Appendicular abscess medical therapy: Difference between revisions

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Latest revision as of 20:28, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

No universal standard treatment exists for appendicitis complicated by abscess. The mainstay of treatment includes abscess drainage along with empiric antibiotics. It resolves most of the abscess. Once the abscess is resolved, it is followed by appendectomy 8-12 weeks after the pharmacological treatment.

Treatment

The preferred treatment includes non-operative management such as drainage and broad spectrum IV antibiotics along with IV fluids followed by surgery which includes interval laparoscopic appendectomy. It has proved to have a high success rates up to 97% and low incidences of complications.^[1]^[2]^[3]^[4]

Medical Therapy

Antibiotics should be started immediately once the diagnosis of abscess is made. Preoperative antibiotics have been associated with lower rates of wound and intra-abdominal infections.^[5]^[6]

Duration

The duration of treatment with intravenous antibiotics ranges from 5 to 10 days, until fever resolves, white blood cell count normalizes, and bowel function returns.^[6]

Empiric therapy

Monotherapy with a beta-lactam/beta-lactamase inhibitor:

Preferred regimen (1):Ampicillin-sulbactam 3 g IV q6h
Preferred regimen (2):Ticarcillin-clavulanate 3 g IV q4h
Preferred regimen (3):Piperacillin-tazobactam 3 g or 4.5 g IV q6h

Combination third generation cephalosporins PLUS metronidazole

Preferred regimen (1): Ceftriaxone 1 g IV q24h AND Metronidazole 500 mg IV q8h OR 1500 mg q24h.
Preferred regimen (2): Cefazolin 1–2 g IV q8h AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h
Preferred regimen (3): Cefuroxime 1.5 g IV q8h AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h
Preferred regimen (4): Cefotaxime 1–2 g IV q6–8 h AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h

Alternative empiric regimens

Combination fluoroquinolone PLUS metronidazole:

Preferred regimen (1): Ciprofloxacin 400 mg IV q12h AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h
Preferred regimen (2): Levofloxacin 750 mg IV q24h AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h

Monotherapy with a carbapenem

Preferred regimen (1): Imipenem-cilastatin 500 mg IV q6h OR 1 g q8h
Preferred regimen (2): Meropenem 1 g IV q8h
Preferred regimen (3): Doripenem 500 mg IV q8h
Preferred regimen (4): Ertapenem 1 g IV q24h

References

↑ Samuel M, Hosie G, Holmes K (2002). "Prospective evaluation of nonsurgical versus surgical management of appendiceal mass". J. Pediatr. Surg. 37 (6): 882–6. PMID 12037755.
↑ Kaminski A, Liu IL, Applebaum H, Lee SL, Haigh PI (2005). "Routine interval appendectomy is not justified after initial nonoperative treatment of acute appendicitis". Arch Surg. 140 (9): 897–901. PMID 16175691.
↑ Ansaloni L, Catena F, Coccolini F, Ercolani G, Gazzotti F, Pasqualini E, Pinna AD (2011). "Surgery versus conservative antibiotic treatment in acute appendicitis: a systematic review and meta-analysis of randomized controlled trials". Dig Surg. 28 (3): 210–21. doi:10.1159/000324595. PMID 21540609.
↑ Meshikhes AW (2008). "Management of appendiceal mass: controversial issues revisited". J. Gastrointest. Surg. 12 (4): 767–75. doi:10.1007/s11605-007-0399-1. PMID 17999120.
↑ 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.
↑ ^6.0 ^6.1 Sartelli, Massimo; Viale, Pierluigi; Catena, Fausto; Ansaloni, Luca; Moore, Ernest; Malangoni, Mark; Moore, Frederick A; Velmahos, George; Coimbra, Raul; Ivatury, Rao; Peitzman, Andrew; Koike, Kaoru; Leppaniemi, Ari; Biffl, Walter; Burlew, Clay Cothren; Balogh, Zsolt J; Boffard, Ken; Bendinelli, Cino; Gupta, Sanjay; Kluger, Yoram; Agresta, Ferdinando; Di Saverio, Salomone; Wani, Imtiaz; Escalona, Alex; Ordonez, Carlos; Fraga, Gustavo P; Junior, Gerson Alves Pereira; Bala, Miklosh; Cui, Yunfeng; Marwah, Sanjay; Sakakushev, Boris; Kong, Victor; Naidoo, Noel; Ahmed, Adamu; Abbas, Ashraf; Guercioni, Gianluca; Vettoretto, Nereo; Díaz-Nieto, Rafael; Gerych, Ihor; Tranà, Cristian; Faro, Mario Paulo; Yuan, Kuo-Ching; Kok, Kenneth Yuh Yen; Mefire, Alain Chichom; Lee, Jae Gil; Hong, Suk-Kyung; Ghnnam, Wagih; Siribumrungwong, Boonying; Sato, Norio; Murata, Kiyoshi; Irahara, Takayuki; Coccolini, Federico; Lohse, Helmut A Segovia; Verni, Alfredo; Shoko, Tomohisa (2013). "2013 WSES guidelines for management of intra-abdominal infections". World Journal of Emergency Surgery. 8 (1): 3. doi:10.1186/1749-7922-8-3. ISSN 1749-7922.

