Kuuskne is a pgy5 emergency medicine resident and one of the editorsinchief at emsimcases. Intra abdominal infection iai, also spelled intraabdominal is a group of infections that occur within the abdominal cavity. Jun 30, 1986 intra abdominal sepsis most frequently follows penetrating or blunt abdominal trauma or perforated appendicitis or diverticulitis. These updated guidelines replace those previously published in 2002 and 2003. Effects of intraabdominal sepsis on atherosclerosis in mice. Treatment guidelines for intraabdominal infections cid 2003. Effects of intraabdominal sepsis on atherosclerosis in. To be consistent with previous work investigating intraabdominal sepsis after ileocolic resection in crohns disease, 7, 9, 14, 1720 intraabdominal sepsis was defined as an intraperitoneal abscess or anastomotic leak within 30 days of surgery and was graded using the claviendindo classification. Abscesses these are localised collections of infected fluid and can be simple or complex multiloculated.
Severe intraabdominal infections are a frequent and important issue in intensive care icu. Intraabdominal abscess iaa, also known as intraperitoneal abscess, is an intraabdominal collection of pus or infected material and is usually due to a localised infection inside the peritoneal cavity. Guidelines by the surgical infection society and the infectious disease society of america. Intensive care med 2019 dec an international observational study showed that most intraabdominal infections were hospitalacquired, multiresistant pathogens were frequent, and overall mortality was high. The intraabdominal compartment syndrome is a complication of the progression of peritonitis. We read with interest the article by garciasabrido et al 1 in the february 1988 issue of the archives on the openabdomen management of severe intraabdominal sepsis, and we agree, in principle, with their philosophy. Oct 29, 2019 severe intra abdominal infections are a frequent and important issue in intensive care icu. Intraabdominal infection iai, also spelled intraabdominal is a group of infections that occur within the abdominal cavity. Prompt resuscitation of patients with ongoing sepsis is of utmost important. Mar 11, 2016 intra abdominal sepsis this is a term used for any intra abdominal infection and encompasses both localised and generalised peritonitis. Guidelines for treatment of intra abdominal 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.
Jul 23, 2019 intra abdominal sepsis from a perforated viscus ie, secondary peritonitis or suppurative peritonitis results from direct spillage of luminal contents into the peritoneum eg, perforated peptic ulcer, diverticulitis, appendicitis, iatrogenic perforation. Organ dysfunction can be represented by an increase in the sequential sepsis related organ failure assessment. It can involve any intraabdominal organ or can be located freely within the abdominal or pelvic cavities, including in between bowel loops. Intraabdominal sepsis page 3 of 5 champ manual a an immediate ige mediated reaction is characterised by the development of urticaria, angioedema, bronchospasm or anaphylaxis within 1 to 2 hours of drug administration. Antifungal therapy is recommended if candida is cultured from intra abdominal fluid cultures in patients with severe community acquired or healthcare associated infection. Intra abdominal sepsis is frequently seen and dealt with by surgeons.
Severe intraabdominal sepsis and open management jama. See detailed information below for a list of 20 causes of intraabdominal sepsis, symptom checker, including diseases and drug side effect causes. However, in the setting of acute perforation, antifungal therapy is generally unnecessary unless the patient is immunosuppressed, has. Pdf purpose the abdomen is the second most common source of sepsis and is associated with unacceptably high morbidity and mortality. Tertiary peritonitis is defined as a serious recurrent or persistent intraabdominal infection after the ostensibly successful control of secondary. Although bacteroides fragilis is the most commonly recognized pathogen, other anaerobes, including other members of the b. Intra abdominal abscess iaa, also known as intraperitoneal abscess, is an intra abdominal collection of pus or infected material and is usually due to a localised infection inside the peritoneal cavity. The inflammatory response in patients with sepsis depends on the causative pathogen and the host genetic characteris. The interrelationship of sepsis resuscitation and intra. Intra abdominal sepsis page 3 of 5 champ manual a an immediate ige mediated reaction is characterised by the development of urticaria, angioedema, bronchospasm or anaphylaxis within 1 to 2 hours of drug administration. The surgical infection society sis developed and disseminated guidelines for the management of these infections in 1992, in 2002 2,3, and most recently in 2010 as a joint guideline with the infectious diseases society of america idsa.
The cornerstones of effective treatment of iais are early recognition, adequate source control, and appropriate antimicrobial therapy. It presents as a spectrum of conditions ranging from uncomplicated localized infection through to severe systemic sepsis with generalized peritoneal infection. The peritoneum, which is an otherwise sterile environment, reacts to various pathologic stimuli with a fairly uniform inflammatory response. Intraabdominal infections iais are common surgical emergencies and have been reported as major. Prompt resuscitation of patients with ongoing sepsis is of utmost. Severe sepsis is defined as sepsis associated with at least one acute organ dysfunction, hypoperfusion or hypotension. Diagnosis and management of complicated intraabdominal. In the antibiotic era, surgical procedures for source control in abdominal sepsis have been complemented with drugs targeting persistent organisms after luminal inflammation, obstruction, or. Abdominal infections are usually polymicrobial and result in an intra abdominal abscess or secondary peritonitis, which may be generalized or localized phlegmon. Recently, the essential definitions of sepsis and septic shock were updated third international consensus definitions for sepsis and septic shock, sepsis3 and modified.
