Spectrum: Local Antimicrobial Stewardship, for Prisma Health-Midlands

Intraabdominal Infection (IAI)

Note

All dosages assume normal renal and hepatic function

Culture (Prior to starting antibiotics)

  • Obtain 2 sets of blood cultures in all hospitalized adults with IAI

  • Also obtain fluid or tissue cultures from the primary site of infection, as applicable

Source Control

Optimal management of IAI includes appropriate antimicrobial therapy as well as adequate source control

  • Relief of biliary obstruction

  • Drainage of intra-abdominal or pelvic abscesses, etc.

Empiric Antimicrobial Therapy

Community-Onset

Hospital-Acquired, Re-opening Abdominal Surgery, Severely Immunocompromised, or Critically Ill

Hospital-acquired:

  • Symptom onset >5 days after hospital admission

Critically ill:

  • Persistent hypotension

  • Unexplained metabolic acidosis

  • ICU admission

  • qSOFA score ≥2

  • Pitt bacteremia score ≥4

Severely immunocompromised:

  • Chemotherapy

  • Neutropenia

  • Transplant recipient

  • Treatment with high dose steroids (>20mg of prednisone equivalents dailsy for >2 weeks)

  • Other immunosuppressive medications within one month

More Information

Contact the Antimicrobial Stewardship and Support Team (ASST) during business hours or an Infectious Diseases specialist for assistance in determining optimal empirical/definitive antimicrobial therapy

References
  1. Solomkin JS, Mazuski JE, Bradley JS, et al. 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: 133-64.
  2. Gomi H, Solomkin JS, Takada T, et al; Tokyo Guideline Revision Committee. TG13 antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2013;20:60-70.
  3. Sawyer RG, Claridge JA, Nathens AB, et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med 2015; 372:1996-2005.
  4. Nelson A, Justo JA, Bookstaver PB, Kohn J, Albrecht H, Al-Hasan MN. Optimal duration of antimicrobial therapy for bloodstream infections due to gram negative bacilli. IDWeek, New Orleans, LA, 26-30 October 2016. Abstract #59811.
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  6. Justo JA, Dickert EL, Kohn J, Bookstaver PB. Comparative risk of acute kidney injury in patients receiving vancomycin monotherapy or vancomycin and betalactam combination therapy. 54th Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington DC, 5-9 September 2014. Abstract #2544.
  7. Gomes DM, Smotherman C, Birch A, et al. Comparison of acute kidney injury during treatment with vancomycin in combination with piperacillintazobactam or cefepime. Pharmacotherapy 2014;34:662-9.
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  11. Jeffres MN, Narayanan PP, Shuster JE, Schramm GE. Consequences of avoiding β-lactams in patients with β-lactam allergies. J Allergy Clin Immunol 2016;137:1148-53.
  12. Dan S, Shah A, Justo JA, et al. Prediction of fluoroquinolone resistance in gram-negative bacteria causing bloodstream infections. Antimicrob Agents Chemother 2016; 60:2265-72.
  13. Hammer KL, Stoessel A, Justo JA, et al. Association between chronic hemodialysis and bloodstream infections due to chromosomally-mediated AmpC producing Enterobacteriaceae. Am J Infect Control 2016
  14. Augustine MR, Testerman TL, Justo JA, et al. Clinical risk score for prediction of extended-spectrum beta-lactamase-producing Enterobacteriaceae in bloodstream isolates. Infect Control Hosp Epidemiol 2017;38:266-172.
  15. Orsi GB, Bencardino A, Vena A, et al. Patient risk factors for outer membrane permeability and KPC-producing carbapenem-resistant Klebsiella pneumoniae isolation: results of a double case-control study. Infection 2013;41:61-7.