Intraabdominal infections are frequent and dangerous entity in intensive care units. Mortality and morbidity are high, causes are numerous, and treatment options are variable. The intensivist is challenged to recognize and treat intraabdominal infections in a timely fashion to prevent complications and death. Diagnosis of intraabdominal infection is often complicated by confounding underlying disease or masked by overall comorbidity. Current research describes a wide heterogeneity of patient populations, making it difficult to suggest a general treatment regimen and stressing the need of an individualized approach to decision making. Early focus-oriented intervention and antibiotic coverage tailored to the individual patient and hospital is warranted.
MossM. Epidemiology of sepsis: race, sex, and chronic alcohol abuse. Clin Infect Dis. 2005;41(suppl 7):S490–S497.
2.
KalliafasSZieglerDWFlancbaumLChobanPS. Acute acalculous cholecystitis: incidence, risk factors, diagnosis and outcome. Am Surg. 1998;64(5):471–476.
3.
LeclairMAAllardCLesurOPépinJ. Clostridium difficile infection in the intensive care unit. J Intensive Care Med. 2010;25(1):23–30.
4.
AnayaDANathensAB. Risk factors for severe sepsis in secondary peritonitis. Surg Infect (Larchmt). 2003;4(4):355–362.
5.
de RuiterJWeelJManusamaEKingmaWPvan der VoortPH. The epidemiology of intra-abdominal flora in critically ill patients with secondary and tertiary abdominal sepsis. Infection. 2009;37(6):522–527.
6.
BlotSDe WaeleJJVogelaersD. Essentials for selecting antimicrobial therapy for intra-abdominal infections. Drugs. 2012;72(6):e17–e32.
7.
MazuskiJESolomkinJS. Intra-abdominal infections. Surg Clin North Am. 2009;89(2):421–437.
WiestRKragAGerbesA. Spontaneous bacterial peritonitis: recent guidelines and beyond. Gut. 2012;61(2):297–310.
10.
ParkJYMoonSYSonJSLeeMSJungMH. Unusual primary peritonitis due to Streptococcus pyogenes in a young healthy woman. J Korean Med Sci. 2012;27(5):553–555.
11.
ElkassemSDixonEConlyJDoigC. Primary peritonitis in a young healthy woman: an unusual case. Can J Surg. 2008;51(2):E40–E41.
12.
SahaPMorewoodTNaftalinJHopkinsS. Acute abdomen in a healthy woman: primary peritonitis due to group A streptococcus. J Obstet Gynaecol. 2006;26(7):700–701.
13.
MoskovitzMEhrenbergEGriecoR. Primary peritonitis due to group A streptococcus. J Clin Gastroenterol. 2000;30(3):332–335.
14.
HynninenMWennervirtaJLeppäniemiAPettiläV. Organ dysfunction and long term outcome in secondary peritonitis. Langenbecks Arch Surg. 2008;393(1):81–86.
15.
GauzitRPéanYBarthXMistrettaFLalaudeO. Epidemiology, management, and prognosis of secondary non-postoperative peritonitis: a French prospective observational multicenter study. Surg Infect (Larchmt). 2009;10(2):119–127.
16.
RichéFCDrayXLaisnéMJ. Factors associated with septic shock and mortality in generalized peritonitis: comparison between community-acquired and postoperative peritonitis. Crit Care. 2009;13(3):R99.
17.
BergerDButtenschoenK. Management of abdominal sepsis. Langenbecks Arch Surg. 1998;383(1):35–43.
18.
van TillJWvan VeenSQvan RulerOLammeBGoumaDJBoermeesterMA. The innate immune response to secondary peritonitis. Shock. 2007;28(5):504–517.
19.
MalangoniMA. Evaluation and management of tertiary peritonitis. Am Surg. 2000;66(2):157–161.
BuijkSEBruiningHA. Future directions in the management of tertiary peritonitis. Intensive Care Med. 2002;28(8):1024–1029.
22.
NathensABRotsteinODMarshallJC. Tertiary peritonitis: clinical features of a complex nosocomial infection. World J Surg. 1998;22(2):158–163.
23.
ChromikAMMeiserAHöllingJ. Identification of patients at risk for development of tertiary peritonitis on a surgical intensive care unit. J Gastrointest Surg. 2009;13(7):1358–1367.
24.
EvansHLRaymondDPPelletierSJCrabtreeTDPruettTLSawyerRG.Tertiary peritonitis (recurrent diffuse or localized disease) is not an independent predictor of mortality in surgical patients with intraabdominal infection. Surg Infect (Larchmt). 2001;2(4):255–263; discussion 264-265.
25.
De WaeleJJHosteEAJBlotSI. Blood stream infections of abdominal origin in the intensive care unit: characteristics and determinants of death. Surg Infect (Larchmt). 2008:9(2):171–177.
26.
MarshallJCChristouNVMeakinsJL. The gastrointestinal tract. The `undrained abscess' of multiple organ failure. Ann Surg. 1993;218(2):111–119.
27.
MontraversPGauzitRMullerCMarmuseJPFichelleADesmontsJM. Emergence of antibiotic-resistant bacteria in cases of peritonitis after intraabdominal surgery affects the efficacy of empirical antimicrobial therapy. Clin Infect Dis. 1996;23(3):486–494.
28.
KlevensRMMorrisonMANadleJ. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA. 2007;298(15):1763–1771.
29.
Sitges-SerraALopezMJGirventMAlmirallSSanchoJJ. Postoperative enterococcal infection after treatment of complicated intra-abdominal sepsis. Br J Surg. 2002;89(3):361–367.
30.
SwensonBRMetzgerRHedrickTL. Choosing antibiotics for intra-abdominal infections: what do we mean by high-risk?Surg Infect (Larchmt). 2009;10(1):29–39.
