Intra-Abdominal Infections

Intra-Abdominal Infections

Jessica Thompson, PharmD, BCPS (AQ-ID) Infectious Diseases Pharmacy Clinical Specialist

Renown Health April 19, 2018

Select guidelines

? Mazuski JE, et al. The Surgical Infection Society revised guidelines on the management of intra-abdominal infection. Surgical Infections 2017; 18: 1-76.

? Stollman N, et al. American Gastroenterological Association Institute guideline on the management of acute diverticulitis 2015; 149: 19441949.

? Solomkin, et al. Diagnosis and management of complicated intraabdominal infection in adults and children: guidelines by the Surgical Infection Society and Infectious Diseases Society of America. Clinical Infectious Diseases 2010; 50:133-164.

? IDSA: "Update in Progress"

Intra-abdominal infection (IAI)

? Infection of any of the organs or organ spaces in the abdominal cavity

? Lower part of the esophagus ? Stomach ? Intestines (small and large) ? Colon ? Rectum ? Gall bladder ? Spleen

Intra-abdominal infection

Uncomplicated

? Infection contained within a single organ (stomach, gallbladder, intestines, etc) without anatomic disruption

? May or may not require surgical management

Complicated

? Infection extends beyond the organ with spillage of microorganisms into normally sterile space

? Primary management is oftentimes source control

Common pathogens

? Most common

? E.coli

Empiric treatment

? Bacteroides species

? Other common pathogens

? Other Enterobacteriaceae ? Streptococcus species

of communityonset IAI should

target these organisms

Empiric treatment of hospital-onset IAI should target

? Clostridial species

these organisms

? Hospital-associated or tertiary peritonitis pathogens

? Pseudomonas aeruginosa

? Enterococcus species

Management of intra-abdominal infections

Expeditious diagnosis

Early resuscitation

Timely and appropriate source control

Antimicrobial Therapy

Arguably, the most important aspect of

treatment

? What is it?

? Drainage of infected fluid ? Debridement of necrotic tissue ? Definitive measure to control contamination and restore normal

gastrointestinal anatomy and function

? What is the goal?

? Reduce bacterial and toxin load ? Transform the local environment such that further microbial growth is

impeded and host defenses can be optimize

IV antimicrobials for empiric therapy

Preferred Alternative

Severe Beta-lactam allergy

Mild to Moderate IAI or Lower-Risk Patients

(Ceftriaxone or cefotaxime) PLUS metronidazole Ertapenem

Ciprofloxacin PLUS metronidazole (only for mild or very-low risk)

Severe IAI or High-Risk Patients

Piperacillin-tazobactam

Cefepime PLUS metronidazole OR Anti-pseudomonal carbapenem Aztreonam PLUS metronidazole PLUS vancomycin

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