Intra-Abdominal Infections

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)

Definitions

  • gastroduodenal perforation

  • cholangitis

  • cholecystitis

  • appendicitis

  • diverticulitis

  • peritonitis

With no evidence of systemic toxicity (APACHE II score <15)

  • with APACHE II score ≥15

  • signs of systemic toxicity

  • >70 years old

  • immunocompromised

  • secondary peritonitis

  • cancer

  • poor nutritional status

  • incomplete/delayed source control

  • Hospitalized >48 hours at time of onset

  • Recent prolonged hospitalization

  • Post-operative infection

  • Long term care

  • Rehab

  • Dialysis

  • Nursing home

  • Recent antibiotics

More Information

Guideline content derived from:

  • NB Provincial Health Authorities Anti-Infective Stewardship Committee. Antimicrobial Therapy for Intra-Abdominal Infections. 09-2018

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