Skip to main content
SpringerLink
Log in

Abdominal Sepsis and Complicated Intraabdominal Infections

  • Chapter
  • First Online:
Evidence-Based Critical Care

  • 313 Accesses

Abstract

Complicated intraabdominal infections (cIAI) are a common cause of morbidity and mortality in the intensive care unit. Uncomplicated infections do not involve perforation or disruption of the gastrointestinal tract whereas complicated infections are associated with the presence of microbial pathogens in a normal sterile area of the abdomen. They usually manifest as peritonitis and/or abscess formation.

The mainstays of treatment for cIAI include prompt diagnosis, resuscitation, source control and anti-infective therapy. Diagnostic tools include physical exam, computed tomography and ultrasound if a biliary source is suspected. Resuscitation should follow the Surviving Sepsis Campaign guidelines, and is aimed at early goal directed resuscitation with at least 30 mL/kg of intravenous fluid be given within the first 3 h and antimicrobial administration within the first hour after recognition of sepsis and septic shock (Rhodes A, et al. Crit Care Med. 45:486–552, 2017). Source control includes drainage of infected fluid collections, debridement of infected tissue, and definitive measures to control ongoing contamination and restore anatomy and function. Source control can be gained either by operative intervention or percutaneous drainage.

At a minimum, antimicrobial therapy should empirically cover common gram negative Enterobacteriaceae and enteric anaerobes. For patients with health-care-associated infections, broader-spectrum agents having activity against resistant gram negative flora such as Pseudomonas aeruginosa and Acinetobacter sp., enterococci, occasionally methicillin-resistant staphylococci, and yeast may be needed as well. Specific therapies should be guided by hospital and ICU antibiograms.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45(3):486–552.

    Article  Google Scholar 

  2. Mazuski JE, Tessier J, May AK, Sawyer RG, Nadler EP, Rosengart MR, et al. The surgical infection society revised guidelines on the management of intra-abdominal infection. Surg Infect. 2017;18(1):1–76.

    Article  Google Scholar 

  3. Crandall M, West MA. Evaluation of the abdomen in the critically ill patient: opening the black box. Curr Opin Crit Care. 2006;12(4):333–9.

    PubMed  Google Scholar 

  4. Pieracci FM, Barie PS. Management of severe sepsis of abdominal origin. Scand J Surg. 2007;96(3):184–96.

    Article  CAS  Google Scholar 

  5. Shirah GR, O’Neill PJ. Intra-abdominal infections. Surg Clin North Am. 2014;94(6):1319–33.

    Article  Google Scholar 

  6. Noone TC, Semelka RC, Chaney DM, Reinhold C. Abdominal imaging studies: comparison of diagnostic accuracies resulting from ultrasound, computed tomography, and magnetic resonance imaging in the same individual. Magn Reson Imaging. 2004;22(1):19–24.

    Article  Google Scholar 

  7. Lopez N, Kobayashi L, Coimbra R. A comprehensive review of abdominal infections. World J Emerg Surg. 2011;6:7.

    Article  Google Scholar 

  8. Marshall JC, Maier RV, Jimenez M, Dellinger EP. Source control in the management of severe sepsis and septic shock: an evidence-based review. Crit Care Med. 2004;32(11 Suppl):S513–26.

    Article  Google Scholar 

  9. Koperna T, Schulz F. Relaparotomy in peritonitis: prognosis and treatment of patients with persisting intraabdominal infection. World J Surg. 2000;24(1):32–7.

    Article  CAS  Google Scholar 

  10. Waibel BH, Rotondo MF. Damage control for intra-abdominal sepsis. Surg Clin North Am. 2012;92(2):243–57.

    Article  Google Scholar 

  11. Weber DG, Bendinelli C, Balogh ZJ. Damage control surgery for abdominal emergencies. Br J Surg. 2014;101(1):e109–18.

    Article  CAS  Google Scholar 

  12. van Ruler O, Mahler CW, Boer KR, Reuland EA, Gooszen HG, Opmeer BC, et al. Comparison of on-demand vs planned relaparotomy strategy in patients with severe peritonitis; a randomized trial. JAMA. 2007;298(8):865–72.

    Article  Google Scholar 

  13. Akinci D, Akhan O, Ozmen MN, Karabulut N, Ozkan O, Cil BE, et al. Percutaneous drainage of 300 intraperitoneal abscesses with long-term follow up. Cardiovasc Intervent Radiol. 2005;28(6):744–50.

