VASF Intra-abdominal Infections (IAI) Treatment Guidelines

Site: 
VA Medical Center San Francisco
Modified Date: 
December 1, 2023
Category: 
Syndrome Specific Guidelines

Intra-abdominal Infections (IAI)

  • Intra-abdominal infections are those contained within the peritoneal cavity or retroperitoneal space.
  • May be generalized or localized, complicated or uncomplicated, and community or healthcare-associated

Possible Intra-abdominal Infection Etiologies1

Clinical Risk Factors Identifying Patients at High Risk2,3,6
  • Peptic ulcer perforation
  • Perforation of a gastrointestinal organ
  • Appendicitis
  • Endometritis secondary to intrauterine device
  • Bile peritonitis
  • Pancreatitis
  • Operative contamination
  • Diverticulitis
  • Cholecystitis
  • Intestinal neoplasms
  • Secondary to peritoneal dialysis

Patients with > 1 of the following:

  • High severity of illness (APACHE II score ≥ 15)
  • Severe sepsis or septic shock
  • Diffuse, generalized peritonitis
  • Delayed initial source control > 24 hours
  • Inability to achieve adequate source control

Patients with > 2 of the following:

  • Advanced age ( > 70 years of age)
  • Malignancy
  • Significant cardiovascular compromise
  • Significant liver disease or cirrhosis
  • Significant renal disease
  • Hypoalbuminemia

 

References

  1. Gross AE, DiPiro JT. Chapter 92. Intraabdominal Infections. Pharmacotherapy: A Pathophysiologic Approach, 9e. New York, NY: McGrRaw-Hill; 2014.
  2. Solomkin, Joseph S., et al. "Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America." Clinical infectious diseases 50.2 (2010): 133-164.
  3. Knaus WA Draper EA et al. APACHE II: A severity of disease classification system. Critical Care Medicine. 1985; 13
  4. Marshall JC, Innes M. Intensive care unit management of intraabdominal infection. Crit Care Med 2003;31:2228–2237
  5. Montravers P, Lepape A, Dubreuil L, et al. Clinical and microbiological profiles of community-acquired and nosocomial infections: Results of the French prospective, observational EBIIA study. J Antimicrob Chemother 2009;63:785–794
  6. Mazuski, John E., et al. "The surgical infection society revised guidelines on the management of intra-abdominal infection." Surgical infections 18.1 (2017): 1-76.