Treatment Criteria and Considerations
Antimicrobial therapy does not preclude source control (e.g. percutaneous drainage or surgery)
Recommend blood, intraoperative and/or abscess fluid cultures in patients with post-operative or healthcare-associated infections; those with treatment failure and/or requiring re-operation; or recently on antimicrobial therapy
Blood cultures recommended if patient has sepsis syndrome
Reassess initial empiric therapy based on clinical state & results of microbiological analysis
acute perforation of the stomach, duodenum and/or proximal jejunum (if no acid-reducing therapy or malignancy; and source control achieved)
penetrating bowel trauma repaired within 12 hours
intraoperative contamination of a surgical field from enteric contents
acute appendicitis without perforation, abscess or local peritonitis
patients undergoing cholecystectomy for acute cholecystitis without evidence of infection outside wall of the gallbladder (ex. perforation)
With no evidence of systemic toxicity (APACHE II score <15)
with APACHE II score ≥15
signs of systemic toxicity
>70 years old
poor nutritional status
incomplete/delayed source control
Hospitalized >48 hours at time of onset
Recent prolonged hospitalization
Long term care
Guideline content derived from:
- NB Provincial Health Authorities Anti-Infective Stewardship Committee. Antimicrobial Therapy for Intra-Abdominal Infections. 09-2018
- Ball, C., Hansen, G., Harding, G., Kirkpatrick, A., Weiss, K. & Zhanel, G. (2010). Canadian practice guidelines for surgical intra-abdominal infections. Canadian Journal of Infectious Disease and Medical Microbiology, 21(1), 11-37.
- Doyle, J., Nathens, A., Morris, A., Nelson, S., & McLeod, R. (2011). Best practice in general surgery guideline #4: Management of Intra-abdominal infections. Toronto, ON: University of Toronto, Faculty of Medicine.
- INESSS. Antibiotic Treatment Guide: Intra-abdominal Infections in Adults. June 2012
- So, M. (2010). Intra-abdominal infections education module. Toronto, ON: Mount Sinai Hospital and University Health Network.
- Solomkin, J., Mazuski, J., Bradley, J, et al. (2010). Diagnosis and management of complicated intra-abdominal infections in adults and children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clinical Infectious Disease, 50 (15 January)., 133-163.
- Blondel-Hill E. & Fryters S. (2012). Bugs & Drugs. An Antimicrobial/Infectious Diseases Reference. Alberta Health Services.
- Young-FAdok, T., & Pemberton, J. (2014). Treatment of acute diverticulitis. UpToDate. Retrieved from www.uptodate.com.
- Antimicrobial Stewardship Treatment Guidelines for Common Infections. 1st Edition Vancouver Coastal Health. March 2011
- Antimicrobial Handbook – 2012. Editor: Dr Kathy Slayter. Antimicrobial Agents Subcommittee. Capital Health, Nova Scotia
- Sawyer RG, Claridge JA, Nathens AB, Rotstein OD, Duane TM et al. Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection. N Engl J Med 2015;372(21):1996
- Smith SE, Rumbaugh KA, & May AK. Evaluation of a Short Course of Antimicrobial Therapy for Complicated Intra-Abdominal Infections in Critically Ill Surgical Patients. Surgical Infections 2017; 18 (6): 742-750
- Hassinger TE et al. Longer-Duration Antimicrobial Therapy Does Not Prevent Treatment Failure in High-Risk Patients with Complicated Intra-Abdominal Infections. Surgical Infections 2017; 18 (6): 659-663