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Published in: Current Infectious Disease Reports 8/2016

01-08-2016 | Sepsis and ICU (JL Vincent, Section Editor)

Abdominal Sepsis

Author: Jan J. De Waele

Published in: Current Infectious Disease Reports | Issue 8/2016

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Abstract

Abdominal infections are an important challenge for the intensive care physician. In an era of increasing antimicrobial resistance, selecting the appropriate regimen is important and, with new drugs coming to the market, correct use is important more than ever before and abdominal infections are an excellent target for antimicrobial stewardship programs. Biomarkers may be helpful, but their exact role in managing abdominal infections remains incompletely understood. Source control also remains an ongoing conundrum, and evidence is increasing that its importance supersedes the impact of antibiotic therapy. New strategies such as open abdomen management may offer added benefit in severely ill patients, but more data are needed to identify its exact role. The role of fungi and the need for antifungal coverage, on the other hand, have been investigated extensively in recent years, but at this point, it remains unclear who requires empirical as well as directed therapy.
Literature
1.
go back to reference De Waele JJ, Schouten J, Dimopoulos G. Understanding antibiotic stewardship for the critically ill. Intensive Care Med. 2015. in press. De Waele JJ, Schouten J, Dimopoulos G. Understanding antibiotic stewardship for the critically ill. Intensive Care Med. 2015. in press.
2.
go back to reference Popovski Z, Mercuri M, Main C, Sne N, Walsh K, Sung M, et al. Multifaceted intervention to optimize antibiotic use for intra-abdominal infections. J Antimicrob Chemother. 2015;70:1226–9.PubMed Popovski Z, Mercuri M, Main C, Sne N, Walsh K, Sung M, et al. Multifaceted intervention to optimize antibiotic use for intra-abdominal infections. J Antimicrob Chemother. 2015;70:1226–9.PubMed
3.
go back to reference Sartelli M, Catena F, Ansaloni L, Coccolini F, Di Saverio S, Griffiths EA. Duration of antimicrobial therapy in treating complicated intra-abdominal infections: a comprehensive review. Surg Infect. 2016;17:9–12.CrossRef Sartelli M, Catena F, Ansaloni L, Coccolini F, Di Saverio S, Griffiths EA. Duration of antimicrobial therapy in treating complicated intra-abdominal infections: a comprehensive review. Surg Infect. 2016;17:9–12.CrossRef
4.•
go back to reference Montravers P, Dupont H, Leone M, Constantin JM, Mertes PM, Société FDEDRS, et al. Guidelines for management of intra-abdominal infections. Anaesth Crit Care Pain Med. 2015;34:117–30. French guidelines discussing many of the controversial issues in IAI management.CrossRefPubMed Montravers P, Dupont H, Leone M, Constantin JM, Mertes PM, Société FDEDRS, et al. Guidelines for management of intra-abdominal infections. Anaesth Crit Care Pain Med. 2015;34:117–30. French guidelines discussing many of the controversial issues in IAI management.CrossRefPubMed
5.
go back to reference Sawyer RG, Claridge JA, Nathens AB, Rotstein OD, Duane TM, Evans HL, et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med. 2015;372:1996–2005.CrossRefPubMedPubMedCentral Sawyer RG, Claridge JA, Nathens AB, Rotstein OD, Duane TM, Evans HL, et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med. 2015;372:1996–2005.CrossRefPubMedPubMedCentral
6.•
go back to reference Bassetti M, De Waele JJ, Eggimann P, Garnacho-Montero J, Kahlmeter G, Menichetti F, et al. Preventive and therapeutic strategies in critically ill patients with highly resistant bacteria. Intensive Care Med. 2015;41:776–95. A review focusing on several aspects of the management of patients with MDR infections.CrossRefPubMed Bassetti M, De Waele JJ, Eggimann P, Garnacho-Montero J, Kahlmeter G, Menichetti F, et al. Preventive and therapeutic strategies in critically ill patients with highly resistant bacteria. Intensive Care Med. 2015;41:776–95. A review focusing on several aspects of the management of patients with MDR infections.CrossRefPubMed
7.
