Postoperative Intra-abdominal Infection

  • Paul B. McBeth
  • Andrew W. Kirkpatrick
Chapter

Abstract

Postoperative intra-abdominal infections are common; therefore early recognition and treatment are needed to improve patient outcomes. This chapter provides a discussion of the evaluation of patients with suspected postoperative abdominal infections. A review of common etiologies, diagnoses, and therapeutic approaches is provided. The fundamental principles of management of intra-abdominal infections are predicated on early clinical recognition and diagnosis followed by goal-directed resuscitation, broad-spectrum antimicrobial therapy, and early source control. There is also a growing recognition and appreciation of a patient’s microbiome where humans are not living in isolation but in reality a complex commensal organism in conjunction with trillions of microbiological organisms.

Keywords

Intra-abdominal infections Resuscitation Source control Antibiotics Gut microbiome 

References

  1. 1.
    Dellinger EP, Wertz MJ, Meakins JL, et al. Surgical infection stratification system for intra-abdominal infection: multicenter trial. Arch Surg. 1985;120:21.CrossRefGoogle Scholar
  2. 2.
    Simmons BP. Guideline for prevention of surgical wound infections. Infect Control. 1982;3:185–96.Google Scholar
  3. 3.
    Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, O'Neill PJ, Chow AW, Dellinger EP, Eachempati SR, Gorbach S, Hilfiker M, May AK, Nathens AB, Sawyer RG, Bartlett JG. 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. Clin Infect Dis. 2010;50(2):133–64.CrossRefGoogle Scholar
  4. 4.
    Xiao Z, Wilson C, Robertson HL, Roberts DJ, Ball CG, Jenne CN, et al. Inflammatory mediators in intra-abdominal sepsis or injury - a scoping review. Crit Care. 2015;19(1):373.CrossRefGoogle Scholar
  5. 5.
    Ogilvie H. Large intestine colic due to sympathetic deprivation: a new clinical syndrome. Br J Med. 1948;2:671.CrossRefGoogle Scholar
  6. 6.
    Ponec RJ, Saunders MD, Kimmey MB. Neostigmine for the treatment of acute colonic pseudo-obstruction. N Engl J Med. 1999;341:137.CrossRefGoogle Scholar
  7. 7.
    Edwards MS, Cherr GS, Craven TE, et al. Acute occlusive mesenteric ischemia: surgical management and outcomes. Ann Vasc Surg. 2003;17:72.CrossRefGoogle Scholar
  8. 8.
    Birnabaum W, Rudy L, Wylie EJ. Colonic and rectal ischemia following abdominal aneurysmectomy. Dis Colon Rectum. 1964;7:293.CrossRefGoogle Scholar
  9. 9.
    Stoney RJ, Cunningham CG. Acute mesenteric ischemia. Surgery. 1993;114:489.PubMedGoogle Scholar
  10. 10.
    Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368–77.CrossRefGoogle Scholar
  11. 11.
    Roberts DJ, Ball CG, Kirkpatrick AW. Increased pressure within the abdominal compartment: intra-abdominal hypertension and the abdominal compartment syndrome. Curr Opin Crit Care. 2016;22(2):174–85.PubMedGoogle Scholar
  12. 12.
    Malbrain ML, De Laet I. AIDS is coming to your ICU: be prepared for acute bowel injury and acute intestinal distress syndrome. Intensive Care Med. 2008;34(9):1565–9.CrossRefGoogle Scholar
  13. 13.
    Malbrain ML, De Laet I. It’s all in the gut: introducing the concept of acute bowel injury and acute intestinal distress syndrome. Crit Care Med. 2009;37(1):365–6.CrossRefGoogle Scholar
  14. 14.
    Alejandria MM, Lansang MA, Dans LF, Mantaring JB. Intravenous immunoglobulin for treating sepsis, severe sepsis and septic shock. Cochrane Database Syst Rev. 2013;9:CD001090.Google Scholar
  15. 15.
    Laupland KB, Kirkpatrick AW, Delaney A. Polyclonal intravenous immunoglobulin for the treatment of severe sepsis and septic shock in critically ill adults: a systematic review and meta-analysis. Crit Care Med. 2007;35(12):2686–92.PubMedGoogle Scholar
  16. 16.
    Opal SM, Dellinger RP, Vincent JL, Masur H, Angus DC. The next generation of sepsis clinical trial designs: what is next after the demise of recombinant human activated protein C?*. Crit Care Med. 2014;42(7):1714–21.CrossRefGoogle Scholar
  17. 17.
    Gentile LF, Moldawer LL. HMGB1 as a therapeutic target for sepsis: it's all in the timing! Expert Opin Ther Targets. 2014;18(3):243–5.CrossRefGoogle Scholar
