Intra-Abdominal Infections

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Most intra-abdominal infections develop from a source in the gastrointestinal tract. They are usually caused by aerobic and anaerobic enteric bacteria. Management generally involves an invasive procedure to control the source of the infection and antimicrobial therapy directed against the causative microorganisms. In a few highly select patients, these infections may be treated without a definitive source control procedure. Antimicrobial therapy is tailored to the individual patient, with narrower spectrum agents used to treat community-acquired intraabdominal infections, and broader spectrum agents used for hospital-acquired infections. Overall, these infections remain associated with significant morbidity and mortality, particularly in higher-risk patients who have impaired host defenses.

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Microbiology

The resident gastrointestinal flora are the cause of most intra-abdominal infections. Because the microbiology of the gastrointestinal tract changes markedly with location, the types of microorganisms isolated in these infections may also vary, depending on the source of the infecting inoculum. As one progresses down the gastrointestinal tract in the normal individual, the number of microorganisms increases and their character changes. Few microorganisms are found in the normal stomach and

Source control

Source control is the general term for the interventional procedures used to control or eliminate the focus of an intra-abdominal infection. Marshall1 has described source control as “drainage of abscesses or infected fluid collections, debridement of necrotic infected tissue, and definitive measures to control a source of ongoing microbial contamination and to restore anatomy and function.” Source control of uncomplicated intra-abdominal infections, such as nonperforated appendicitis or

Antimicrobial therapy

Antimicrobial therapy is generally considered an adjunct to the use of appropriate source control in the treatment of intra-abdominal infections. However, in patients in whom source control is deferred, antimicrobial therapy plays a more definitive role.

The general principle underlying antimicrobial therapy for patients who have intra-abdominal infections is to use agents effective against the aerobic/facultative anaerobic gram-negative bacilli, aerobic gram-positive cocci, and obligate

Clinical outcomes

Treatment of patients who have complicated intra-abdominal infections using a combination of adequate source control and appropriate antimicrobial therapy has generally been thought to produce satisfactory results. Contemporary clinical trials have demonstrated cure in 78% to 86% of patients who were considered clinically evaluable, with an overall mortality of 2% to 3% among all enrolled patients.77, 78, 79 However, results from published clinical trials are not representative of the true

Summary

“Intra-abdominal infection” is a term that is applied to various infections usually described as peritonitis or intra-abdominal abscess. The prognosis of these infections varies widely, depending on the source of the infection, the patient's underlying physiologic reserves, and the extent of prior treatment. The principles of therapy remain restoration of systemic perfusion through fluid resuscitation and adjunctive measures for managing sepsis, source control to prevent ongoing microbial

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