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January 2010
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New Guideline for Intra-Abdominal Infection Released

An updated guideline for the diagnosis and management of complicated intra-abdominal infection in adults and children is now available. Developed by IDSA and the Surgical Infection Society, the guideline appears in the Jan. 15 issue of Clinical Infectious Diseases and can be found online.

Replacing those published in 2002 and 2003, the updated guideline incorporates new recommendations for managing intra-abdominal infection in children, particularly in cases where this guidance differs from that for adults. The guideline also provides recommendations for treating appendicitis in patients of all ages and for necrotizing enterocolitis in newborns.

The guideline notes that the management of these infections has evolved considerably.

“There have been substantial changes in diagnostic methods, approaches to non-operative management—including aggressive antimicrobial therapy and radiographically guided percutaneous drainage—staged surgical management, use of antimicrobials, and heightened awareness of the value of locally developed practice pathways and stewardship programs,” said Joseph S. Solomkin, MD, FACS, FIDSA, co-chair of the expert panel that prepared the updated guidelines.

“The latest recommendations are intended to provide a framework that encompasses these issues, including an expansion into pediatric infections, especially appendicitis,” said John E. Mazuski, MD, panel co-chair.

The document addresses more than 20 clinical questions related to intra-abdominal infections, including:

  • appropriate diagnostic procedures for evaluating patients with suspected intra-abdominal infection
  • initiation of antimicrobial therapy
  • appropriate dosing and duration of therapy
  • requirements for effective source control, including operation and/or percutaneous drainage
  • when and how microbiological specimens should be taken and processed, and when culture results should be used to adjust therapy

Tables outline available agents and regimens for empiric treatment of community- and health care-associated infections and provide both pediatric and adult dosages for antibiotic treatment. The document also addresses managing suspected treatment failure.

An important goal of this guideline was to provide template information that should be considered in developing clinical pathways to standardize diagnosis and management of appendicitis, based upon the frequency of this disease. Performance measures related to appendicitis are included as well. The guideline emphasizes the role of antimicrobial stewardship programs in implementing the recommendations.

The update also highlights areas needing more research. These include appropriate specimen processing and the effects of delaying appendectomy. There also remains a pressing need for more study of the appropriate duration of antimicrobial therapy and the potential impact of prolonged therapy on the development of resistant organisms, the authors note.

The guideline is available online now. Other IDSA guidelines also are available on the Standards, Practice Guidelines, and Statements page of our website.
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