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Complicated Abdominal Infection

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Complicated Abdominal Infection, Complicated Intraabdominal Infection

  • See Also
  1. Acute Abdominal Pain
  2. Acute Pelvic Pain
  3. Pediatric Abdominal Pain
  4. Abdominal Pain in Older Adults
  5. Abdominal Pain Evaluation
  • Definitions
  1. Complicated Abdominal Infection
    1. Intraabdominal infection that spreads beyond its origin to cause peritonitis with or with abscess
  • Causes
  1. Acute Appendicitis
  2. Acute Cholecystitis
  3. Acute Cholangitis
  4. Acute Diverticulitis
  5. Abdominal abscess
  6. Secondary bowel perforation
  7. Acute necrotizing peritonitis
  • Findings
  1. See Abdominal Pain Evaluation
  • Labs
  1. Blood Culture Indications
    1. Sepsis
    2. Fever AND Hypotension, Tachypnea or Delirium
    3. Antibiotic Resistance risk factors
      1. High local Antibiotic Resistance to common empiric Antibiotics
      2. Personal history of resistant infection or colonization
      3. Antibiotic use in past 90 days
      4. Older age
      5. Immunocompromised status
      6. Significant comorbidity
      7. Health Care Associated Infection
  2. Intraabdominal Fluid Culture (by fluid inoculation) Indications
    1. Planned source control procedure for Complicated Intraabdominal Infection
    2. Consider in Immunocompromised patients
    3. Consider when complicated disease is suspected during surgery
  • Imaging
  • First-Line Studies
  1. See Abdominal Pain Evaluation
  2. Appendicitis
    1. Children: Appendix Ultrasound
    2. Pregnancy: MRI or Ultrasound
    3. Non-Pregnant Adults: CT Abdomen with IV Contrast
  3. Cholecystitis or Cholangitis
    1. RUQ Ultrasound
  4. Diverticulitis
    1. Pregnancy: MRI (or Ultrasound)
    2. Non-Pregnant Adults: CT Abdomen with IV Contrast
  5. Intraabdominal abscess
    1. Children: Ultrasound
    2. Pregnancy: MRI or Ultrasound
    3. Non-Pregnant Adults: CT Abdomen with IV Contrast
  • Management
  1. See Acute Abdominal Pain
  2. See Acute Pelvic Pain
  3. See Pediatric Abdominal Pain
  4. See Abdominal Pain in Older Adults
  5. See specific conditions (e.g. Appendicitis, Acute Cholecystitis, acute Diverticulitis) for Antibiotic selection
    1. Acute Appendicitis
    2. Acute Cholecystitis
    3. Acute Cholangitis
    4. Acute Diverticulitis
    5. Acute Pancreatitis
  • Prognosis
  1. APACHE 2 Score
    1. Calculate in first 24 hours of hospitalization (Recommended by IDSA)
  2. Alternatives to APACHE 2 Score
    1. APACHE 4 has replaced the APACHE 2 Score and is best performed via calculators
      1. Ko (2018) Acute Crit Care 33(4):216-21 +PMID: 31723888 [PubMed]
    2. APACHE 4 Calculator: Intensive Care network calculator
      1. https://intensivecarenetwork.com/Calculators/Files/Apache4.html
  • References
  1. Bonomo (2024) Clin Infect Dis 79(suppl 3): S81-7 [PubMed]