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, Jan 2010

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.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://cid.oxfordjournals.org/content/50/2/133.full.pdf

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. - 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)


This is a preview of a remote PDF: https://cid.oxfordjournals.org/content/50/2/133.full.pdf

Joseph S. Solomkin, John E. Mazuski, John S. Bradley, Keith A Rodvold, Ellie J.C. Goldstein, Ellen J. Baron, Patrick J. O'Neill, Anthony W. Chow, E. Patchen Dellinger, Soumitra R. Eachempati, Sherwood Gorbach, Mary Hilfiker, Addison K. May, Avery B. Nathens, Robert G. Sawyer, John G. Bartlett. 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, 2010, pp. 133-164, 50/2, DOI: 10.1086/649554