Intraabdominal infection results from entry of bacteria into the peritoneal or retroperitoneal spaces or from bacterial collections within intraabdominal organs. Surgical approach to peritonitis and abdominal sepsis. An intraabdominal abscess is a collection of pus or infected fluid that is surrounded by inflamed tissue inside the belly. Updated guideline on diagnosis and treatment of intra abdominal infections. Guidelines for treatment of intraabdominal infections in adults appendicitis, cholecystitis, cholangitis, diverticulitis, and secondarytertiary peritonitis see subsequent pages for treatment of spontaneous bacterial peritonitis and pancreatitis clinical setting empiric therapy duration comments community acquired, mildtomoderate. Computed tomography ct facilitates abscess drainage procedures while reducing the risks and costs associated with surgery. An intraabdominal abscess usually signals that something serious is. It can involve any intraabdominal organ or can be located freely within the abdominal or pelvic cavities, including in between bowel loops. Appendicitis is the most common abdominal inflammatory process in children which were sometimes followed by complications including intraabdominal abscess. Complicated intraabdominal infection guidelines cid 2010. Diagnosis and management of complicated intraabdominal.
An intraabdominal abscess may be caused by bacteria. Computed tomography in the diagnosis of intraabdominal. Abdominal infections biliary tract infections treatment communityacquired infections in patients without previous biliary procedures and who are not severely ill ceftriaxone 1 g iv q24h plus metronidazole 500 mg iv q8h or ertapenem 1 g iv q24h or pcn allergy. These updated guidelines replace those previously published in 2002 and 2003. Intraabdominal abscess prevention bmj best practice. Intraabdominal collection of pus or infected material, usually due to a localized infection inside the peritoneal cavity. Lower complication rates, shorter hospital stay, and lower cost have been achieved when patients are stabilized and optimized first, prior to undergoing surgery on an elective.
Appendicitis is the most frequent cause of abscess. For patients with septic shock, antibiotics should be administered as soon as. Updated guideline on diagnosis and treatment of intra. Ultrasound and ct are the imaging modalities of choice. These guidelines do not include management of nonperforated primary enteritis andor colitis or perforations due to diseases that are rare in north america.
Intraabdominal abscess iaa, also known as intraperitoneal abscess, is an intraabdominal collection of pus or infected material and is usually due to a localized infection inside the peritoneal cavity. In many cases, drainage combined with systemic antibiotic therapy is often all that is necessary for abscess. Antimicrobial therapy should be initiated once a patient receives a diagnosis of an intraabdominal infection or once such an infection is considered likely. Hospital records of children treated in our unit for intraabdominal post appendectomy abscesses over a 6. Other imaging studies, if done, may show abnormalities. Almost all intraabdominal abscesses require drainage, either by percutaneous catheters or surgery. Intraabdominal abscesses are localized collections of pus that are confined in the peritoneal cavity or retroperitoneal space by an inflammatory barrier 7. Although bacteroides fragilis is the most commonly recognized pathogen, other anaerobes, including other members of the b.
Antifungal therapy is recommended if candida is cultured from intraabdominal fluid cultures in patients with severe community acquired or healthcare associated infection. Ct of the abdomen and pelvis with oral contrast is the preferred diagnostic modality for suspected abscess. Intraabdominal abscess is a sample topic from the johns hopkins abx guide. Erroneously, the term intraabdominal abscess has been used and still is as a synonym with secondary peritonitis. Although various imaging techniques, such as ultrasonography, gallium scans, and indiumlabeled whitebloodcell scans, can be used for the diagnosis and localization of intraabdominal abscesses, computerassisted tomography is the most useful study. Intraabdominal abscess references bmj best practice.
Full text get a printable copy pdf file of the complete article 1. Occasionally, cystic lesions of the liver may first present due to complications such as spontaneous intracystic hemorrhage, rupture into the peritoneal cavity or bile duct, compression of the biliary tree. An immunologically compromised patient was found to have a postoperative intraabdominal abscess from which staphylococcus epidermidis was the sole isolate. Intraabdominal abscess health encyclopedia university. Intraabdominal abscess continues to be an important and serious problem in surgical practice. We evaluated the efficacy of antibiotic treatment and surgical drainage. Sepsis is a dynamic process that can evolve into conditions of varying severity 10, 11.
