. (2013). "Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012". Intensive Care Med. 39 (2): 165–228. doi:10.1007/s00134-012-2769-8. PMID 23361625.