intra-abdominal infection
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Etiology
- intestinal perforation
- abdominal surgery
- appendicitis (community-acquired)
- cholangitis, cholecystitis (healthcare-associated)
- diverticulitis
- infection associates with pancreatitis
- peritonitis
Management
- empiric antibiotics (general)
- gram-positive, gram negative & anaerobe coverage
- oral antibiotics ok; IV not needed[4]
- suggested regimens
- metronidazole plus ceftazidime, cefepime or ciprofloxacin [4]
- others
- moxifloxacin (monotherapy)
- amoxicillin clavulanate
- piperacillin-tazobactam may not provide coverage of Enterococcus faecalis
- imipenem-cilastatin, meropenem, doripenem
- healthcare-associated infection
- target gram-negative aerobic & facultative bacilli:
- enterococcal coverage recommended, especially if post-op, prior cephalosporin use, immunocompromised, or patient has valvular heart disease or prosthetic vascular material
- target vancomycin-resistant Enterococcus (VRE) in very high-risk patients (known colonization, liver transplant with infection of hepatobiliary origin)
- MRSA suspected (known colonization, prior antibiotic failure)
- vancomycin first-line
- quinupristin-dalfopristin, linezolid, daptomycin, & tigecycline have in vitro activity
- guidelines do not recommend specific drug for VRE coverage
- infectious disease consult
- duration of antibiotic therapy
- 4 days of therapy may be sufficient after source has been controlled ( (ie, percutaneous or surgical drainage)[3]
- antibiotic treatment for 8 versus 15 days reduces antibiotic exposure without compromising outcomes in critically ill patients with postoperative intra-abdominal infection (also see postoperative infection)
- surgery
- drainage of abscess, peritoneal effusion etc
More general terms
References
- ↑ Malangoni MA et al, Randomized controlled trial of moxifloxacin compared with piperacillin-tazobactam and amoxicillin-clavulanate for the treatment of complicated intra-abdominal infections. Ann Surg 2006, 244:204 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16858182
- ↑ Prescriber's Letter 17(3): 2010 CHART: Antibiotics for Complicated Intra-Abdominal Infections GUIDELINES: Diagnosis and Management of Complicated Intra- abdominal Infections Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260321&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 3.0 3.1 Sawyer RG et al Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection. N Engl J Med 2015; 372:1996-2005. May 21, 2015. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25992746 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1411162
Wenzel RP, Edmond MB Antibiotics for Abdominal Sepsis. N Engl J Med 2015; 372:2062-2063. May 21, 2015. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25992751 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1503936 - ↑ 4.0 4.1 4.2 Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
- ↑ Montravers P, Tubach F, Lescot T et al. Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: The DURAPOP randomised clinical trial. Intensive Care Med. 2018 Mar;44(3):300-310 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29484469 https://link.springer.com/article/10.1007%2Fs00134-018-5088-x