An intraabdominal abscess is defined as a pocket in the abdominal cavity that is filled with infected pus and fluid. Intraabdominal abscesses gastrointestinal disorders merck. Guidelines for the treatment of intraabdominal infections in patients on pediatric services table of contents severe sepsis or septic shock necrotizing enterocolitis nec in neonates appendicitis managed with immediate appendectomy intraabdominal abscess including appendicitis managed with delayed appendectomy, postoperative abscess. Peritonitis and intraperitoneal abscesses infectious. Evidencebased guidelines for managing patients with intraabdominal infection were prepared by an expert panel of the surgical infection society and the infectious diseases society of america. For patients with septic shock, antibiotics should be administered as soon as possible aiii. Guidelines for the selection of antiinfective agents for. Two cases of monomicrobial intraabdominal abscesses due to. Intraabdominal infections, sepsis, peritonitis, antibiotics.
The guidelines are intended for treating patients who either have these infections or may be at risk for them. Intraabdominal infections are those contained within the peritoneum or retroperitoneal space. Studies of the isolate in a rabbit and in mice showed no evidence for unusual virulence of the organism. The various imaging modalities available for the radiologic diagnosis of intraabdominal abscess are described and are compared to ct diagnosis regarding their pitfalls. Complicated intraabdominal infections extend beyond the hollow viscus of origin into the peritoneal space and are associated either with abscess formation or with peritonitis. Advances in imaging and percutaneous techniques now lead to imageguided percutaneous drainage as a major factor for the management of intraabdominal abscesses. Intraabdominal infections are biphasic, synergistic processes with early peritonitis and bacteremia due to aerobes and a later abscess component due to anaerobes. In case 1, a 50yearold hivnegative italian woman with chronic pancreatitis showed infection of a pancreatic pseudocystic lesion caused by kpckp. The aim of this paper is to promote global standards of care in iais and update the 20 wses guidelines for management of intraabdominal infections. To perform their role in ctguided intraabdominal abscess drainage, radiologic technologists must understand patient. Practice guidelines are systematically developed statements to assist practitioners and patients in making decisions about appropriate health care for specific clinical circumstances. Conservative management of postappendicectomy intra.
Acsase medical student core curriculum intraabdominal. Official website of the johns hopkins antibiotic abx, hiv, diabetes, and psychiatry guides, powered by unbound medicine. Garcia et al 5 conducted a retrospective study of 51 patients with intraabdominal abscesses and crohn disease, 10 of whom underwent treatment with antibiotics alone. Diagnosis and treatment of intraabdominal abscesses. Studies have shown this method of abscess drainage to be effective in the treatment of liver, appendiceal, tuboovarian and pelvic abscesses. However, in the setting of acute perforation, antifungal therapy is generally unnecessary unless the patient is immunosuppressed, has. Medical versus interventional treatment of intraabdominal. Complicated intraabdominal infection extends beyond the hollow viscus of origin into the peritoneal space and is associated with either abscess formation or peritonitis. We herein describe two cases of intraabdominal abscesses due to monomicrobial infection by klebsiella pneumoniae sequence type 258 producing k. They can cause inflammation and kill healthy tissue. In the management of intra abdominal abscess, initial management using intravenous antibiotics administration and percutaneous drainage has become the standard of care. Guidelines by the surgical infection society and the infectious diseases society of america. Management of intraabdominal abscesses surgical treatment.
Intraabdominal infections pharmacotherapy quick guide. These procedures require collaboration to ensure positive patient outcomes. Abscess recurrence in the medical treatment group was 50%, with. To view other topics, please sign in or purchase a subscription. Diagnosis and management of complicated intraabdominal infection in adults and children. Such an abscess is normally encased in an inflammatory barrier, keeping the infectious bacteria locked inside a persons abdominal cavity. Intraabdominal abscesses arise from complications of surgery and disease. Intraabdominal infection enteric contents enter the peritoneal cavity leading to abscess or peritonitis obtaining adequate early source control is the rule localized appendicitis, diverticulitis, cholecystitis with or without perforation contained perforation without hemodynamic instability. Treatment of intraabdominal abscesses with antibiotics alone has been less widely studied in the literature. The management of intraabdominal infections from a global. Intraabdominal abscess symptoms, diagnosis and treatment bmj. Intraabdominal abscesses gastrointestinal disorders.
Other causes of intraabdominal sepsis in elderly persons, such as volvulus. Intraabdominal abscess presenting as a thigh abscess. Causes of an intraabdominal abscess include perforation of a gastric. Before sharing sensitive information, make sure youre on a federal government site. Abdominal sepsis represents the hostssystemic inflammatory response to intraabdominal infections. It can involve any intraabdominal organ or be located in between bowel loops, or be free within the peritoneal cavity itself. Attributes of good guidelines include validity, reliability, reproducibility, clinical applicability, clinical flexibility, clarity, multidisciplinary process. Appropriate treatment is often delayed because of the obscure nature of many conditions resulting in abscess formation, which can make diagnosis and localization difficult. The inflammatory response in patients with sepsis depends on the causative pathogen and.
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