go back to reference Hackel MA, Badal RE, Bouchillon SK, Biedenbach DJ, Hoban DJ. Resistance rates of intra-abdominal isolates from intensive care units and non-intensive care units in the United States: the study for monitoring antimicrobial resistance trends 2010-2012. Surg Infect. 2015;16:298–304.CrossRef Hackel MA, Badal RE, Bouchillon SK, Biedenbach DJ, Hoban DJ. Resistance rates of intra-abdominal isolates from intensive care units and non-intensive care units in the United States: the study for monitoring antimicrobial resistance trends 2010-2012. Surg Infect. 2015;16:298–304.CrossRef
8.•
go back to reference Montravers P, Dufour G, Guglielminotti J, Desmard M, Muller C, Houissa H, et al. Dynamic changes of microbial flora and therapeutic consequences in persistent peritonitis. Crit Care. 2015;19:70. A study in patients with persistent peritonitis demonstrating the complex interaction between lack of source control, antibiotic exposure, and MDR development.CrossRefPubMedPubMedCentral Montravers P, Dufour G, Guglielminotti J, Desmard M, Muller C, Houissa H, et al. Dynamic changes of microbial flora and therapeutic consequences in persistent peritonitis. Crit Care. 2015;19:70. A study in patients with persistent peritonitis demonstrating the complex interaction between lack of source control, antibiotic exposure, and MDR development.CrossRefPubMedPubMedCentral
9.•
go back to reference Lee YR, McMahan D, McCall C, Perry GK. Complicated intra-abdominal infections: the old antimicrobials and the new players. Drugs. 2015;75:2097–117. A review of current therapeutic options in IAI including new drugs.CrossRefPubMed Lee YR, McMahan D, McCall C, Perry GK. Complicated intra-abdominal infections: the old antimicrobials and the new players. Drugs. 2015;75:2097–117. A review of current therapeutic options in IAI including new drugs.CrossRefPubMed
10.•
go back to reference Solomkin J, Hershberger E, Miller B, Popejoy M, Friedland I, Steenbergen J, et al. Ceftolozane/tazobactam plus metronidazole for complicated intra-abdominal infections in an era of multidrug resistance: results from a randomized, double-blind, phase 3 trial (ASPECT-cIAI). Clin Infect Dis. 2015;60:1462–71. A phase III RCT demonstrating non-inferiority of ceftolozane/tazobactam plus metronidazole as a new treatment option for IAI.PubMedPubMedCentral Solomkin J, Hershberger E, Miller B, Popejoy M, Friedland I, Steenbergen J, et al. Ceftolozane/tazobactam plus metronidazole for complicated intra-abdominal infections in an era of multidrug resistance: results from a randomized, double-blind, phase 3 trial (ASPECT-cIAI). Clin Infect Dis. 2015;60:1462–71. A phase III RCT demonstrating non-inferiority of ceftolozane/tazobactam plus metronidazole as a new treatment option for IAI.PubMedPubMedCentral
11.
go back to reference Lucasti C, Popescu I, Ramesh MK, Lipka J, Sable C. Comparative study of the efficacy and safety of ceftazidime/avibactam plus metronidazole versus meropenem in the treatment of complicated intra-abdominal infections in hospitalized adults: results of a randomized, double-blind, phase II trial. J Antimicrob Chemother. 2013;68:1183–92.CrossRefPubMed Lucasti C, Popescu I, Ramesh MK, Lipka J, Sable C. Comparative study of the efficacy and safety of ceftazidime/avibactam plus metronidazole versus meropenem in the treatment of complicated intra-abdominal infections in hospitalized adults: results of a randomized, double-blind, phase II trial. J Antimicrob Chemother. 2013;68:1183–92.CrossRefPubMed
12.
