Background: Serious nosocomial intra-abdominal infections are associated with high morbidity
and mortality and represent a substantial drain on healthcare resources. Effective management
of this type of infection requires the early use of appropriate, broad-spectrum empiric
antimicrobial therapy. The consequences of delayed or inappropriate antimicrobial
treatment can be severe—leading to an increased risk of death, re-operation, or prolonged
hospitalization. Therefore, it is necessary to begin treatment as soon as possible with the most
appropriate regimen, in terms of spectrum, timing, and duration.
Methods: Review of pertinent English-language literature.
Results: Serious nosocomial intra-abdominal infections require broad-spectrum coverage
because of the wide range of possible pathogens, which include difficult-to-treat organisms
such as Pseudomonas aeruginosa and Bacteroides spp., and resistant strains of Klebsiella spp.,
Escherichia coli, and methicillin-resistant Staphylococcus aureus acquired from the hospital
flora. The early use of appropriate, broad-spectrum empiric antimicrobial therapy for treating
high-risk patients with intra-abdominal infections is considered, and appropriate use of
the carbapenems, meropenem, and imipenem/cilastatin, is described.
Conclusion: The carbapenems meropenem and imipenem/cilastatin have a spectrum of antimicrobial
activity that covers the majority of expected pathogens, including anaerobes, as
well as difficult-to-treat and resistant gram-negative strains. Early and appropriate use can reduce
mortality and morbidity. Data from published clinical trials support the clinical effectiveness
of these two carbapenems in intra-abdominal infections.
