Guidelines for management of intra-abdominal infections.
Intra-abdominal infections are one of the most common gastrointestinal emergencies and a leading cause of septic shock. A consensus conference on the management of community-acquired peritonitis was published in 2000. A new consensus as well as new guidelines for less common situations such as peritonitis in paediatrics and healthcare-associated infections had become necessary. The objectives of these Clinical Practice Guidelines (CPGs) were therefore to define the medical and surgical management of community-acquired intra-abdominal infections, define the specificities of intra-abdominal infections in children and describe the management of healthcare-associated infections. The literature review was divided into six main themes: diagnostic approach, infection source control, microbiological data, paediatric specificities, medical treatment of peritonitis, and management of complications. The GRADE(®) methodology was applied to determine the level of evidence and the strength of recommendations. After summarising the work of the experts and application of the GRADE(®) method, 62 recommendations were formally defined by the organisation committee. Recommendations were then submitted to and amended by a review committee. After 2 rounds of Delphi scoring and various amendments, a strong agreement was obtained for 44 (100%) recommendations. The CPGs for peritonitis are therefore based on a consensus between the various disciplines involved in the management of these patients concerning a number of themes such as: diagnostic strategy and the place of imaging; time to management; the place of microbiological specimens; targets of empirical anti-infective therapy; duration of anti-infective therapy. The CPGs also specified the value and the place of certain practices such as: the place of laparoscopy; the indications for image-guided percutaneous drainage; indications for the treatment of enterococci and fungi. The CPGs also confirmed the futility of certain practices such as: the use of diagnostic biomarkers; systematic relaparotomies; prolonged anti-infective therapy, especially in children.
Département d'anesthésie-réanimation, CHU Bichat-Claude-Bernard, AP-HP, université Paris VII Sorbonne Cité, 46, rue Henri-Huchard, 75018 Paris, France. Electronic address: philippe.montravers@bch.aphp.fr.
Philippe
P
Montravers
Pôle anesthésie-réanimation, CHU d'Amiens, 80054 Amiens, France.
Hervé
H
Dupont
Département d'anesthésie-réanimation, CHU Nord, 13915 Marseille, France.
Marc
M
Leone
Service d'anesthésie-réanimation, CHU Estaing, 63003 Clermont-Ferrand, France.
Jean-Michel
JM
Constantin
Service d'anesthésie-réanimation, CHU de Strasbourg, Nouvel Hopital Civil, BP 426, 67091 Strasbourg, France.
Paul-Michel
PM
Mertes
Pierre-Francois
PF
Laterre
Benoit
B
Misset
Jean-Pierre
JP
Bru
Rémy
R
Gauzit
Albert
A
Sotto
Cecile
C
Brigand
Antoine
A
Hamy
Jean-Jacques
JJ
Tuech
D017714:Community-Acquired Infections / Q000175:diagnosis / Q000628:therapy; D003428:Cross Infection / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D059413:Intraabdominal Infections / Q000175:diagnosis* / Q000628:therapy*; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy