CURRENT Essentials of Critical Care.pdf

Chapter 10 Infectious Disease 143■■■Intra-abdominal InfectionEssentials of Diagnosis• Wide array of clinical syndromes, including intraperitoneal, pancreaticand hepatic abscesses, spontaneous and secondary peritonitis,colitis, cholangitis• Symptoms often nonspecific, such as vague abdominal pain,anorexia, fever• Bowel sounds may be diminished or absent• Laboratory findings nonspecific• Abdominal imaging by CT scan (abscess or perforation) or ultrasound(biliary process) useful to localize site of infection• Majority of infections are polymicrobial, involving native gastrointestinalflora (aerobic and microaerophilic streptococci, enterobacteriaceae,enterococci and anaerobes); hepatic abscessfrom Entamoeba histolytica• GI colonization with Candida spp in about 50% of patients• Antibiotic use increases likelihood of Candida spp, resistantgram-negative bacilli, enterococciDifferential Diagnosis• Ischemic bowel• Perforated viscus, pancreatitis, peptic ulcer disease, biliary colic• TumorsTreatment• Broad-spectrum antimicrobial therapy targeting enteric flora (especiallygram-negative bacilli and anaerobes)• Antifungal therapy in patients with significant risk factors• Surgical drainage of abscesses and debridement of necrotic tissue■ PearlLack of physical findings in intra-abdominal infection is common inimmunocompromised (steroids, chemotherapy, neutropenia), obese,and elderly patients.ReferenceMcClean KL: Intraabdominal infection: a review. Clin Infect Dis 1994;19:100.[PMID: 7948510]