Skip to main content
SpringerLink
Log in

Abdominal Sepsis

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

Abstract

Abdominal infections are an important challenge for the intensive care physician. In an era of increasing antimicrobial resistance, selecting the appropriate regimen is important and, with new drugs coming to the market, correct use is important more than ever before and abdominal infections are an excellent target for antimicrobial stewardship programs. Biomarkers may be helpful, but their exact role in managing abdominal infections remains incompletely understood. Source control also remains an ongoing conundrum, and evidence is increasing that its importance supersedes the impact of antibiotic therapy. New strategies such as open abdomen management may offer added benefit in severely ill patients, but more data are needed to identify its exact role. The role of fungi and the need for antifungal coverage, on the other hand, have been investigated extensively in recent years, but at this point, it remains unclear who requires empirical as well as directed therapy.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

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

  1. De Waele JJ, Schouten J, Dimopoulos G. Understanding antibiotic stewardship for the critically ill. Intensive Care Med. 2015. in press.

  2. Popovski Z, Mercuri M, Main C, Sne N, Walsh K, Sung M, et al. Multifaceted intervention to optimize antibiotic use for intra-abdominal infections. J Antimicrob Chemother. 2015;70:1226–9.

    CAS  PubMed  Google Scholar 

  3. Sartelli M, Catena F, Ansaloni L, Coccolini F, Di Saverio S, Griffiths EA. Duration of antimicrobial therapy in treating complicated intra-abdominal infections: a comprehensive review. Surg Infect. 2016;17:9–12.

    Article  Google Scholar 

  4. Montravers P, Dupont H, Leone M, Constantin JM, Mertes PM, Société FDEDRS, et al. Guidelines for management of intra-abdominal infections. Anaesth Crit Care Pain Med. 2015;34:117–30. French guidelines discussing many of the controversial issues in IAI management.

    Article  PubMed  Google Scholar 

  5. Sawyer RG, Claridge JA, Nathens AB, Rotstein OD, Duane TM, Evans HL, et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med. 2015;372:1996–2005.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bassetti M, De Waele JJ, Eggimann P, Garnacho-Montero J, Kahlmeter G, Menichetti F, et al. Preventive and therapeutic strategies in critically ill patients with highly resistant bacteria. Intensive Care Med. 2015;41:776–95. A review focusing on several aspects of the management of patients with MDR infections.

    Article  CAS  PubMed  Google Scholar 

  7. Hackel MA, Badal RE, Bouchillon SK, Biedenbach DJ, Hoban DJ. Resistance rates of intra-abdominal isolates from intensive care units and non-intensive care units in the United States: the study for monitoring antimicrobial resistance trends 2010-2012. Surg Infect. 2015;16:298–304.

    Article  Google Scholar 

  8. Montravers P, Dufour G, Guglielminotti J, Desmard M, Muller C, Houissa H, et al. Dynamic changes of microbial flora and therapeutic consequences in persistent peritonitis. Crit Care. 2015;19:70. A study in patients with persistent peritonitis demonstrating the complex interaction between lack of source control, antibiotic exposure, and MDR development.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lee YR, McMahan D, McCall C, Perry GK. Complicated intra-abdominal infections: the old antimicrobials and the new players. Drugs. 2015;75:2097–117. A review of current therapeutic options in IAI including new drugs.

    Article  CAS  PubMed  Google Scholar 

  10. Solomkin J, Hershberger E, Miller B, Popejoy M, Friedland I, Steenbergen J, et al. Ceftolozane/tazobactam 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. A phase III RCT demonstrating non-inferiority of ceftolozane/tazobactam plus metronidazole as a new treatment option for IAI.

    PubMed  PubMed Central  Google Scholar 

  11. Lucasti C, Popescu I, Ramesh MK, Lipka J, Sable C. Comparative study of the efficacy and safety of ceftazidime/avibactam plus metronidazole versus meropenem in the treatment of complicated intra-abdominal infections in hospitalized adults: results of a randomized, double-blind, phase II trial. J Antimicrob Chemother. 2013;68:1183–92.

    Article  CAS  PubMed  Google Scholar 

  12. Solomkin JS, Ramesh MK, Cesnauskas G, Novikovs N, Stefanova P, Sutcliffe JA, et al. Phase 2, randomized, double-blind study of the efficacy and safety of two dose regimens of eravacycline versus ertapenem for adult community-acquired complicated intra-abdominal infections. Antimicrob Agents Chemother. 2014;58:1847–54.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Assfalg V, Wolf P, Reim D, Hüser N, Hellbrügge G, Matevossian E, et al. Procalcitonin ratio and on-demand relaparotomy for septic peritonitis: validation of the focus index (FI). Surg Today. 2016;46:603–12. Procalcitonin levels in postoperative days may help to identify failed source control.

    Article  CAS  PubMed  Google Scholar 

  14. Rettig TC, Verwijmeren L, Dijkstra IM, Boerma D, van de Garde EM, Noordzij PG. Postoperative interleukin-6 level and early detection of complications after elective major abdominal surgery. Ann Surg. 2016;263:1207–12.

    Article  PubMed  Google Scholar 

  15. Leppäniemi A, Kimball EJ, De Laet I, Malbrain ML, Balogh ZJ, De Waele JJ. Management of abdominal sepsis—a paradigm shift. Anaesth Intensive Ther. 2015;47:400–8. A review on the changing surgical management of patients with severe abdominal infections.

