Skip to main content
Log in

Advances in Intra-abdominal Sepsis: What Is New?

  • Sepsis and ICU (L Napolitano, Section Editor)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

We have reviewed the literature regarding recent advances in the management of intra-abdominal sepsis, with a focus on antimicrobial agents, duration of therapy, and source control. Several important developments in these areas are discussed in this review. The introduction of a new antimicrobial agent—ceftolozane/tazobactam—marks the first novel agent for treating intra-abdominal infections in a number of years, and its indications for use and supporting evidence are reviewed here. In addition, we discuss recent evidence that clarifies the importance of early source control for intra-abdominal infection and new data that suggests that an abbreviated course of antimicrobial therapy for intra-abdominal infection is equally effective as prolonged therapy.

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

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Shirah GR, O’Neill PJ. Intra-abdominal infections. Surg Clin N Am. 2014;94:1319–33. This important multicenter, double-blind, randomized controlled trial describes the results of administering a novel antibiotic, ceftolozane/tazobactom, to cIAI patients, when compared to the current gold standard.

    Article  PubMed  Google Scholar 

  2. Solomkin JS et al. Diagnosis and management of complicated intra-abdominal infections in adults and children. guidelines by the surgical infection society and the infectious diseases society of America. Clin Infect Dis Off Publ Infect Dis Soc Am. 2009;50. This is a multicenter, retrospective study evaluating different levels of procalcitonin and the role of procalcitonin in driving duration of antibiotic therapy. There is increasing evidence that procalcitonin correlates with disease severity.

  3. Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, et al. 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. Surg Infect. 2010;11:79–109.

    Article  Google Scholar 

  4. Sartelli M et al. Complicated intra-abdominal infections worldwide: the definitive data of the CIAOW Study. World J Emerg Surg. 2014;9:37.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Solomkin J et al. Ceftolozane/tazobactum plus metronidazole for complicated intra-abdominal infections in an era of multidrug resistance: results from a randomized, double-blind, phase 3 trial (ASPECT-cIAI). Clin Infect Dis. 2015;60:1462–71. An important prospective, double-blind non-inferiority trial randomizing patients to ceftolozane/tazobactam plus metronidazole versus meropenem. The outcomes demonstrate that ceftolozame/tazobactam is non-inferior, even in patients with multi-drug resistant organisms.

  6. Hong M-C, Hsu DI, Bounthavong M. Ceftolozane/tazobactam: a novel antipseudomonal cephalosporin and β-lactamase-inhibitor combination. Infect Drug Resist. 2013;6:215–23.

    PubMed Central  PubMed  Google Scholar 

  7. Lucasti C et al. Multicenter, double-blind, randomized, phase II trial to assess the safety and efficacy of ceftolozane-tazobactam plus metronidazole compared with meropenem in adult patients with complicated intra-abdominal infections. Antimicrob Agents Chemother. 2014;58:5350–7.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Temkin E, Adler A, Lerner A, Carmeli Y. Carbapenem-resistant Enterobacteriaceae: biology, epidemiology, and management. Ann N Y Acad Sci. 2014;1323:22–42.

    Article  CAS  PubMed  Google Scholar 

  9. Farrell DJ, Sader HS, Flamm RK, Jones RN. Ceftolozane/tazobactam activity tested against Gram-negative bacterial isolates from hospitalised patients with pneumonia in US and European medical centres (2012). Int J Antimicrob Agents. 2014;43:533–9.

    Article  CAS  PubMed  Google Scholar 

  10. Stone HH, Bourneuf AA, Stinson LD. Reliability of criteria for predicting persistent or recurrent sepsis. Arch Surg. 1985;120:17–20.

    Article  CAS  PubMed  Google Scholar 

  11. Sawyer RG, Claridge JA, Nathens AB, et al. Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection. N Engl J Med. 2015;372(21):1996–2005. doi:10.1056/NEJMoa1411162.

  12. Maseda E et al. Procalcitonin-guided therapy may reduce length of antibiotic treatment in intensive care unit patients with secondary peritonitis: a multicenter retrospective study. J Crit Care. 2014;30:10–5. doi:10.1016/j.jcrc.2014.12.014.

    Google Scholar 

  13. Nobre V, Harbarth S, Graf JD, Rohner P, Pugin J. Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial. Am J Respir Crit Care Med. 2008;177:498–505.

    Article  CAS  PubMed  Google Scholar 

  14. Bouadma L et al. Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet. 2010;375:463–74. PRORATA is an interesting clinical trial that randomized patients to varying durations of antibiotic treatment in control and experimental populations.  The experimental group received antibiotic therapy based on procalcitonin levels with predetermined cutoff values, whereas the control group was treated based on current guidelines. Patients in the procalcitonin group had fewer antibiotic days and non-inferior rates of mortality when compared to control patients.

  15. Schroeder S et al. Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: results of a prospective randomized study. Langenbeck's Arch Surg. 2009;394:221–6.

    Article  CAS  Google Scholar 

  16. Hochreiter M et al. Procalcitonin to guide duration of antibiotic therapy in intensive care patients: a randomized prospective controlled trial. Crit Care. 2009;13:R83.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Jensen JU et al. Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: a randomized trial*. Crit Care Med. 2011;39:2048–58.

    Article  CAS  PubMed  Google Scholar 

  18. Schein M, Marshall J. Source control for surgical infections. World J Surg. 2004;28:638–45.

    PubMed  Google Scholar 

  19. Hecker A, Uhle F, Schwandner T, Padberg W, Weigand MA. Diagnostics, therapy and outcome prediction in abdominal sepsis: current standards and future perspectives. Langenbeck's Arch Surg. 2014;399:11–22.

    Article  CAS  Google Scholar 

  20. Dellinger RP et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39:165–228.

    Article  CAS  PubMed  Google Scholar 

  21. De Waele JJ. Early source control in sepsis. Langenbeck's Arch Surg. 2010;395:489–94.

    Article  Google Scholar 

  22. Azuhata T et al. Time from admission to initiation of surgery for source control is a critical determinant of survival in patients with gastrointestinal perforation with associated septic shock. Crit Care. 2014;18:R87.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Rivers E, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345.

Download references

Compliance with Ethics Guidelines

Conflict of Interest

The authors have no relevant financial disclosures to disclose.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Robert G. Sawyer.

Additional information

This article is part of the Topical Collection on Sepsis and ICU

Zachary C. Dietch and Puja M. Shah contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dietch, Z.C., Shah, P.M. & Sawyer, R.G. Advances in Intra-abdominal Sepsis: What Is New?. Curr Infect Dis Rep 17, 40 (2015). https://doi.org/10.1007/s11908-015-0497-2

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11908-015-0497-2

Keywords

Navigation