intra-abdominal%20infections
INTRA-ABDOMINAL INFECTIONS
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 Signs and Symptoms

Introduction

  • In hospital setting, it is the 2nd most common cause of infection that leads to severe sepsis and mortality

Pathophysiology

  • 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 (eg peritoneal cavity or retroperitoneum)

Risk Factors

Parameters Predictive of Severe/High-Risk Intra-abdominal Infections (IAI)

  • Acute physiology and chronic health evaluation-II (APACHE-II) scores ≥15
  • Advanced age
  • Delay of >24 hours in initial intervention 
  • Severe illness
  • Poor nutritional status or low albumin levels
  • Degree of peritoneal involvement or presence of diffuse peritonitis
  • Significant cardiovascular disease or presence of other comorbidities and degree of organ dysfunction
  • Inability to achieve adequate source control
  • Immunocompromised patients (with cancer, inflammatory disease, or posttransplant)
  • Inadequate debridement or control of infection with drainage
  • ≥5 days hospital stay before the operation and ≥2 days preoperative antimicrobial treatment
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