Management of Intra-Abdominal Infections

Abstract

Intra-abdominal infections are common problem in the practice of the acute care surgeon. Evidence based guidelines have been developed to aid clinicians in the diagnosis and management of this common and potentially complex clinical problem (Solomkin et al., Clin Infect Dis Off Publ Infect Dis Soc Am 50:133–164, 2010). The management of patients with intra-abdominal infections consumes considerable hospital resources and spans multiple areas of the hospital including the emergency department, operating room, and intensive care unit. Intra-abdominal infections can be categorized as either uncomplicated or complicated. Uncomplicated intra-abdominal infections involve a single organ and do not spread to the peritoneum. The mainstay of management of uncomplicated intra-abdominal infections is antimicrobial therapy. Complicated intra-abdominal infections extend beyond a single organ and present with focal or diffuse peritonitis necessitating surgical intervention in addition to antimicrobial therapy. Patient outcomes are strongly influenced by the initial clinical decision making, including rapidity of diagnosis, timely operative intervention to obtain source control, and antibiotic selection. This text will provide a concise but comprehensive review of the key diagnostic and management strategies for the management of patients with intra-abdominal infections. Recommendations for surgical intervention for specific disease processes (e.g.., appendicitis, diverticulitis) are beyond the scope of this chapter and will be discussed in subsequent areas of the textbook.