From the Guidelines
Intra-abdominal infections require prompt treatment with antibiotics and often surgical intervention, with a focus on source control and short-course antibiotic therapy, typically ranging from 4-7 days, as supported by recent studies 1.
Key Considerations
- For mild to moderate community-acquired infections, a combination of ceftriaxone 1-2g IV daily plus metronidazole 500mg IV every 8 hours can be used, while for healthcare-associated or severe infections, piperacillin-tazobactam 4.5g IV every 6 hours or meropenem 1g IV every 8 hours are recommended.
- Source control through drainage or surgical removal of infected material is crucial and should be performed as soon as possible, with percutaneous drainage of abscesses and other well-localized fluid collections being preferable to surgical drainage when feasible 1.
- Patients need close monitoring for signs of sepsis, including fever, tachycardia, hypotension, and altered mental status, and fluid resuscitation with crystalloids should be initiated for hemodynamic support.
- Recent studies have shown that short-course treatments are as effective as long-course treatments for both complicated and postoperative intra-abdominal infections requiring intensive care unit admission, after adequate source control has been achieved 1.
Management Approach
- A multidisciplinary, multimodality approach to source control is recommended, taking into account the causative event, source of infection bacteria, local bacterial flora, patient condition, and comorbidities 1.
- The goal of antimicrobial therapy is to promote patient recovery, reduce recurrence risk, and prevent antimicrobial resistance, with treatment duration guided by clinical improvement.
- Nutritional support should be considered early, and deep venous thrombosis prophylaxis is recommended for hospitalized patients, with transition to oral antibiotics possible once the patient shows clinical improvement and has a functioning gastrointestinal tract.
From the Research
Intra-Abdominal Infection Treatment
- The treatment of intra-abdominal infections often requires broad-spectrum empiric coverage due to their polymicrobial nature and associated mortality risk 2.
- Studies have compared the efficacy and safety of different antimicrobial regimens, such as piperacillin/tazobactam and imipenem/cilastatin, in the treatment of intra-abdominal infections 2, 3.
- Piperacillin/tazobactam has been shown to be safe and efficacious in the treatment of patients hospitalized with intra-abdominal infections, with a favorable response rate of 87% and a bacteriologic eradication rate of 100% 3.
- The duration of antimicrobial therapy for intra-abdominal infections is also an important consideration, with guidelines recommending a duration of four to seven days 4.
- A study comparing short-course and prolonged antimicrobial therapy found no significant difference in clinical outcomes, including clinical cure, hospital length of stay, and 28-day all-cause mortality rate 4.
Antimicrobial Regimens
- Piperacillin/tazobactam is a commonly used antimicrobial regimen for the treatment of intra-abdominal infections, with a broad spectrum of activity against gram-negative and anaerobic pathogens 2, 3, 5.
- Imipenem/cilastatin is another antimicrobial regimen that has been used to treat intra-abdominal infections, with a broad spectrum of activity against gram-negative and anaerobic pathogens 2, 3.
- The choice of antimicrobial regimen should be based on the severity of the infection, the presence of resistant pathogens, and the patient's underlying medical conditions 6.
Resistance and De-escalation
- The development of resistant pathogens is a concern in the treatment of intra-abdominal infections, particularly in patients with nosocomially-acquired infections 6.
- De-escalation of an initially broad antimicrobial regimen should be undertaken once definitive culture results are available, to minimize the risk of resistance and reduce the potential for iatrogenic complications 6.