go back to reference Solomkin JS, Ramesh MK, Cesnauskas G, Novikovs N, Stefanova P, Sutcliffe JA, et al. Phase 2, randomized, double-blind study of the efficacy and safety of two dose regimens of eravacycline versus ertapenem for adult community-acquired complicated intra-abdominal infections. Antimicrob Agents Chemother. 2014;58:1847–54.CrossRefPubMedPubMedCentral Solomkin JS, Ramesh MK, Cesnauskas G, Novikovs N, Stefanova P, Sutcliffe JA, et al. Phase 2, randomized, double-blind study of the efficacy and safety of two dose regimens of eravacycline versus ertapenem for adult community-acquired complicated intra-abdominal infections. Antimicrob Agents Chemother. 2014;58:1847–54.CrossRefPubMedPubMedCentral
13.•
go back to reference Assfalg V, Wolf P, Reim D, Hüser N, Hellbrügge G, Matevossian E, et al. Procalcitonin ratio and on-demand relaparotomy for septic peritonitis: validation of the focus index (FI). Surg Today. 2016;46:603–12. Procalcitonin levels in postoperative days may help to identify failed source control.CrossRefPubMed Assfalg V, Wolf P, Reim D, Hüser N, Hellbrügge G, Matevossian E, et al. Procalcitonin ratio and on-demand relaparotomy for septic peritonitis: validation of the focus index (FI). Surg Today. 2016;46:603–12. Procalcitonin levels in postoperative days may help to identify failed source control.CrossRefPubMed
14.
go back to reference Rettig TC, Verwijmeren L, Dijkstra IM, Boerma D, van de Garde EM, Noordzij PG. Postoperative interleukin-6 level and early detection of complications after elective major abdominal surgery. Ann Surg. 2016;263:1207–12.CrossRefPubMed Rettig TC, Verwijmeren L, Dijkstra IM, Boerma D, van de Garde EM, Noordzij PG. Postoperative interleukin-6 level and early detection of complications after elective major abdominal surgery. Ann Surg. 2016;263:1207–12.CrossRefPubMed
15.•
go back to reference Leppäniemi A, Kimball EJ, De Laet I, Malbrain ML, Balogh ZJ, De Waele JJ. Management of abdominal sepsis—a paradigm shift. Anaesth Intensive Ther. 2015;47:400–8. A review on the changing surgical management of patients with severe abdominal infections.CrossRef Leppäniemi A, Kimball EJ, De Laet I, Malbrain ML, Balogh ZJ, De Waele JJ. Management of abdominal sepsis—a paradigm shift. Anaesth Intensive Ther. 2015;47:400–8. A review on the changing surgical management of patients with severe abdominal infections.CrossRef
16.•
go back to reference Bloos F, Thomas-Rüddel D, Rüddel H, Engel C, Schwarzkopf D, Marshall JC, et al. Impact of compliance with infection management guidelines on outcome in patients with severe sepsis: a prospective observational multi-center study. Crit Care. 2014;18:R42. A large multicenter study in sepsis patients with specific attention to source control.CrossRefPubMedPubMedCentral Bloos F, Thomas-Rüddel D, Rüddel H, Engel C, Schwarzkopf D, Marshall JC, et al. Impact of compliance with infection management guidelines on outcome in patients with severe sepsis: a prospective observational multi-center study. Crit Care. 2014;18:R42. A large multicenter study in sepsis patients with specific attention to source control.CrossRefPubMedPubMedCentral
17.
go back to reference Tellor B, Skrupky LP, Symons W, High E, Micek ST, Mazuski JE. Inadequate source control and inappropriate antibiotics are key determinants of mortality in patients with intra-abdominal sepsis and associated bacteremia. Surg Infect. 2015;16:785–93.CrossRef Tellor B, Skrupky LP, Symons W, High E, Micek ST, Mazuski JE. Inadequate source control and inappropriate antibiotics are key determinants of mortality in patients with intra-abdominal sepsis and associated bacteremia. Surg Infect. 2015;16:785–93.CrossRef
18.••
go back to reference Bassetti M, Righi E, Ansaldi F, Merelli M, Scarparo C, Antonelli M, et al. A multicenter multinational study of abdominal candidiasis: epidemiology, outcomes and predictors of mortality. Intensive Care Med. 2015;41:1601–10. The largest cohort study of patients with intra-abdominal candidiasis.CrossRefPubMed Bassetti M, Righi E, Ansaldi F, Merelli M, Scarparo C, Antonelli M, et al. A multicenter multinational study of abdominal candidiasis: epidemiology, outcomes and predictors of mortality. Intensive Care Med. 2015;41:1601–10. The largest cohort study of patients with intra-abdominal candidiasis.CrossRefPubMed
19.
