intra-abdominal%20infections
INTRA-ABDOMINAL INFECTIONS
Intra-abdominal infections (IAI) occur due to disruption of the normal anatomic barrier.
In the 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 intra-abdominal infection is usually secondary to gastroduodenal perforation, ascending cholangitis, cholecystitis, appendicitis, colon diverticulitis with or without perforation, or pancreatitis.
Uncomplicated IAI infectious process involves only a single organ and does not extend to the peritoneum.
Complicated IAI is when infection extends beyond the hollow viscus of origin into the peritoneal space and may be associated with peritonitis or abscess formation.

Introduction

Intra-Abdominal Infections (IAI)

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

Pathophysiology

  • Occur due to disruption of the normal anatomic barrier
    • Hollow viscera is where common disruptions occur, which allows intraluminal bacteria to invade & 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 & chronic health evaluation-II (APACHE-II) scores ≥15
  • Advanced age
  • Poor nutritional status or low albumin levels
  • Degree of peritoneal involvement or presence of diffuse peritonitis
  • Significant cardiovascular disease or presence of other comorbidity & degree of organ dysfunction
  • Inability to achieve adequate source control
  • Immunocompromised patients (w/ cancer, inflammatory disease, or posttransplant)
  • Inadequate debridement or control of drainage
  • ≥5 days hospital stay before the operation & ≥2 days preoperative antimicrobial treatment
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