[pmid12037755-1] Samuel M, Hosie G, Holmes K (2002). "Prospective evaluation of nonsurgical versus surgical management of appendiceal mass". J. Pediatr. Surg. 37 (6): 882–6. PMID 12037755.

[pmid16175691-2] Kaminski A, Liu IL, Applebaum H, Lee SL, Haigh PI (2005). "Routine interval appendectomy is not justified after initial nonoperative treatment of acute appendicitis". Arch Surg. 140 (9): 897–901. PMID 16175691.

[pmid21540609-3] Ansaloni L, Catena F, Coccolini F, Ercolani G, Gazzotti F, Pasqualini E, Pinna AD (2011). "Surgery versus conservative antibiotic treatment in acute appendicitis: a systematic review and meta-analysis of randomized controlled trials". Dig Surg. 28 (3): 210–21. doi:10.1159/000324595. PMID 21540609.

[pmid17999120-4] Meshikhes AW (2008). "Management of appendiceal mass: controversial issues revisited". J. Gastrointest. Surg. 12 (4): 767–75. doi:10.1007/s11605-007-0399-1. PMID 17999120.

[pmid20034345-5] 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.

[SartelliViale2013-6] 6.0 ^6.1 Sartelli, Massimo; Viale, Pierluigi; Catena, Fausto; Ansaloni, Luca; Moore, Ernest; Malangoni, Mark; Moore, Frederick A; Velmahos, George; Coimbra, Raul; Ivatury, Rao; Peitzman, Andrew; Koike, Kaoru; Leppaniemi, Ari; Biffl, Walter; Burlew, Clay Cothren; Balogh, Zsolt J; Boffard, Ken; Bendinelli, Cino; Gupta, Sanjay; Kluger, Yoram; Agresta, Ferdinando; Di Saverio, Salomone; Wani, Imtiaz; Escalona, Alex; Ordonez, Carlos; Fraga, Gustavo P; Junior, Gerson Alves Pereira; Bala, Miklosh; Cui, Yunfeng; Marwah, Sanjay; Sakakushev, Boris; Kong, Victor; Naidoo, Noel; Ahmed, Adamu; Abbas, Ashraf; Guercioni, Gianluca; Vettoretto, Nereo; Díaz-Nieto, Rafael; Gerych, Ihor; Tranà, Cristian; Faro, Mario Paulo; Yuan, Kuo-Ching; Kok, Kenneth Yuh Yen; Mefire, Alain Chichom; Lee, Jae Gil; Hong, Suk-Kyung; Ghnnam, Wagih; Siribumrungwong, Boonying; Sato, Norio; Murata, Kiyoshi; Irahara, Takayuki; Coccolini, Federico; Lohse, Helmut A Segovia; Verni, Alfredo; Shoko, Tomohisa (2013). "2013 WSES guidelines for management of intra-abdominal infections". World Journal of Emergency Surgery. 8 (1): 3. doi:10.1186/1749-7922-8-3. ISSN 1749-7922.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Appendicular abscess}}
-{{CMG}};{{AE}}{{ADG}}
+{{CMG}}; {{AE}}{{ADG}}
 ==Overview==
+No universal standard treatment exists for [[appendicitis]] complicated by [[abscess]]. The mainstay of treatment includes abscess drainage along with empiric [[antibiotics]]. It resolves most of the abscess. Once the abscess is resolved, it is followed by [[appendectomy]] 8-12 weeks after the [[pharmacological]] treatment.
 ==Treatment==
