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
Joseph S. Solomkin
()
9
John E. Mazuski
8
John S. Bradley
7
Keith A. Rodvold
15
Ellie J. C. Goldstein
12
Ellen J. Baron
11
Patrick J. O'Neill
14
Anthony W. Chow
2
E. Patchen Dellinger
10
Soumitra R. Eachempati
5
Sherwood Gorbach
6
Mary Hilfiker
13
Addison K. May
3
Avery B. Nathens
0
Robert G. Sawyer
4
John G. Bartlett
1
0
St Michael's Hospital
,
Toronto
, Ontario,
Canada
1
Department of Medicine, Johns Hopkins University School of Medicine
,
Baltimore, Maryland
2
Department of Medicine, University of British Columbia
,
Vancouver
,
British Columbia
3
Department of Surgery, Vanderbilt University Medical Center
,
Nashville, Tennessee
4
Department of Surgery, University of Virginia
,
Charlottesville
5
Department of Surgery, Cornell Medical Center
,
New York, New York
6
Department of Medicine, Tufts University School of Medicine
,
Boston, Massachusetts
7
Pediatric Infectious Diseases
8
Department of Surgery, Washington University School of Medicine
, Saint Louis,
Missouri
;
Departments of
9
Department of Surgery, the University of Cincinnati College of Medicine
, Cincinnati,
Ohio
10
Department of Surgery, University of Washington
,
Seattle
11
Department of Pathology, Stanford University School of Medicine
, Palo Alto,
California
;
Departments of
12
R. M. Alden Research Laboratory, David Geffen School of Medicine at UCLA
,
Los Angeles
13
Surgery, Rady Children's Hospital of San Diego
,
San Diego
14
Department of Surgery, The Trauma Center at Maricopa Medical Center
, Phoenix,
Arizona
15
Medicine, University of Illinois at Chicago
,
Chicago
Evidence-based 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. These updated guidelines replace those previously published in 2002 and 2003. The guidelines are intended for treating patients who either have these infections or may be at risk for them. New information, based on publications from the period 2003-2008, is incorporated into this guideline document. The panel has also added recommendations for managing intra-abdominal infection in children, particularly where such management differs from that of adults; for appendicitis in patients of all ages; and for necrotizing enterocolitis in neonates.
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EXECUTIVE SUMMARY
The 2009 update of the guidelines contains
evidencebased recommendations for the initial diagnosis and
subsequent management of adult and pediatric patients with
complicated and uncomplicated intra-abdominal
infection. The multifaceted nature of these infections has led
to collaboration and endorsement of these
recommendations by the following organizations: American Society
for Microbiology, American Society of Health-System
Pharmacists, Pediatric Infectious Diseases Society, and
Society of Infectious Diseases Pharmacists.
These guidelines make therapeutic recommendations
on the basis of the severity of infection, which is defined
for these guidelines as a composite of patient age,
physiologic derangements, and background medical
conditions. These values are captured by severity scoring
systems, but for the individual patient, clinical
judgment is at least as accurate as a numerical score [14].
High risk is intended to describe patients with a range
This guideline might be updated periodically. To be sure you have the most
recent version, check the Web site of the journal (http://www.journals.uchicago
.edu/page/cid/IDSAguidelines.html).
It is important to realize that guidelines cannot always account for individual
variation among patients. They are not intended to supplant physician judgment
with respect to particular patients or special clinical situations. The Infectious
Diseases Society of America considers adherence to these guidelines to be
voluntary, with the ultimate determination regarding their application to be made
by the physician in the light of each patients individual circumstances.
of reasons for increased rates of treatment failure in addition
to a higher severity of infection, particularly patients with an
anatomically unfavorable infection or a health careassociated
infection [5] (Table 1).
Initial Diagnostic Evaluation
1. Routine history, physical examination, and laboratory
studies will identify most patients with suspected
intra-abdominal infection for whom further evaluation and management
is warranted (A-II).
2. For selected patients with unreliable physical examination
findings, such as those with an obtunded mental status or spinal
cord injury or those immunosuppressed by disease or therapy,
intra-abdominal infection should be considered if the patient
presents with evidence of infection from an undetermined
source (B-III).
3. Further diagnostic imaging is unnecessary in patients with
obvious signs of diffuse peritonitis and in whom immediate
surgical intervention is to be performed (B-III).
4. In adult patients not undergoing immediate laparotomy, computed tomography (CT) scan is the imag (...truncated)