Intra-abdominal sepsis: new definitions and current clinical standards

  • A. HeckerEmail author
  • M. Reichert
  • C. J. Reuß
  • T. Schmoch
  • J. G. Riedel
  • E. Schneck
  • W. Padberg
  • M. A. Weigand
  • M. Hecker
Review Article



The abdomen is the second most common source of sepsis and is associated with unacceptably high morbidity and mortality. Recently, the essential definitions of sepsis and septic shock were updated (Third International Consensus Definitions for Sepsis and Septic Shock, Sepsis-3) and modified. The purpose of this review is to provide an overview of the changes introduced by Sepsis-3 and the current state of the art regarding the treatment of abdominal sepsis.


While Sepsis-1/2 focused on detecting systemic inflammation as a response to infection, Sepsis-3 defines sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection. The Surviving Sepsis Campaign (SSC) guideline, which was updated in 2016, recommends rapid diagnosis and initiating standardized therapy. New diagnostic tools, the establishment of antibiotic stewardship programs, and a host of new-generation antibiotics are new landmark changes in the sepsis literature of the last few years. Although the “old” surgical source control consisting of debridement, removal of infected devices, drainage of purulent cavities, and decompression of the abdominal cavity is the gold standard of surgical care, the timing of gastrointestinal reconstruction and closure of the abdominal cavity (“damage control surgery”) are discussed intensively in the literature. The SSC guidelines provide evidence-based sepsis therapy. Nevertheless, treating critically ill intensive care patients requires individualized, continuous daily re-evaluation and flexible therapeutic strategies, which can be best discussed in the interdisciplinary rounds of experienced surgeons and intensive care medicals.


Sepsis-3 Surviving Sepsis Campaign SOFA qSOFA 



Surviving Sepsis Campaign


Sequential Organ Failure Assessment


quick Sequential Organ Failure Assessment


World Society of Emergency Surgeons


Systemic Inflammatory Response Syndrome


World Health Organization




C-reactive protein


Mean Arterial Pressure


Postoperative Day


Early Goal–directed Therapy


Abdominal Compartment Syndrome


Antimicrobials: A global alliance for optimizing their rational use in intra-abdominal infections


Medical Education for Sepsis Source Control and Antibiotics


European Society for Clinical Microbiology and Infectious Diseases


Intensive Care Unit


Central Venous Pressure


Oxygen Saturation


Acute Respiratory Distress Syndrome


Compliance with ethical standards

Conflict of interest

The authors A.H., M.R., C.J.R., T.S., J.G.R., E.S., W.P., and M.H. declare that they have no conflict of interest. M.A.W. reports personal fees from MSD, personal fees from Pfizer, personal fees from Gilead, outside the submitted work. In addition, M.A.W. has a patent EP 17198330.7 issued.

Ethical approval

This article does not contain any studies with animals performed by any of the authors. This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of General and Thoracic SurgeryUniversity Hospital of GiessenGießenGermany
  2. 2.Department of AnesthesiologyUniversity Hospital of HeidelbergHeidelbergGermany
  3. 3.Department of AnesthesiologyUniversity Hospital of GiessenGiessenGermany
  4. 4.Medical Clinic IIUniversity Hospital of GiessenGiessenGermany

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