-No universal standard treatment exists for appendicitis complicated by abscess. The preferred treatment includes non-operative management such as drainage and broad spectrum IV antibiotics along with IV fluids followed by surgery which includes interval laparoscopic appendectomy. It has proved to have a high success rates up to 97% and low incidences of complications.<ref name="pmid12037755">{{cite journal |vauthors=Samuel M, Hosie G, Holmes K |title=Prospective evaluation of nonsurgical versus surgical management of appendiceal mass |journal=J. Pediatr. Surg. |volume=37 |issue=6 |pages=882–6 |year=2002 |pmid=12037755 |doi= |url=}}</ref><ref name="pmid16175691">{{cite journal |vauthors=Kaminski A, Liu IL, Applebaum H, Lee SL, Haigh PI |title=Routine interval appendectomy is not justified after initial nonoperative treatment of acute appendicitis |journal=Arch Surg |volume=140 |issue=9 |pages=897–901 |year=2005 |pmid=16175691 |doi= |url=}}</ref><ref name="pmid21540609">{{cite journal |vauthors=Ansaloni L, Catena F, Coccolini F, Ercolani G, Gazzotti F, Pasqualini E, Pinna AD |title=Surgery versus conservative antibiotic treatment in acute appendicitis: a systematic review and meta-analysis of randomized controlled trials |journal=Dig Surg |volume=28 |issue=3 |pages=210–21 |year=2011 |pmid=21540609 |doi=10.1159/000324595 |url=}}</ref><ref name="pmid17999120">{{cite journal |vauthors=Meshikhes AW |title=Management of appendiceal mass: controversial issues revisited |journal=J. Gastrointest. Surg. |volume=12 |issue=4 |pages=767–75 |year=2008 |pmid=17999120 |doi=10.1007/s11605-007-0399-1 |url=}}</ref>
+The preferred treatment includes non-operative management such as drainage and broad spectrum IV antibiotics along with [[IV fluids]] followed by surgery which includes interval [[laparoscopic]] [[appendectomy]]. It has proved to have a high success rates up to 97% and low incidences of complications.<ref name="pmid12037755">{{cite journal |vauthors=Samuel M, Hosie G, Holmes K |title=Prospective evaluation of nonsurgical versus surgical management of appendiceal mass |journal=J. Pediatr. Surg. |volume=37 |issue=6 |pages=882–6 |year=2002 |pmid=12037755 |doi= |url=}}</ref><ref name="pmid16175691">{{cite journal |vauthors=Kaminski A, Liu IL, Applebaum H, Lee SL, Haigh PI |title=Routine interval appendectomy is not justified after initial nonoperative treatment of acute appendicitis |journal=Arch Surg |volume=140 |issue=9 |pages=897–901 |year=2005 |pmid=16175691 |doi= |url=}}</ref><ref name="pmid21540609">{{cite journal |vauthors=Ansaloni L, Catena F, Coccolini F, Ercolani G, Gazzotti F, Pasqualini E, Pinna AD |title=Surgery versus conservative antibiotic treatment in acute appendicitis: a systematic review and meta-analysis of randomized controlled trials |journal=Dig Surg |volume=28 |issue=3 |pages=210–21 |year=2011 |pmid=21540609 |doi=10.1159/000324595 |url=}}</ref><ref name="pmid17999120">{{cite journal |vauthors=Meshikhes AW |title=Management of appendiceal mass: controversial issues revisited |journal=J. Gastrointest. Surg. |volume=12 |issue=4 |pages=767–75 |year=2008 |pmid=17999120 |doi=10.1007/s11605-007-0399-1 |url=}}</ref>
-===Percutaneous drainage===
-*Percutaneous drainage can be performed under USG or CT guidance, using either the Seldinger or trocar technique.<ref name="pmid14767853">{{cite journal |vauthors=Hogan MJ |title=Appendiceal abscess drainage |journal=Tech Vasc Interv Radiol |volume=6 |issue=4 |pages=205–14 |year=2003 |pmid=14767853 |doi= |url=}}</ref>