go back to reference Sartelli M, Abu-Zidan FM, Ansaloni L, Bala M, Beltrán MA, Biffl WL, et al. The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper. World J Emerg Surg. 2015;10:35.CrossRefPubMedPubMedCentral Sartelli M, Abu-Zidan FM, Ansaloni L, Bala M, Beltrán MA, Biffl WL, et al. The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper. World J Emerg Surg. 2015;10:35.CrossRefPubMedPubMedCentral
20.
go back to reference Mutafchiyski VM, Popivanov GI, Kjossev KT, Chipeva S. Open abdomen and VAC® in severe diffuse peritonitis. J R Army Med Corps. 2016;162:30–4.CrossRefPubMed Mutafchiyski VM, Popivanov GI, Kjossev KT, Chipeva S. Open abdomen and VAC® in severe diffuse peritonitis. J R Army Med Corps. 2016;162:30–4.CrossRefPubMed
21.••
go back to reference Kirkpatrick AW, Roberts DJ, Faris PD, Ball CG, Kubes P, Tiruta C, et al. Active negative pressure peritoneal therapy after abbreviated laparotomy: the intraperitoneal vacuum randomized controlled trial. Ann Surg. 2015;262:38–46. The first proper RCT comparing standard open abdomen management with negative pressure therapy.CrossRefPubMedPubMedCentral Kirkpatrick AW, Roberts DJ, Faris PD, Ball CG, Kubes P, Tiruta C, et al. Active negative pressure peritoneal therapy after abbreviated laparotomy: the intraperitoneal vacuum randomized controlled trial. Ann Surg. 2015;262:38–46. The first proper RCT comparing standard open abdomen management with negative pressure therapy.CrossRefPubMedPubMedCentral
22.
go back to reference van Ruler O, Mahler CW, Boer KR, Reuland EA, Gooszen HG, Opmeer BC, et al. Comparison of on-demand vs planned relaparotomy strategy in patients with severe peritonitis: a randomized trial. JAMA. 2007;298:865–72.CrossRefPubMed van Ruler O, Mahler CW, Boer KR, Reuland EA, Gooszen HG, Opmeer BC, et al. Comparison of on-demand vs planned relaparotomy strategy in patients with severe peritonitis: a randomized trial. JAMA. 2007;298:865–72.CrossRefPubMed
23.
go back to reference Aguilar G, Delgado C, Corrales I, Izquierdo A, Gracia E, Moreno T, et al. Epidemiology of invasive candidiasis in a surgical intensive care unit: an observational study. BMC Res Notes. 2015;8:491.CrossRefPubMedPubMedCentral Aguilar G, Delgado C, Corrales I, Izquierdo A, Gracia E, Moreno T, et al. Epidemiology of invasive candidiasis in a surgical intensive care unit: an observational study. BMC Res Notes. 2015;8:491.CrossRefPubMedPubMedCentral
24.
go back to reference Lichtenstern C, Herold C, Mieth M, Brenner T, Decker S, Busch CJ, et al. Relevance of Candida and other mycoses for morbidity and mortality in severe sepsis and septic shock due to peritonitis. Mycoses. 2015;58:399–407.CrossRefPubMed Lichtenstern C, Herold C, Mieth M, Brenner T, Decker S, Busch CJ, et al. Relevance of Candida and other mycoses for morbidity and mortality in severe sepsis and septic shock due to peritonitis. Mycoses. 2015;58:399–407.CrossRefPubMed
25.
go back to reference Zappella N, Desmard M, Chochillon C, Ribeiro-Parenti L, Houze S, Marmuse JP, et al. Positive peritoneal fluid fungal cultures in postoperative peritonitis after bariatric surgery. Clin Microbiol Infect. 2015;21:853.e1-3.CrossRefPubMed Zappella N, Desmard M, Chochillon C, Ribeiro-Parenti L, Houze S, Marmuse JP, et al. Positive peritoneal fluid fungal cultures in postoperative peritonitis after bariatric surgery. Clin Microbiol Infect. 2015;21:853.e1-3.CrossRefPubMed
26.
go back to reference Liao X, Qiu H, Li R, Guo F, Liu W, Kang M, et al. Risk factors for fluconazole-resistant invasive candidiasis in intensive care unit patients: an analysis from the China Survey of Candidiasis study. J Crit Care. 2015;30:862.e1-5.CrossRefPubMed Liao X, Qiu H, Li R, Guo F, Liu W, Kang M, et al. Risk factors for fluconazole-resistant invasive candidiasis in intensive care unit patients: an analysis from the China Survey of Candidiasis study. J Crit Care. 2015;30:862.e1-5.CrossRefPubMed
27.
