Abdominal Sepsis and Complicated Intraabdominal Infections
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Complicated intraabdominal infections (cIAI) are a common cause of morbidity and mortality in the intensive care unit. Uncomplicated infections do not involve perforation or disruption of the gastrointestinal tract whereas complicated infections are associated with the presence of microbial pathogens in a normal sterile area of the abdomen. They usually manifest as peritonitis and/or abscess formation.
The mainstays of treatment for cIAI include prompt diagnosis, resuscitation, source control and anti-infective therapy. Diagnostic tools include physical exam, computed tomography and ultrasound if a biliary source is suspected. Resuscitation should follow the Surviving Sepsis Campaign guidelines, and is aimed at early goal directed resuscitation with at least 30 mL/kg of intravenous fluid be given within the first 3 h and antimicrobial administration within the first hour after recognition of sepsis and septic shock (Rhodes A, et al. Crit Care Med. 45:486–552, 2017). Source control includes drainage of infected fluid collections, debridement of infected tissue, and definitive measures to control ongoing contamination and restore anatomy and function. Source control can be gained either by operative intervention or percutaneous drainage.
At a minimum, antimicrobial therapy should empirically cover common gram negative Enterobacteriaceae and enteric anaerobes. For patients with health-care-associated infections, broader-spectrum agents having activity against resistant gram negative flora such as Pseudomonas aeruginosa and Acinetobacter sp., enterococci, occasionally methicillin-resistant staphylococci, and yeast may be needed as well. Specific therapies should be guided by hospital and ICU antibiograms.
KeywordsComplicated intraabdominal infections Source control Resuscitation Antibiotics Peritonitis Damage control surgery Laparoscopic peritoneal lavage
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