-*USG is limited if the abscess is small, obscured by other structures, or if precise placement is required because of nearby vessels or organs. In these cases, CT is the optimal imaging modality.<ref name="pmid11232683">{{cite journal |vauthors=Gress F, Schmitt C, Sherman S, Ciaccia D, Ikenberry S, Lehman G |title=Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience |journal=Am. J. Gastroenterol. |volume=96 |issue=2 |pages=409–16 |year=2001 |pmid=11232683 |doi=10.1111/j.1572-0241.2001.03551.x |url=}}</ref>
-*When an abscess is deep in the pelvis, depending on the specific location of the fluid collection, access may be obtained via transgluteal, transvaginal, or transrectal approaches.<ref name="urlRetroperitoneal Perforation of the Appendix Presenting as a Right Thigh Abscess">{{cite web |url=http://dx.doi.org/10.1155/2015/707191 |title=Retroperitoneal Perforation of the Appendix Presenting as a Right Thigh Abscess |format= |work= |accessdate=}}</ref>
-*If the fluid collection is sterile, a transgluteal approach is preferred because it allows for sterile technique.<ref name="pmid11232683">{{cite journal |vauthors=Gress F, Schmitt C, Sherman S, Ciaccia D, Ikenberry S, Lehman G |title=Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience |journal=Am. J. Gastroenterol. |volume=96 |issue=2 |pages=409–16 |year=2001 |pmid=11232683 |doi=10.1111/j.1572-0241.2001.03551.x |url=}}</ref>
-*Depending on the location of abscess,patient is placed in prone or supine position on the CT table
-*Localization scan using CT allows in selecting a safe window of access into the collection.
-*A coaxial micropuncture introducer set is advanced into the abscess under CT guidance.
-*An Amplatz guidewire is advanced through the sheath and coiled within the abscess.
-*After serial dilatation of the tract with a dilator, an pigtail drain is advanced over the guidewire and deployed.
 ===Medical Therapy===
-Antibiotics should be started immediately once the diagnosis of abscess is made. Preoperative antibiotics have been associated with lower rates of wound and intra-abdominal infections.<ref name="pmid20034345">{{cite journal| author=Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ et al.| title=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. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 2 | pages= 133-64 | pmid=20034345 | doi=10.1086/649554 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20034345  }} </ref> <ref name="SartelliViale2013">{{cite journal|last1=Sartelli|first1=Massimo|last2=Viale|first2=Pierluigi|last3=Catena|first3=Fausto|last4=Ansaloni|first4=Luca|last5=Moore|first5=Ernest|last6=Malangoni|first6=Mark|last7=Moore|first7=Frederick A|last8=Velmahos|first8=George|last9=Coimbra|first9=Raul|last10=Ivatury|first10=Rao|last11=Peitzman|first11=Andrew|last12=Koike|first12=Kaoru|last13=Leppaniemi|first13=Ari|last14=Biffl|first14=Walter|last15=Burlew|first15=Clay Cothren|last16=Balogh|first16=Zsolt J|last17=Boffard|first17=Ken|last18=Bendinelli|first18=Cino|last19=Gupta|first19=Sanjay|last20=Kluger|first20=Yoram|last21=Agresta|first21=Ferdinando|last22=Di