The rats challenged with pooled colonic contents showed a biphasic disease. Practice guidelines are systematically developed statements to assist practitioners and patients in making decisions about appropriate health care for specific clinical circumstances. The spectrum of diseases that cause intraabdominal sepsis in elderly individuals is different from the spectrum in younger populations table 1. Intraabdominal infections iais are common surgical emergencies and have been reported as major contributors to nontrauma deaths in the emergency departments worldwide. Intraabdominal sepsis is defined as inflammation of the peritoneum caused by pathogenic microorganisms and their products. Epidemiology of intraabdominal infection and sepsis in. Additionally, intraabdominal abscess results in abdominal adhesions with lifelong complications. In a prospective, randomized trial involving 100 patients with severe intra. Association of excessive duration of antibiotic therapy for intra abdominal infection with subsequent extra abdominal infection and death. Inflammatory and protein mediators cytokine, chemokine, acute phase proteins play an important, but still not completely understood, role in the morbidity and mortality of intra abdominal sepsis injury. Inflammatory mediators in intraabdominal sepsis or injury. Attributes of good guidelines include validity, reliability, reproducibility, clinical applicability, clinical flexibility, clarity, multidisciplinary process. Updated guideline on diagnosis and treatment of intra.
Patients who present with either a suspected or diagnosed intra abdominal infection should have some form of volume resuscitation. 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. Using a combination of existing murine models for atherosclerosis and sepsis, we found that clp, a model of intraabdominal sepsis, accelerates atheroma development. Intra abdominal infections iais are common surgical emergencies and have been reported as major contributors to nontrauma deaths in the emergency departments worldwide. Several factors should come into play once suspicion for an intra abdominal infection is entertained. A missed case of intraabdominal sepsis bmj case reports. Intraabdominal infections, sepsis, peritonitis, antibiotics. The surgical treatment of intraabdominal sepsis surgery. The intra abdominal compartment syndrome is a complication of the progression of peritonitis. An overview of intraabdominal sepsis is necessary at this time with new experimental studies, scoring systems and audits on.
Intraabdominal sepsis this is a term used for any intraabdominal infection and encompasses both localised and generalised peritonitis. Intraabdominal abscess symptoms, diagnosis and treatment. The term sepsis encompasses a spectrum of disease ranging from systemic inflammatory response syndrome sirs to severe sepsis and multiple organ failure. Antifungal therapy is recommended if candida is cultured from intraabdominal fluid cultures in patients with severe community acquired or healthcare associated infection. Adjuncts to source control are effective broadspectrum antibiotic cover and effec tive fluid resuscitation. Pdf the challenge of intraabdominal sepsis researchgate. Also, because of the variety of physiologic and anatomic changes that occur with age, the frequency of each disease changes. Association of excessive duration of antibiotic therapy for intraabdominal infection with subsequent extraabdominal infection and death. Management of intraabdominal infections world journal of. These include resuscitation, antibiotic usage, and source control itself. We wish to refer to the discussion section that follows their article.
Perforation of gastric carcinoma occurs at the advanced stage in 1% of all gastric malignancies, 2 but is unknown to heal spontaneously after perforation. Evidencebased guidelines for managing patients with intra abdominal infection were prepared by an expert panel of the surgical infection society and the infectious diseases society of america. Postoperative infection has surpassed hemorrhage as the leading cause of mortality among surgical patients. This case highlights the fact that early referral in suspected intraabdominal sepsis is crucial.
Intra abdominal infections pose several particular clinical challenges. Intraabdominal sepsis from a perforated viscus ie, secondary peritonitis or suppurative peritonitis results from direct spillage of luminal contents into the peritoneum eg, perforated peptic. The initial leakage of the endogenous gastrointestinal microflora into the peritoneal cavity results in peritonitis and secondary septicemia, which is frequently followed by localized intra abdominal abscess. Numerous conditions can be sources of infection in patients who have sepsis. Intraabdominal sepsis complicates oct 01, 2018 abdominal cavity pathology is the second most common site of sepsis, with perforated appendicitis being the most frequent source of an abdominal infection. Further diagnostic imaging is unnecessary in patients with obvious signs of diffuse peritonitis and in whom immediate surgical intervention is to be performed biii. Sep 01, 2002 intraabdominal infections are biphasic, synergistic processes with early peritonitis and bacteremia due to aerobes and a later abscess component due to anaerobes. Request pdf a case study in intraabdominal sepsis intraabdominal infections are a common problem for the general surgeon and major sources of morbidity and mortality in the intensive care. According to international literature, the abdomen often ranks first or second among the sources of infection or sepsis 1,2,3. Intraabdominal infections are biphasic, synergistic processes with early peritonitis and bacteremia due to aerobes and a later abscess component due to anaerobes. Ridolfi, mdb intraabdominal infections iais are a common problem for the general surgeon and a major source of morbidity and mortality in the intensive care unit icu.
