Intra-abdominal infections (IAI) occur due to disruption of the normal anatomic barrier.
Hollow viscera is where common disruptions occur, which allows intraluminal bacteria to invade and proliferate in the usually sterile area (ie peritoneal cavity or retroperitoneum).
Community-acquired IAI is usually secondary to gastroduodenal perforation, ascending cholangitis, cholecystitis, appendicitis, colon diverticulitis with or without perforation, or pancreatitis.
Healthcare-associated IAI is usually secondary to leak or perforations from anastomosis or abscess from surgical site and/or wound infections.

Intra-abdominal%20infections Management

Management of Treatment Failure

  • If the patient is not improving with the microbiologically adequate initial empiric therapy, alternative diagnosis (eg extra-abdominal sources or noninfectious inflammatory conditions) should be considered and further diagnostic investigation is warranted  
  • Consider an infection with antibiotic-resistant organisms in patients with known colonization of antibiotic-resistant bacteria, healthcare-acquired infection, or a history of travel to areas with high prevalence of antibiotic-resistant organisms within a few weeks before onset of infection or if antibiotics were taken during the travel
  • CT scan or ultrasound imaging should be done to patients who show persistent or recurrent clinical evidence of IAI after 4-7 days of treatment to check for inadequate source control 
  • Aerobic and anaerobic cultures from 1 specimen of sufficient amount (at least 1 mL of fluid or tissue) should be obtained from patients who do not respond initially and from whom focus of infection remains
  • Consider consultation with an infectious disease specialist for complex cases
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