Saverio|first22=Salomone|last23=Wani|first23=Imtiaz|last24=Escalona|first24=Alex|last25=Ordonez|first25=Carlos|last26=Fraga|first26=Gustavo P|last27=Junior|first27=Gerson Alves Pereira|last28=Bala|first28=Miklosh|last29=Cui|first29=Yunfeng|last30=Marwah|first30=Sanjay|last31=Sakakushev|first31=Boris|last32=Kong|first32=Victor|last33=Naidoo|first33=Noel|last34=Ahmed|first34=Adamu|last35=Abbas|first35=Ashraf|last36=Guercioni|first36=Gianluca|last37=Vettoretto|first37=Nereo|last38=Díaz-Nieto|first38=Rafael|last39=Gerych|first39=Ihor|last40=Tranà|first40=Cristian|last41=Faro|first41=Mario Paulo|last42=Yuan|first42=Kuo-Ching|last43=Kok|first43=Kenneth Yuh Yen|last44=Mefire|first44=Alain Chichom|last45=Lee|first45=Jae Gil|last46=Hong|first46=Suk-Kyung|last47=Ghnnam|first47=Wagih|last48=Siribumrungwong|first48=Boonying|last49=Sato|first49=Norio|last50=Murata|first50=Kiyoshi|last51=Irahara|first51=Takayuki|last52=Coccolini|first52=Federico|last53=Lohse|first53=Helmut A Segovia|last54=Verni|first54=Alfredo|last55=Shoko|first55=Tomohisa|title=2013 WSES guidelines for management of intra-abdominal infections|journal=World Journal of Emergency Surgery|volume=8|issue=1|year=2013|pages=3|issn=1749-7922|doi=10.1186/1749-7922-8-3}}</ref>
+[[Antibiotics]] should be started immediately once the diagnosis of abscess is made. Preoperative antibiotics have been associated with lower rates of [[wound]] and [[Intra-abdominal infection|intra-abdominal infections]].<ref name="pmid20034345">{{cite journal| author=Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ et al.| title=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. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 2 | pages= 133-64 | pmid=20034345 | doi=10.1086/649554 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20034345  }} </ref><ref name="SartelliViale2013">{{cite journal|last1=Sartelli|first1=Massimo|last2=Viale|first2=Pierluigi|last3=Catena|first3=Fausto|last4=Ansaloni|first4=Luca|last5=Moore|first5=Ernest|last6=Malangoni|first6=Mark|last7=Moore|first7=Frederick A|last8=Velmahos|first8=George|last9=Coimbra|first9=Raul|last10=Ivatury|first10=Rao|last11=Peitzman|first11=Andrew|last12=Koike|first12=Kaoru|last13=Leppaniemi|first13=Ari|last14=Biffl|first14=Walter|last15=Burlew|first15=Clay Cothren|last16=Balogh|first16=Zsolt J|last17=Boffard|first17=Ken|last18=Bendinelli|first18=Cino|last19=Gupta|first19=Sanjay|last20=Kluger|first20=Yoram|last21=Agresta|first21=Ferdinando|last22=Di Saverio|first22=Salomone|last23=Wani|first23=Imtiaz|last24=Escalona|first24=Alex|last25=Ordonez|first25=Carlos|last26=Fraga|first26=Gustavo P|last27=Junior|first27=Gerson Alves Pereira|last28=Bala|first28=Miklosh|last29=Cui|first29=Yunfeng|last30=Marwah|first30=Sanjay|last31=Sakakushev|first31=Boris|last32=Kong|first32=Victor|last33=Naidoo|first33=Noel|last34=Ahmed|first34=Adamu|last35=Abbas|first35=Ashraf|last36=Guercioni|first36=Gianluca|last37=Vettoretto|first37=Nereo|last38=Díaz-Nieto|first38=Rafael|last39=Gerych|first39=Ihor|last40=Tranà|first40=Cristian|last41=Faro|first41=Mario