Intraabdominal abscess continues to be an important and serious problem in surgical practice. Advances in imaging and percutaneous techniques now lead to imageguided percutaneous drainage as a major factor for the management of intraabdominal abscesses. Updated guideline on diagnosis and treatment of intra abdominal infections. In case 1, a 50yearold hivnegative italian woman with chronic pancreatitis showed infection of a pancreatic pseudocystic lesion caused by kpckp. Complicated intraabdominal infection guidelines cid 2010. Abdominal sepsis represents the hostssystemic inflammatory response to intraabdominal infections. In the management of intra abdominal abscess, initial management using intravenous antibiotics administration and percutaneous drainage has become the standard of care. An intraabdominal abscess may be caused by bacteria. Guidelines by the surgical infection society and the infectious diseases society of america. 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.
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. An immunologically compromised patient was found to have a postoperative intraabdominal abscess from which staphylococcus epidermidis was the sole isolate. Complicated intraabdominal infection extends beyond the hollow viscus of origin into the peritoneal space and is associated with either abscess formation or peritonitis. We evaluated the efficacy of antibiotic treatment and surgical drainage. Attributes of good guidelines include validity, reliability, reproducibility, clinical applicability, clinical flexibility, clarity, multidisciplinary process. Computed tomography ct facilitates abscess drainage procedures while reducing the risks and costs associated with surgery. Intraabdominal infections are biphasic, synergistic processes with early peritonitis and bacteremia due to aerobes and a later abscess component due to anaerobes. Causes of an intraabdominal abscess include perforation of a gastric. Intraabdominal abscess prevention bmj best practice.
Intraabdominal infections, sepsis, peritonitis, antibiotics. Intraabdominal abscess symptoms, diagnosis and treatment bmj. An intraabdominal abscess is a collection of pus or infected fluid that is surrounded by inflamed tissue inside the belly. 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. Intraabdominal abscesses are localized collections of pus that are confined in the peritoneal cavity or retroperitoneal space by an inflammatory barrier 7. Other causes of intraabdominal sepsis in elderly persons, such as volvulus. To view other topics, please sign in or purchase a subscription. However, in the setting of acute perforation, antifungal therapy is generally unnecessary unless the patient is immunosuppressed, has. Intraabdominal abscess presenting as a thigh abscess. These guidelines do not include management of nonperforated primary enteritis andor colitis or perforations due to diseases that are rare in north america. Appropriate treatment is often delayed because of the obscure nature of many conditions resulting in abscess formation, which can make diagnosis and localization difficult. Antifungal therapy is recommended if candida is cultured from intraabdominal fluid cultures in patients with severe community acquired or healthcare associated infection.
It can involve any intraabdominal organ or can be located freely within the abdominal or pelvic cavities, including in between bowel loops. Almost all intraabdominal abscesses require drainage, either by percutaneous catheters or surgery. Computed tomography in the diagnosis of intraabdominal. It can involve any intraabdominal organ or be located in between bowel loops, or be free within the peritoneal cavity itself. An intraabdominal abscess usually signals that something serious is. Intraabdominal infections pharmacotherapy quick guide. Peritonitis and intraperitoneal abscesses infectious. Guidelines for the selection of antiinfective agents for. Conservative management of postappendicectomy intra. Other imaging studies, if done, may show abnormalities.
Diagnosis and management of complicated intraabdominal infection in adults and children. Intraabdominal collection of pus or infected material, usually due to a localized infection inside the peritoneal cavity. For patients with septic shock, antibiotics should be administered as soon as. The management of intraabdominal infections from a global. Practice guidelines are systematically developed statements to assist practitioners and patients in making decisions about appropriate health care for specific clinical circumstances. Such an abscess is normally encased in an inflammatory barrier, keeping the infectious bacteria locked inside a persons abdominal cavity.
Studies have shown this method of abscess drainage to be effective in the treatment of liver, appendiceal, tuboovarian and pelvic abscesses. Diagnosis and management of complicated intraabdominal. Antimicrobial therapy should be initiated once a patient receives a diagnosis of an intraabdominal infection or once such an infection is considered likely. Intraabdominal abscesses arise from complications of surgery and disease. Diagnosis and treatment of intraabdominal abscesses. They can cause inflammation and kill healthy tissue. Abscess recurrence in the medical treatment group was 50%, with. Sepsis is a dynamic process that can evolve into conditions of varying severity 10, 11. Intraabdominal abscesses gastrointestinal disorders. 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. Acsase medical student core curriculum intraabdominal. Appendicitis is the most frequent cause of abscess. We herein describe two cases of intraabdominal abscesses due to monomicrobial infection by klebsiella pneumoniae sequence type 258 producing k. Intraabdominal infection results from entry of bacteria into the peritoneal or retroperitoneal spaces or from bacterial collections within intraabdominal organs.
Although bacteroides fragilis is the most commonly recognized pathogen, other anaerobes, including other members of the b. Erroneously, the term intraabdominal abscess has been used and still is as a synonym with secondary peritonitis. 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. The guidelines are intended for treating patients who either have these infections or may be at risk for them.
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. Hospital records of children treated in our unit for intraabdominal post appendectomy abscesses over a 6. Intraabdominal abscesses gastrointestinal disorders merck. Before sharing sensitive information, make sure youre on a federal government site. Ultrasound and ct are the imaging modalities of choice. Full text get a printable copy pdf file of the complete article 1. 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. Intraabdominal abscess health encyclopedia university. The inflammatory response in patients with sepsis depends on the causative pathogen and. Complicated intraabdominal infections extend beyond the hollow viscus of origin into the peritoneal space and are associated either with abscess formation or with peritonitis. To perform their role in ctguided intraabdominal abscess drainage, radiologic technologists must understand patient. 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.
Two cases of monomicrobial intraabdominal abscesses due to. Updated guideline on diagnosis and treatment of intra. Intraabdominal infections are those contained within the peritoneum or retroperitoneal space. Medical versus interventional treatment of intraabdominal. In many cases, drainage combined with systemic antibiotic therapy is often all that is necessary for abscess. 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. Intraabdominal abscess is a sample topic from the johns hopkins abx guide. Surgical approach to peritonitis and abdominal sepsis. These procedures require collaboration to ensure positive patient outcomes. Appendicitis is the most common abdominal inflammatory process in children which were sometimes followed by complications including intraabdominal abscess. An intraabdominal abscess is defined as a pocket in the abdominal cavity that is filled with infected pus and fluid. These updated guidelines replace those previously published in 2002 and 2003.
Treatment of intraabdominal abscesses with antibiotics alone has been less widely studied in the literature. 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. 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. The various imaging modalities available for the radiologic diagnosis of intraabdominal abscess are described and are compared to ct diagnosis regarding their pitfalls. Studies of the isolate in a rabbit and in mice showed no evidence for unusual virulence of the organism. Intraabdominal abscess references bmj best practice. Official website of the johns hopkins antibiotic abx, hiv, diabetes, and psychiatry guides, powered by unbound medicine. Ct of the abdomen and pelvis with oral contrast is the preferred diagnostic modality for suspected abscess. Management of intraabdominal abscesses surgical treatment.
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