28.•
go back to reference Grau S, Luque S, Campillo N, Samsó E, Rodríguez U, García-Bernedo CA, et al. Plasma and peritoneal fluid population pharmacokinetics of micafungin in post-surgical patients with severe peritonitis. J Antimicrob Chemother. 2015;70:2854–61. The first study on antifungal pharmacokinetics demonstrating considerable variability.CrossRefPubMed Grau S, Luque S, Campillo N, Samsó E, Rodríguez U, García-Bernedo CA, et al. Plasma and peritoneal fluid population pharmacokinetics of micafungin in post-surgical patients with severe peritonitis. J Antimicrob Chemother. 2015;70:2854–61. The first study on antifungal pharmacokinetics demonstrating considerable variability.CrossRefPubMed
29.
go back to reference Muñoz P, Vena A, Valerio M, Álvarez-Uría A, Guinea J, Escribano P, et al. Risk factors for late recurrent candidaemia. A retrospective matched case-control study. Clin Microbiol Infect. 2016;22:277.e11-20.CrossRefPubMed Muñoz P, Vena A, Valerio M, Álvarez-Uría A, Guinea J, Escribano P, et al. Risk factors for late recurrent candidaemia. A retrospective matched case-control study. Clin Microbiol Infect. 2016;22:277.e11-20.CrossRefPubMed
30.
go back to reference Klingspor L, Tortorano AM, Peman J, Willinger B, Hamal P, Sendid B, et al. Invasive Candida infections in surgical patients in intensive care units: a prospective, multicentre survey initiated by the European Confederation of Medical Mycology (ECMM) (2006-2008). Clin Microbiol Infect. 2015;21:87.e1–87.e10.CrossRef Klingspor L, Tortorano AM, Peman J, Willinger B, Hamal P, Sendid B, et al. Invasive Candida infections in surgical patients in intensive care units: a prospective, multicentre survey initiated by the European Confederation of Medical Mycology (ECMM) (2006-2008). Clin Microbiol Infect. 2015;21:87.e1–87.e10.CrossRef
31.••
go back to reference Knitsch W, Vincent JL, Utzolino S, François B, Dinya T, Dimopoulos G, et al. A randomized, placebo-controlled trial of preemptive antifungal therapy for the prevention of invasive candidiasis following gastrointestinal surgery for intra-abdominal infections. Clin Infect Dis. 2015;61:1671–8. RCT comparing micafungin as preemptive therapy in severe abdominal infection to placebo that failed to show a difference.PubMedPubMedCentral Knitsch W, Vincent JL, Utzolino S, François B, Dinya T, Dimopoulos G, et al. A randomized, placebo-controlled trial of preemptive antifungal therapy for the prevention of invasive candidiasis following gastrointestinal surgery for intra-abdominal infections. Clin Infect Dis. 2015;61:1671–8. RCT comparing micafungin as preemptive therapy in severe abdominal infection to placebo that failed to show a difference.PubMedPubMedCentral
32.•
go back to reference Dupont H, Guilbart M, Ntouba A, Perquin M, Petiot S, Regimbeau JM, et al. Can yeast isolation be predicted in complicated secondary non-postoperative intra-abdominal infections. Crit Care. 2015;19:60. An introduction of a scoring system to predict yeast isolation in IAI that was prospectively validated.CrossRefPubMedPubMedCentral Dupont H, Guilbart M, Ntouba A, Perquin M, Petiot S, Regimbeau JM, et al. Can yeast isolation be predicted in complicated secondary non-postoperative intra-abdominal infections. Crit Care. 2015;19:60. An introduction of a scoring system to predict yeast isolation in IAI that was prospectively validated.CrossRefPubMedPubMedCentral
Metadata
Title
Abdominal Sepsis
Author
Jan J. De Waele
Publication date
01-08-2016
Publisher
Springer US
Published in
Current Infectious Disease Reports / Issue 8/2016
Print ISSN: 1523-3847
Electronic ISSN: 1534-3146
DOI
https://doi.org/10.1007/s11908-016-0531-z
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