    Article  Google Scholar 

  14. Hemming A, Davis NL, Robins RE. Surgical versus percutaneous drainage of intra-abdominal abscesses. Am J Surg. 1991;161(5):593–5.

    Article  CAS  Google Scholar 

  15. Sartelli M, Abu-Zidan FM, Ansaloni L, Bala M, Beltrán MA, Biffl WL, et al. The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper. World J Emerg Surg. 2015;10:35.

    Article  Google Scholar 

  16. Bruns BR, Ahmad SA, O’Meara L, Tesoriero R, Lauerman M, Klyushnenkova E, et al. Nontrauma open abdomens: a prospective observational study. J Trauma Acute Care Surg. 2016;80(4):631–6.

    Article  Google Scholar 

  17. Open Abdomen Advisory Panel, Campbell A, Chang M, Fabian T, Franz M, Kaplan M, Moore F, et al. Management of the open abdomen: from initial operation to definitive closure. Am Surg. 2009;75(11 Suppl):S1–S22.

    Google Scholar 

  18. Carlson GL, Patrick H, Amin AI, McPherson G, MacLennan G, Afolabi E, et al. Management of the open abdomen: a national study of clinical outdome and safety of negative pressure wound therapy. Ann Surg. 2013;257(6):1154–9.

    Article  Google Scholar 

  19. Coccolini F, Biffl W, Catena F, Ceresoli M, Chiara O, Cimbanassi S, et al. The open abdomen, indications, management and definitive closure. World J Emerg Surg. 2015;10:32.

    Article  Google Scholar 

  20. Sartelli M, Catena F, Ansaloni L, Coccolini F, Corbella D, Moore EE, et al. Complicated intra-abdominal infections worldwide: the definitive data of the CIAOW study. World J Emerg Surg. 2014;9:37.

    Article  Google Scholar 

  21. Coccolini F, Montori G, Ceresoli M, Catena F, Moore EE, Ivatury R, et al. The role of the open abdomen in non-trauma patient: WSES consensus paper. World J Emerg Surg. 2017;12:39.

    Article  Google Scholar 

  22. Bassetti M, Righi E, Ansaldi F, Merelli M, Scarparo C, Antonelli M, Garnacho-Montero J, Diaz-Martin A, Palacios-Garcia I, Luzzati R, Rosin C, Lagunes L, Rello J, Almirante B, Scotton PG, Baldin G, Dimopoulos G, Nucci M, Munoz P, Vena A, Bouza E, de Egea V, Colombo AL, Tascini C, Menichetti F, Tagliaferri E, Brugnaro P, Sanguinetti M, Mesini A, Sganga G, Viscoli C, Tumbarello M. A multicenter multinational study of abdominal candidiasis: epidemiology, outcomes and predictors of mortality. Intensive Care Med. 2015;41(9):1601–10.

    Article  Google Scholar 

  23. Soop M, Carlson GL. Recent developments in the surgical management of complex intra-abdominal infection. Br J Surg. 2017;104(2):e65–74.

    Article  CAS  Google Scholar 

  24. Montravers P, Dupont H, Gauzit R, Verber B, Auboyer C, Blin P, et al. Candida as a risk factor for mortality in peritonitis. Crit Care Med. 2006;34(3):646–52.

    Article  Google Scholar 

  25. Zilberberg M, Yu HT, Chaudhari P, Emons MF, Khandelwal N, Shorr AF. Relationship of fluconazole prophylaxis with fungal microbiology in hospitalized intra-abdominal surgery patients: a descriptive cohort study. Crit Care. 2014;18(5):590.

    Article  Google Scholar 

  26. Vergidis P, Clancy CJ, Shields RK, Park SY, Wildfeuer BN, Simmons RL, et al. Intra-abdominal candidiasis: the importance of early source control and antifungal treatment. PLoS One. 2016;11(4):e0153247.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA

    Sara A. Buckman & John E. Mazuski

Authors
  1. Sara A. Buckman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John E. Mazuski
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sara A. Buckman .

Editor information

Editors and Affiliations

  1. Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA

    Robert C. Hyzy

  2. Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA

    Jakob McSparron

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Buckman, S.A., Mazuski, J.E. (2020). Abdominal Sepsis and Complicated Intraabdominal Infections. In: Hyzy, R.C., McSparron, J. (eds) Evidence-Based Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-26710-0_87

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-26710-0_87

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-26709-4

  • Online ISBN: 978-3-030-26710-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation