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  • Image not available. Most intraabdominal infections are “secondary” infections that are polymicrobic and are caused by a defect in the gastrointestinal tract that must be treated by surgical drainage, resection, and/or repair.
  • Image not available. Primary peritonitis is generally caused by a single organism (Staphylococcus aureus in patients undergoing chronic ambulatory peritoneal dialysis [CAPD] or Escherichia coli in patients with cirrhosis).
  • Image not available. Secondary intraabdominal infections are usually caused by a mixture of bacteria, including enteric gram-negative bacilli and anaerobes, which enhances the pathogenic potential of the bacteria.
  • Image not available. For peritonitis, early and aggressive intravenous fluid resuscitation and electrolyte replacement therapy are essential. A common cause of early death is hypovolemic shock caused by inadequate intravascular volume and tissue perfusion.
  • Image not available. Cultures of secondary intraabdominal infection sites are generally not useful for directing antimicrobial therapy. Treatment is generally initiated on a “presumptive” or empirical basis.
  • Image not available. Antimicrobial regimens for secondary intraabdominal infections should include coverage for enteric gram-negative bacilli and anaerobes. Antimicrobials that may be used for the treatment of secondary intraabdominal infections include (a) a β-lactam–β-lactamase inhibitor combination (such as piperacillin-tazobactam), (b) a carbapenem (imipenem or meropenem), (c) quinolone (ciprofloxacin) plus metronidazole, or an aminoglycoside (gentamicin) plus clindamycin (or metronidazole).
  • Image not available. Treatment of primary peritonitis for CAPD patients should include an antistaphylococcal antimicrobial such as a first-generation cephalosporin (cefazolin) or vancomycin (usually given by the intraperitoneal route).
  • Image not available. The duration of antimicrobial treatment should be for a total of 5 to 7 days for most secondary intraabdominal infections.
  • Image not available. Patients treated for intraabdominal infections should be assessed for the occurrence of drug-related adverse effects, particularly hypersensitivity reactions (β-lactam antimicrobials), diarrhea (most agents), fungal infections (most agents), and nephrotoxicity (aminoglycosides).

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On completion of the chapter, the reader will be able to:

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  • 1. Define and describe the difference between primary, secondary, and tertiary intraabdominal infections.
  • 2. Define the terms abscess and peritonitis.
  • 3. Describe the typical microbiology of intraabdominal infections.
  • 4. Describe the typical clinical presentation of peritonitis and intraabdominal abscess.
  • 5. Describe the appropriate role of culture and susceptibility information for diagnosis and treatment of intraabdominal infections.
  • 6. Describe the most appropriate drug and nondrug measures to treat intraabdominal infections.
  • 7. Provide examples of antimicrobial agents that would be appropriate to treat a secondary intraabdominal infection such as an appendiceal abscess.
  • 8. Describe the appropriate antimicrobial treatment for a primary intraabdominal infection such as peritonitis associated with peritoneal dialysis.
  • 9. Describe the proper duration of treatment of an intraabdominal infection given details of the patient condition and type of infection.
  • 10. Describe the proper assessment of patients during treatment of intraabdominal infections.

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Intraabdominal infections are those contained within the peritoneal cavity or retroperitoneal space. The peritoneal cavity extends from the undersurface of the diaphragm to the floor of the pelvis and contains the stomach, small bowel, large bowel, liver, gallbladder, and spleen. The duodenum, pancreas, kidneys, adrenal glands, great vessels (aorta and vena cava), and most mesenteric vascular structures reside in the retroperitoneum. Intraabdominal infections may be generalized ...

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