Intra-abdominal Infections

Bottom Line

 

  • Treatment is a combined modality that includes surgical intervention for source control.
  • Empiric therapy is based upon two classification systems – uncomplicated/complicated and community acquired vs. hospital acquired.
  • Therapy is targeted at core pathogens:  enteric facultative Gram negative bacilli and anaerobes.
  • Anti-pseudomonal coverage is not typically required unless it is the only pathogen recovered or the patient is not responding to antimicrobial treatment.
  • Anti-enterococcal coverage is rarely required.

Empiric Therapy



  • Uncomplicated (single organ involvement and no anatomical disruption): no antimicrobial coverage required.

  •  



    Complicated (infection extending beyond original source/organ causing peritonitis):



  • Community-acquired (mild to moderate severity):    moxifloxacin 
  • Community-acquired (severe):   ciprofloxacin + metronidazole or ceftriaxone + metronidazole