Diagnosis and management of complicated intraabdominal infections in adults and childrens. With the spillage of the contents, gramnegative and anaerobic bacteria, including common. The approach to antimicrobial selection and administration for intra abdominal infections in adults is discussed here. Conclusion intra abdominal sepsis management of patient in an intensive care unit setup with adequate surgery, open abdomen treatment and antibiotics given based on blood culture and sensitivity. Guidelines for the selection of antiinfective agents for. Conclusion intraabdominal sepsis management of patient in an intensive care unit setup with adequate surgery, open abdomen treatment and antibiotics given based on blood culture and sensitivity.
Patients who present with either a suspected or diagnosed intraabdominal infection should have some form of volume resuscitation. The surgical infection society revised guidelines on the. Intraabdominal sepsis is one of the most challenging situations in surgery and usually presents as peritonitis. Sepsis is a dynamic process that can evolve into conditions of varying severity 10, 11. Intraabdominal sepsis bacteria antibiotic regimens for lowrisk intraabdominal infections antibiotic regimens for highrisk intraabdominal infections antibiotics for healthcareassociated intraabdominal infections risk factors in intraabdominal infections related topics. Wilson 0 0 department of surgery, university of california, irvine medical center, orange elderly patients represent a greater percentage of the population now than ever before, with 12. For patients with septic shock, antibiotics should be administered as soon as. The initial leakage of the endogenous gastrointestinal microflora into the peritoneal cavity results in peritonitis and secondary septicemia, which is frequently followed by localized intraabdominal abscess.
Using a combination of existing murine models for atherosclerosis and sepsis, we found that clp, a model of intra abdominal sepsis, accelerates atheroma development. The principles in the management of complicated intraabdominal sepsis include rapid diagnosis using appropriate imaging techniques, the administration of broadspectrum antibiotics within the golden hour of diagnosis and goaldirected fluid resuscitation. Source control is paramount and may use either surgical or radiological techniques. The interrelationship of sepsis resuscitation and intraabdominal hypertension timothy r. The inflammatory response in patients with sepsis depends on the causative pathogen and. The interrelationship of sepsis resuscitation and intra abdominal hypertension timothy r. Accelerated atheroma burden was associated with prolonged systemic, endothelial and intimal inflammation and was not explained by ongoing infection. Abdominal cavity pathology is the second most common site of sepsis, with perforated appendicitis being the most frequent source of an abdominal infection. September 29, 2015 september 28, 2015 martin kuuskne.
It can involve any intra abdominal organ or can be located freely within the abdominal or pelvic cavities, including in between bowel loops. Several factors should come into play once suspicion for an intraabdominal infection is entertained. Some of these patients present with peritonitis and can rapidly progress to septic shock and need. Antimicrobial therapy should be initiated once a patient receives a diagnosis of an intraabdominal infection or once such an infection is considered likely. Jan 26, 2019 recently, the essential definitions of sepsis and septic shock were updated third international consensus definitions for sepsis and septic shock, sepsis 3 and modified. Intraabdominal sepsis most frequently follows penetrating or blunt abdominal trauma or perforated appendicitis or diverticulitis. Lessons from an animal model of intraabdominal sepsis. Jul 23, 2019 peritonitis is defined as an inflammation of the serosal membrane that lines the abdominal cavity and the organs contained therein. If it is not recognized, it can progress to septic shock with a 1% mortality rate. Inflammatory and protein mediators cytokine, chemokine, acute phase proteins play an important, but still not completely understood, role in the morbidity and mortality of intraabdominal sepsisinjury. Intraabdominal sepsis after ileocolic resection in crohn. Intra abdominal sepsis ias is the second most common form of sepsis after pulmonary sepsis requiring management in the intensive care unit and is frequently associated with high morbidity and mortality. Abdominal sepsis represents the hostssystemic inflammatory response to intraabdominal infections.
Intraabdominal infections pose several particular clinical challenges. Intra abdominal infection iai is a common disease process managed by surgical practitioners. Dr egmund alludes to our sandwich technique 2 but mistakenly mentions the use of a. The management of intraabdominal infections from a global. Intraabdominal sepsis after ileocolic resection in crohns. The guidelines are intended for treating patients who either have these infections or may be at risk for them. Severe sepsis may be a reasonable approximation of the inflection point between stable and critical clinical conditions in the management of intraabdominal infections.
759 866 516 147 1429 556 671 1513 10 1237 1370 1231 587 996 1510 531 941 364 1438 1028 74 1210 1539 795 822 1034 599 1297 396 1402 370 600 1038 1317 1004 936 883 843 874 603 1137 1032 1076