    Article  Google Scholar 

  16. Bloos F, Thomas-Rüddel D, Rüddel H, Engel C, Schwarzkopf D, Marshall JC, et al. Impact of compliance with infection management guidelines on outcome in patients with severe sepsis: a prospective observational multi-center study. Crit Care. 2014;18:R42. A large multicenter study in sepsis patients with specific attention to source control.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Tellor B, Skrupky LP, Symons W, High E, Micek ST, Mazuski JE. Inadequate source control and inappropriate antibiotics are key determinants of mortality in patients with intra-abdominal sepsis and associated bacteremia. Surg Infect. 2015;16:785–93.

    Article  Google Scholar 

  18. Bassetti M, Righi E, Ansaldi F, Merelli M, Scarparo C, Antonelli M, et al. A multicenter multinational study of abdominal candidiasis: epidemiology, outcomes and predictors of mortality. Intensive Care Med. 2015;41:1601–10. The largest cohort study of patients with intra-abdominal candidiasis.

    Article  PubMed  Google Scholar 

  19. 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  PubMed  PubMed Central  Google Scholar 

  20. Mutafchiyski VM, Popivanov GI, Kjossev KT, Chipeva S. Open abdomen and VAC® in severe diffuse peritonitis. J R Army Med Corps. 2016;162:30–4.

    Article  PubMed  Google Scholar 

  21. Kirkpatrick AW, Roberts DJ, Faris PD, Ball CG, Kubes P, Tiruta C, et al. Active negative pressure peritoneal therapy after abbreviated laparotomy: the intraperitoneal vacuum randomized controlled trial. Ann Surg. 2015;262:38–46. The first proper RCT comparing standard open abdomen management with negative pressure therapy.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 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;298:865–72.

    Article  PubMed  Google Scholar 

  23. Aguilar G, Delgado C, Corrales I, Izquierdo A, Gracia E, Moreno T, et al. Epidemiology of invasive candidiasis in a surgical intensive care unit: an observational study. BMC Res Notes. 2015;8:491.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Lichtenstern C, Herold C, Mieth M, Brenner T, Decker S, Busch CJ, et al. Relevance of Candida and other mycoses for morbidity and mortality in severe sepsis and septic shock due to peritonitis. Mycoses. 2015;58:399–407.

    Article  PubMed  Google Scholar 

  25. Zappella N, Desmard M, Chochillon C, Ribeiro-Parenti L, Houze S, Marmuse JP, et al. Positive peritoneal fluid fungal cultures in postoperative peritonitis after bariatric surgery. Clin Microbiol Infect. 2015;21:853.e1-3.

    Article  PubMed  Google Scholar 

  26. Liao X, Qiu H, Li R, Guo F, Liu W, Kang M, et al. Risk factors for fluconazole-resistant invasive candidiasis in intensive care unit patients: an analysis from the China Survey of Candidiasis study. J Crit Care. 2015;30:862.e1-5.

    Article  PubMed  Google Scholar 

  27. Perlin DS. Echinocandin resistance in Candida. Clin Infect Dis. 2015;61 Suppl 6:S612–7.

    Article  PubMed  Google Scholar 

  28. Grau S, Luque S, Campillo N, Samsó E, Rodríguez U, García-Bernedo CA, et al. Plasma and peritoneal fluid population pharmacokinetics of micafungin in post-surgical patients with severe peritonitis. J Antimicrob Chemother. 2015;70:2854–61. The first study on antifungal pharmacokinetics demonstrating considerable variability.

    Article  CAS  PubMed  Google Scholar 

  29. Muñoz P, Vena A, Valerio M, Álvarez-Uría A, Guinea J, Escribano P, et al. Risk factors for late recurrent candidaemia. A retrospective matched case-control study. Clin Microbiol Infect. 2016;22:277.e11-20.

    Article  PubMed  Google Scholar 

  30. Klingspor L, Tortorano AM, Peman J, Willinger B, Hamal P, Sendid B, et al. Invasive Candida infections in surgical patients in intensive care units: a prospective, multicentre survey initiated by the European Confederation of Medical Mycology (ECMM) (2006-2008). Clin Microbiol Infect. 2015;21:87.e1–87.e10.

    Article  CAS  Google Scholar 

  31. Knitsch W, Vincent JL, Utzolino S, François B, Dinya T, Dimopoulos G, et al. A randomized, placebo-controlled trial of preemptive antifungal therapy for the prevention of invasive candidiasis following gastrointestinal surgery for intra-abdominal infections. Clin Infect Dis. 2015;61:1671–8. RCT comparing micafungin as preemptive therapy in severe abdominal infection to placebo that failed to show a difference.

    PubMed  PubMed Central  Google Scholar 

  32. Dupont H, Guilbart M, Ntouba A, Perquin M, Petiot S, Regimbeau JM, et al. Can yeast isolation be predicted in complicated secondary non-postoperative intra-abdominal infections. Crit Care. 2015;19:60. An introduction of a scoring system to predict yeast isolation in IAI that was prospectively validated.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Critical Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    Jan J. De Waele

Authors
  1. Jan J. De Waele
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jan J. De Waele.

Ethics declarations

Conflict of Interest

Dr. De Waele declares no conflicts of interests.

Human and Animal Rights and Informed Consent

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

Additional information

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

De Waele, J.J. Abdominal Sepsis. Curr Infect Dis Rep 18, 23 (2016). https://doi.org/10.1007/s11908-016-0531-z

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11908-016-0531-z

Keywords

Search

Navigation