Intra-abdominal
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
- Hospital-acquired (>48 hours after hospitalization): ciprofloxacin + metronidazole or Piperacillin/tazobactam