  18. 18.
    Malig MS, Jenne CN, Ball CG, Roberts DJ, Xiao Z, Kirkpatrick AW. High mobility group Box-1 protein and outcomes in critically ill surgical patients requiring open abdominal management. Mediat Inflamm. 2017;2017:1-8.CrossRefGoogle Scholar
  19. 19.
    Pappas PG, Rex JH, Sobel JD, et al. Guidelines for treatment of candidiasis. Clin Infect Dis. 2004;38:161–89.CrossRefGoogle Scholar
  20. 20.
    Holzheimer RG, Dralle H. Management of mycoses in surgical patients: review of the literature. Eur J Med Res. 2002;7:200–26.PubMedGoogle Scholar
  21. 21.
    Blot S, Vandewoude K. Management of invasive candidiasis in critically ill patients. Drugs. 2004;64:2159–75.CrossRefGoogle Scholar
  22. 22.
    De Waele JJ, Vogelaers D, Hoste E, et al. Emergence of antibiotic resistance in infected pancreatic necrosis. Arch Surg. 2004;139:1371–5.CrossRefGoogle Scholar
  23. 23.
    Blot S, Vandewoude K. Early detection of systemic infection. Acta Clin Belg. 2004;59:20–3.CrossRefGoogle Scholar
  24. 24.
    Blot S, Depuydt P, Vogelaers D, et al. Colonization status and appropriate antibiotic therapy in nosocomial bacteremia caused by antibiotic-resistant gram- negative bacteria in an ICU. Infect Control Hosp Epidemiol. 2005;26:575–9.CrossRefGoogle Scholar
  25. 25.
    Harbarth S, Cosgrove S, Carmeli Y. Effects of antibiotics on nosocomial epidemiology of vancomycin-resistant enterococci. Antimicrob Agents Chemother. 2002;46:1619–28.CrossRefGoogle Scholar
  26. 26.
    Fernandez-Guerrero ML, Herrero L, Bellver M, et al. Nosocomial enterococcal endocarditis: a serious hazard for hospitalized patients with enterococcal bacteraemia. J Intern Med. 2002;252:510–5.CrossRefGoogle Scholar
  27. 27.
    Solomkin JS, Mazuski JE, Baron EJ, et al. Guidelines for the selection of anti-infective agents for complicated intra-abdominal infections. Clin Infect Dis. 2003;37:997–1005.CrossRefGoogle Scholar
  28. 28.
    Alverdy JC, Hyoju SK, Weigerinck M, Gilbert JA. The gut microbiome and the mechanism of surgical infection. Br J Surg. 2017;104(2):e14–23.CrossRefGoogle Scholar
  29. 29.
    Guyton K, Alverdy JC. The gut microbiota and gastrointestinal surgery. Nat Rev Gastroenterol Hepatol. 2017;14(1):43–54.CrossRefGoogle Scholar
  30. 30.
    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.CrossRefGoogle Scholar
  31. 31.
    Sartelli M, Abu-Zidan FM, Ansaloni L, Bala M, Beltran 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.CrossRefGoogle Scholar
  32. 32.
    Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801–10.CrossRefGoogle Scholar
  33. 33.
    Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36(1):296–327.CrossRefGoogle Scholar
  34. 34.
    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.CrossRefGoogle Scholar
  35. 35.
    Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39(7):1190–206.CrossRefGoogle Scholar
  36. 36.
    Khan A, Hsee L, Mathur S, Civil I. Damage-control laparotomy in nontrauma patients: review of indications and outcomes. J Trauma Acute Care Surg. 2013;75(3):365–8.CrossRefGoogle Scholar
  37. 37.
    Leppaniemi A, Kimball EJ, De Laet I, Malbrain ML, Balogh ZJ, De Waele JJ. Management of abdominal sepsis--a paradigm shift? Anaesthesiol Intensive Ther. 2015;47(4):400–8.CrossRefGoogle Scholar
  38. 38.
    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.CrossRefGoogle Scholar
  39. 39.
    Goussous N, Jenkins DH, Zielinski MD. Primary fascial closure after damage control laparotomy: sepsis vs haemorrhage. Injury. 2014;45(1):151–5.CrossRefGoogle Scholar
  40. 40.
    Roberts DJ, Zygun DA, Grendar J, Ball CG, Robertson HL, Ouellet JF, et al. Negative-pressure wound therapy for critically ill adults with open abdominal wounds: a systematic review. J Trauma Acute Care Surg. 2012;73(3):629–39.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Paul B. McBeth
    • 1
  • Andrew W. Kirkpatrick
    • 2
  1. 1.Departments of Surgery and Critical Care MedicineFoothills Medical CentreCalgaryCanada
  2. 2.Regional Trauma Services, Departments of Surgery, Critical Care MedicineUniversity of CalgaryCalgaryCanada

Personalised recommendations