Classification:
Intra-abdominal infections are broadly classified as uncomplicated and complicated. Generally, if the infection remains confined to the viscus, it is considered uncomplicated and if infection spreads from the organ into the peritoneum causing localized or diffuse peritonitis, it is termed as complicated intra-abdominal infection.
For the purpose of management of complicated intra-abdominal infections, take into consideration the suspected point of origin of infection, i.e., community acquired or healthcare associated infections and severity of infection.- Community acquired
- Mild to moderate severity
- High severity or high risk patients
- Hospital acquired infections /Health care associated infections
Broad principles of management of intra-abdominal infections include the following:
- Early initiation of antimicrobials. While culture and sensitivity from intra-op cultures may not be essential for management of an individual case, it would help in formulating empiric antimicrobial policy, particularly for community acquired intraabdominal infection. For hospital acquired infection, culture and sensitivity testing may be useful for guiding empirical therapy.
- For patients requiring hemodynamic support, fluid management should be initiated and done as needed.
- Adequate source control is the backbone of management of patients with intra-abdominal infections. Laparotomy, laparoscopy or percutaneous drainage as appropriate is various options for source control.