Healthcare-associated Intra-abdominal Infections | Infectious Diseases Management Program at UCSF

Patient Population:

Pediatric

Condition	Major Pathogens	First-choice Therapy	Alternative Therapy	Comments
Intra-abdominal infection, healthcare-associated, age > 1 month, and excluding infants with necrotizing enterocolitis Includes patients with any of the following risk factors for resistant or opportunistic organisms:  Hospitalized for at least 48 hours before onset of signs/symptoms of intra-abdominal infection  Significant medical comorbidities and/or healthcare exposure prior to onset of infection Infection developed post-operatively (signs/symptoms were not present prior to surgery) Refer to BCH SF Necrotizing Enterocolitis Pathway for NEC treatment recommendations If the above criteria do not apply and the patient’s signs/symptoms started prior to hospitalization (community-onset), refer to Appendicitis Clinical Algorithm (BCH OAK and BCH SF shared algorithm)	Enteric gram- negative bacteria Pseudomonas aeruginosa, other resistant gram-negative bacteria Anaerobes	Piperacillin-tazobactam (Zosyn) 100 mg piperacillin/kg/dose (max 4000 mg piperacillin/dose) IV q6h	Penicillin allergy with lower risk for allergic reaction: Cefepime 50 mg/kg/dose (max 2000 mg/dose) IV q8h  AND  Metronidazole 10 mg/kg/dose (max 500mg/dose) IV q8h  ------------------------- Penicillin or cephalosporin allergy with higher risk for allergic reaction: Ciprofloxacin 15 mg/kg/dose (max 400 mg/dose)  IV q12h  AND  Metronidazole 10 mg/kg/dose (max 500 mg/dose) IV q8h	Consider ID consult especially if additional patient risk factors for antibiotic resistant infection, immunocompromised patient, severe manifestations or inadequate response to initial empiric therapy If a pathogen is isolated from a normally sterile site, therapy should be modified to treat the identified pathogen, but coverage of enteric gram-negatives and anaerobes should usually be maintained because intra-abdominal infections are usually polymicrobial. Consult ID for further recommendations if needed.  Duration: If adequate source control, 4 days If source control procedure not performed, but favorable response to therapy, 5-7 days guided by clinical parameters (fever, leukocytosis, adequacy of gastrointestinal function)

Condition

Major Pathogens

First-choice Therapy

Alternative Therapy

Comments

Intra-abdominal infection, healthcare-associated, age > 1 month, and excluding infants with necrotizing enterocolitis

Includes patients with any of the following risk factors for resistant or opportunistic organisms: 

Hospitalized for at least 48 hours before onset of signs/symptoms of intra-abdominal infection 

Significant medical comorbidities and/or healthcare exposure prior to onset of infection

Infection developed post-operatively (signs/symptoms were not present prior to surgery)

Refer to BCH SF Necrotizing Enterocolitis Pathway for NEC treatment recommendations

If the above criteria do not apply and the patient’s signs/symptoms started prior to hospitalization (community-onset), refer to Appendicitis Clinical Algorithm (BCH OAK and BCH SF shared algorithm)

Enteric gram- negative bacteria

Pseudomonas aeruginosa, other resistant gram-negative bacteria

Anaerobes

Piperacillin-tazobactam (Zosyn) 100 mg piperacillin/kg/dose (max 4000 mg piperacillin/dose) IV q6h 

Penicillin allergy with lower risk for allergic reaction:

Cefepime
50 mg/kg/dose (max 2000 mg/dose) IV q8h 

AND 

Metronidazole
10 mg/kg/dose (max 500mg/dose) IV q8h 

-------------------------

Penicillin or cephalosporin allergy with higher risk for allergic reaction:

Ciprofloxacin
15 mg/kg/dose (max 400 mg/dose)  IV q12h 

AND 

Metronidazole
10 mg/kg/dose (max 500 mg/dose) IV q8h 

Consider ID consult especially if additional patient risk factors for antibiotic resistant infection, immunocompromised patient, severe manifestations or inadequate response to initial empiric therapy

If a pathogen is isolated from a normally sterile site, therapy should be modified to treat the identified pathogen, but coverage of enteric gram-negatives and anaerobes should usually be maintained because intra-abdominal infections are usually polymicrobial. Consult ID for further recommendations if needed. 

Duration: If adequate source control, 4 days

If source control procedure not performed, but favorable response to therapy, 5-7 days guided by clinical parameters (fever, leukocytosis, adequacy of gastrointestinal function) 

Reference

Mazuski JE, et al. The Surgical Infection Society revised guidelines on the management of intra-abdominal infection. Surgical Infections 2017;18:1-76.

Abdominopelvic Infections