Source Control and Antibiotics in Intra-Abdominal Infections
Abstract
:1. Background
2. Intra-Abdominal Infections
- (1)
- Tachypnea (>22 respiratory acts per minute);
- (2)
- Hypotension (systolic blood pressure < 100 mmHg);
- (3)
- Alteration of the state of consciousness (Glasgow Coma Scale < 15) [15].
- Primary: diffuse bacterial infection without loss of integrity of the gastrointestinal tract (typical of cirrotic ascetic patients or patients who undergo peritoneal dialysis); it usually requires no surgical treatment.
- Secondary (the most common ones): derived from loss of integrity of the gastrointestinal tract.
- Tertiary: recurrent peritoneal infection which occurs more than 48 h after apparently successful and adequate surgical source control of secondary peritonitis (usually associated with multidrug-resistant organisms, common in immunocompromised patients, associated with high morbidity and mortality).
3. Principles of Source Control
Timings of Source Control and Patients Stratification
- Emergent source control (high mortality risk, severe physiological derangement caused by the acute disease): SC is mandatory and must be initiated as soon as feasible.
- Urgent source control: the intervention can be delayed up to 24 h to improve the clinical status of the patient (fluid resuscitation and broad-spectrum antibiotic therapy).
- Delayed source control (stable patient, low risk): the SC can be delayed until the infectious process is well defined to decrease the chance of collateral operation injury.
4. Antibiotic Management
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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SOFA Score | 1 | 2 | 3 | 4 |
---|---|---|---|---|
Respiration | ||||
PaO2/FiO2, mmHg | <400 | <300 | <200 | <100 |
with respiratory support | ||||
Coagulation | ||||
Platelets × 103/mm3 | <150 | <100 | <50 | <20 |
Liver | ||||
Bilirubin, mg/dL | 1.2–1.9 | 2.0–5.9 | 6.0–11.9 | >12.0 |
(μmol/L) | (20–32) | (33–101) | (102–204) | (<204) |
Cardiovascular | ||||
Hypotension | MAP < 70 mmHg | Dopamine < 5 or or dobutamine (any dose) a | Dopamine > 5 or nor-/epinephrine ≤0.1 | Dopamine > 15 or nor-/epinephrine >0.1 |
Central nervous system | ||||
Glasgow Coma Score | 13–14 | 10–12 | 6–9 | <6 |
Renal | ||||
Creatinine, mg/dL | 1.2–1.9 | 2.0–3.4 | 3.5–4.9 | >5.0 |
(μmol/L) or urine | (300–440) | (>440) | ||
output | (110–170) | (171–299) | or <500 mL/day | or <200 mL/day |
Class A | Healthy patients with no or well-controlled comorbidities and no immunocompromise, where the infection is the main problem |
Class B | Patient with major comorbidities and/or moderate immunocompromise but currently clinically stable, in whom the infection can rapidly worsen the prognosis |
Class C | Patients with important comorbidities in advanced stages and/or severe immunocompromise, in which the infection worsens an already severe clinical condition |
E | Enterococcus Faecium |
S | Staphylococcus Aureus |
K | Klebsiella Pneumoniae |
A | Acinetobacter Baumannii |
P | Pseudomonas Aeruginosa Cellulitis, Endocarditis, Prostatitis, UTI, Wound infection and concurrent bacteremia Pneumonia, Skin infections, Endocarditis, Ospeomyelitis, Arthritis Bacteremia, Pneumonia, Gastrointestinal tract infections, Osteomyelitis, Endocarditis Ventilator-associated Pneumonia, Bloodstream infection, Wound infections, Meningitis Endocarditis, Pneumonia, UTI, Wound and Skin infections, Osteomyelitis |
E | Enterobacteriaceae resistant to carbapenem (CRE) |
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Bova, R.; Griggio, G.; Vallicelli, C.; Santandrea, G.; Coccolini, F.; Ansaloni, L.; Sartelli, M.; Agnoletti, V.; Bravi, F.; Catena, F. Source Control and Antibiotics in Intra-Abdominal Infections. Antibiotics 2024, 13, 776. https://doi.org/10.3390/antibiotics13080776
Bova R, Griggio G, Vallicelli C, Santandrea G, Coccolini F, Ansaloni L, Sartelli M, Agnoletti V, Bravi F, Catena F. Source Control and Antibiotics in Intra-Abdominal Infections. Antibiotics. 2024; 13(8):776. https://doi.org/10.3390/antibiotics13080776
Chicago/Turabian StyleBova, Raffaele, Giulia Griggio, Carlo Vallicelli, Giorgia Santandrea, Federico Coccolini, Luca Ansaloni, Massimo Sartelli, Vanni Agnoletti, Francesca Bravi, and Fausto Catena. 2024. "Source Control and Antibiotics in Intra-Abdominal Infections" Antibiotics 13, no. 8: 776. https://doi.org/10.3390/antibiotics13080776