31.
KaffarnikMFUrbanMHoptUTUtzolinoS. Impact of enterococcus on immunocompetent and immunosuppressed patients with perforation of the small or large bowel. Technol Health Care. 2012;20(1):37–48.
32.
HarbarthSUckayI. Are there patients with peritonitis who require empiric therapy for enterococcus?Eur J Clin Microbiol Infect Dis. 2004;23(2):73–77.
PanhoferPIzayBRiedlM. Age, microbiology and prognostic scores help to differentiate between secondary and tertiary peritonitis. Langenbecks Arch Surg. 2009;394(2):265–271.
35.
HughesMGChongTWSmithRLEvansHLPruettTLSawyerRG. Comparison of fungal and nonfungal infections in a broad-based surgical patient population. Surg Infect (Larchmt). 2005;6(1):55–64.
MontraversPDupontHGauzitR. Candida as a risk factor for mortality in peritonitis. Crit Care Med. 2006;34(3):646–652.
38.
PappasPGKauffmanCAAndesD. Clinical practice guidelines for the management candidiasis: 2009. Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48(5):503–535.
39.
SandvenPQvistHSkovlundEGierckskyKE. Significance of Candida recovered from intraoperative specimens in patients with intra-abdominal perforations. Crit Care Med. 2002;30(3):541–547.
40.
FierobeLDecréDMùllerC. Methicillin-resistant Staphylococcus aureus as a causative agent of postoperative intra-abdominal infection: relation to nasal colonization. Clin Infect Dis. 1999;29(5):1231–1238.
41.
RauBMFrigerioIBüchlerMW. Evaluation of procalcitonin for predicting septic multiorgan failure and overall prognosis in secondary peritonitis: a prospective, international multicenter study. Arch Surg. 2007;142(2):134–142.
42.
NovotnyAREmmanuelKHueserN. Procalcitonin ratio indicates successful surgical treatment of abdominal sepsis. Surgery. 2009;145(1):20–26.
43.
AlverdyJCSaundersJChamberlinWHMossGS. Diagnostic peritoneal lavage in intra-abdominal sepsis. Am Surg. 1988;54(7):456–459.
44.
van RulerOKiewietJJvan KetelRJBoermeesterMA. Initial microbial spectrum in severe secondary peritonitis and relevance for treatment. Eur J Clin Microbiol Infect Dis. 2012;31(5):671–682.
45.
NathensAB. Relevance and utility of peritoneal cultures in patients with peritonitis. Surg Infect (Larchmt). 2001;2(2):153–162.
46.
VincentJLSakrYSprungCHarboeSDamasP. Are blood transfusions associated with greater mortality rates? Results of the Sepsis Occurrence in Acutely Ill Patients study. Anesthesiology. 2008;108(1):31–39.
47.
RiversEPKatranjiMJaehneKA. Early interventions in severe sepsis and septic shock: a review of the evidence one decade later. Minerva Anestesiol. 2012;78(6):712–724.
48.
WongPFGilliamADKumarSShenfineJO”DairGNLeaperDJ.Antibiotic regimens for secondary peritonitis of gastrointestinal origin in adults. Cochrane Database Syst Rev. 2005;(2):CD004539.
49.
HerzogTChromikAMUhlW. Treatment of complicated intra-abdominal infections in the era of multi-drug resistant bacteria. Eur J Med Res. 2010;15(12):525–532.
50.
AugustinPKermarrecNMuller-SerieysC. Risk factors for multidrug resistant bacteria and optimization of empirical antibiotic therapy in postoperative peritonitis. Critical Care. 2010;14(1):R20.
51.
EagyeKJKutiJLNicolauDP. Evaluating empiric treatment options for secondary peritonitis using pharmacodynamic profiling. Surg Infect (Larchmt). 2007;8(2):215–226.
52.
MuYPLiuRLWangLQ. Moxifloxacin monotherapy for treatment of complicated intra-abdominal infections: a meta-analysis of randomised controlled trials. Int J Clin Pract. 2012;66(2):210–217.
53.
SolomkinJSMazuskiJEBradleyJS. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the surgical infection society and the infectious diseases society of America. Clin Infect Dis. 2010;50(2):133–164.
54.
AndersenBRKallehaveFLAndersenHK.Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. Cochrane Database Syst Rev. 2005;(3):CD001439.
55.
ScheinMMarshallJ. Source control for surgical infections. World J Surg. 2004;28(7):638–645.
56.
SchneiderCPSeybothCVilsmaierM. Prognostic factors in critically ill patients suffering from secondary peritonitis: a retrospective, observational, survival time analysis. World J Surg. 2009;33(1):34–43.
57.
De WaeleJJ. Early source control in sepsis. Langenbecks Arch Surg. 2010;395(5):489–494.
58.
RüttingerDKuppingerDHölzwimmerM. Acute prognosis of critically ill patients with secondary peritonitis: the impact of the number of surgical revisions, and of the duration of surgical therapy. Am J Surg. 2012;204(1):28–36.
59.
AkinciDAkhanOOzmenMNKarabulutNOzkanO. Percutaneous drainage of 300 intraperitoneal abscesses with long-term follow-up. Cardiovasc Intervent Radiol. 2005;28(6):744–750.
60.
EvansHLRaymondDPPelletierSJCrabtreeTDPruettTLSawyerRG. Diagnosis of intra-abdominal infection in the critically ill patient. Curr Opin Crit Care. 2001;7(2):117–121.
61.
MerlinoJIMalangoniMASmithCMLangeRL.Prospective randomized trials affect the outcomes of intraabdominal infection. Ann Surg. 2001;233(6):859–866.