Paulo|last42=Yuan|first42=Kuo-Ching|last43=Kok|first43=Kenneth Yuh Yen|last44=Mefire|first44=Alain Chichom|last45=Lee|first45=Jae Gil|last46=Hong|first46=Suk-Kyung|last47=Ghnnam|first47=Wagih|last48=Siribumrungwong|first48=Boonying|last49=Sato|first49=Norio|last50=Murata|first50=Kiyoshi|last51=Irahara|first51=Takayuki|last52=Coccolini|first52=Federico|last53=Lohse|first53=Helmut A Segovia|last54=Verni|first54=Alfredo|last55=Shoko|first55=Tomohisa|title=2013 WSES guidelines for management of intra-abdominal infections|journal=World Journal of Emergency Surgery|volume=8|issue=1|year=2013|pages=3|issn=1749-7922|doi=10.1186/1749-7922-8-3}}</ref>
+====Duration====
+The duration of treatment with intravenous antibiotics ranges from 5 to 10 days, until fever resolves, white blood cell count normalizes, and bowel function returns.<ref name="SartelliViale2013">{{cite journal|last1=Sartelli|first1=Massimo|last2=Viale|first2=Pierluigi|last3=Catena|first3=Fausto|last4=Ansaloni|first4=Luca|last5=Moore|first5=Ernest|last6=Malangoni|first6=Mark|last7=Moore|first7=Frederick A|last8=Velmahos|first8=George|last9=Coimbra|first9=Raul|last10=Ivatury|first10=Rao|last11=Peitzman|first11=Andrew|last12=Koike|first12=Kaoru|last13=Leppaniemi|first13=Ari|last14=Biffl|first14=Walter|last15=Burlew|first15=Clay Cothren|last16=Balogh|first16=Zsolt J|last17=Boffard|first17=Ken|last18=Bendinelli|first18=Cino|last19=Gupta|first19=Sanjay|last20=Kluger|first20=Yoram|last21=Agresta|first21=Ferdinando|last22=Di Saverio|first22=Salomone|last23=Wani|first23=Imtiaz|last24=Escalona|first24=Alex|last25=Ordonez|first25=Carlos|last26=Fraga|first26=Gustavo P|last27=Junior|first27=Gerson Alves Pereira|last28=Bala|first28=Miklosh|last29=Cui|first29=Yunfeng|last30=Marwah|first30=Sanjay|last31=Sakakushev|first31=Boris|last32=Kong|first32=Victor|last33=Naidoo|first33=Noel|last34=Ahmed|first34=Adamu|last35=Abbas|first35=Ashraf|last36=Guercioni|first36=Gianluca|last37=Vettoretto|first37=Nereo|last38=Díaz-Nieto|first38=Rafael|last39=Gerych|first39=Ihor|last40=Tranà|first40=Cristian|last41=Faro|first41=Mario Paulo|last42=Yuan|first42=Kuo-Ching|last43=Kok|first43=Kenneth Yuh Yen|last44=Mefire|first44=Alain Chichom|last45=Lee|first45=Jae Gil|last46=Hong|first46=Suk-Kyung|last47=Ghnnam|first47=Wagih|last48=Siribumrungwong|first48=Boonying|last49=Sato|first49=Norio|last50=Murata|first50=Kiyoshi|last51=Irahara|first51=Takayuki|last52=Coccolini|first52=Federico|last53=Lohse|first53=Helmut A Segovia|last54=Verni|first54=Alfredo|last55=Shoko|first55=Tomohisa|title=2013 WSES guidelines for management of intra-abdominal infections|journal=World Journal of Emergency Surgery|volume=8|issue=1|year=2013|pages=3|issn=1749-7922|doi=10.1186/1749-7922-8-3}}</ref>
 ====Empiric therapy====
 Monotherapy with a beta-lactam/beta-lactamase inhibitor:
@@ Line 39: / Line 33: @@
 ==References==
 {{reflist|2}}
+[[Category:Disease]]
+[[Category:Up-To-Date]]
+[[Category:Gastroenterology]]
+[[Category:Surgery]]
+[[Category:Emergency medicine]]
+[[Category:Infectious disease]]