Microbiology
Abdominal infections
Abdominal infections (IAIs) are a major cause of morbidity and mortality, often requiring rapid diagnosis, effective antimicrobial therapy, and timely source control. These infections encompass a wide spectrum of conditions, including complicated appendicitis, diverticulitis, peritonitis, and Clostridioides difficile infection (CDI), each presenting unique challenges in critically ill patients.
Successful management of IAIs relies on early risk assessment, appropriate imaging, and targeted antimicrobial therapy. Prompt source control, whether through surgical intervention or percutaneous drainage, is essential to reducing complications and improving outcomes. The use of risk stratification tools and microbiological evaluation helps guide therapy, particularly in complicated or recurrent infections.
Preventive strategies, including infection control measures, antimicrobial stewardship, and early intervention for high-risk patients, are key to reducing the burden of IAIs in critical care settings. Standardized protocols and adherence to evidence-based guidelines play a crucial role in optimizing patient outcomes and minimizing treatment failures.
For fungal abdominal infections, see this page.
General approach to intra-abdominal infections
Intra-abdominal infections
The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections
Massimo Sartelli et al., World Journal of Emergency Surgery (2017)
What’s inside
The 2017 WSES guidelines provide evidence-based recommendations for the management of intra-abdominal infections (IAIs), focusing on diagnosis, treatment, and source control from a global perspective.
Why it’s relevant
IAIs are a common cause of morbidity and mortality worldwide. These guidelines aim to standardize care, improve outcomes, and address variations in resource availability across different healthcare settings.
Key focus
- Diagnostic criteria and imaging techniques for IAIs
- Antimicrobial therapy protocols, including empiric and targeted treatment
- Importance of early source control (e.g., surgery or drainage)
- Management of specific conditions like complicated appendicitis, diverticulitis, and peritonitis
- Considerations for resource-limited settings
Takeaway
The guidelines emphasize timely diagnosis, appropriate antibiotic use, and prompt source control as critical components of IAI management. They also highlight the need for adaptable strategies to address global disparities in healthcare resources.
Complicated intra-abdominal infections
IDSA 2024 Guideline Update on the Risk Assessment, Diagnostic Imaging, and Microbiological Evaluation of Complicated Intra-abdominal Infections in Adults, Children, and Pregnant People
Robert A. Bonomo et al., Clinical Infectious Diseases (2024)
What’s inside
The 2024 IDSA guideline update provides evidence-based recommendations for the risk assessment, diagnostic imaging, and microbiological evaluation of complicated intra-abdominal infections (cIAIs) in adults, children, and pregnant individuals.
Why it’s relevant
cIAIs are associated with high morbidity and mortality, requiring accurate diagnosis and timely intervention. These guidelines aim to improve outcomes by standardizing diagnostic approaches across diverse patient populations.
Key focus
- Risk stratification tools to identify high-risk patients
- Appropriate use of imaging modalities (e.g., CT, ultrasound) for diagnosis
- Recommendations for microbiological testing and interpretation of results
- Special considerations for children and pregnant individuals
Takeaway
The guidelines emphasize a tailored approach to diagnosing cIAIs, integrating risk assessment, advanced imaging, and microbiological evaluation. They highlight the importance of individualized care to optimize outcomes in all patient groups.
Clostridioides difficile infection
Clostridioides difficile infection
European Society of Clinical Microbiology and Infectious Diseases: 2021 update on the treatment guidance document for Clostridioides difficile infection in adults
Joffrey van Prehn et al., Clinical Microbiology and Infection (2021)
What’s inside
The 2021 ESCMID guidelines provide updated recommendations for the treatment of Clostridioides difficile infection (CDI) in adults, reflecting new evidence and therapeutic advancements.
Why it’s relevant
CDI is a leading cause of healthcare-associated diarrhea, with significant morbidity and mortality. These guidelines aim to optimize treatment strategies and improve patient outcomes.
Key focus
- First-line treatments for initial and recurrent CDI, including fidaxomicin and vancomycin
- Role of bezlotoxumab as an adjunctive therapy for high-risk patients
- Management of severe, fulminant, and complicated CDI
- Strategies for preventing recurrence and improving infection control practices
Takeaway
The guidelines emphasize the use of fidaxomicin and vancomycin as first-line therapies, alongside adjunctive treatments for high-risk patients. They also highlight the importance of prevention and tailored management to reduce recurrence and complications.