Open access
Open access
Powered by Google Translator Translator

IDSA 2024 Guidelines for Managing Complicated Intra-abdominal Infections – Clin Infect Dis

10 Aug, 2024 | 22:10h | UTC

Introduction: The Infectious Diseases Society of America (IDSA) has updated its clinical practice guidelines for managing complicated intra-abdominal infections in adults, children, and pregnant individuals. The update focuses on risk assessment, diagnostic imaging, and microbiological evaluation, with recommendations grounded in systematic literature reviews and the GRADE approach for rating evidence.

Key Points:

1 – Risk Stratification:

– For adults with complicated intra-abdominal infections, the APACHE II score is recommended for risk stratification within 24 hours of hospital or ICU admission. The WSES Sepsis Severity Score is an acceptable alternative.

– No specific severity scoring system is recommended for pediatric patients.

2 – Diagnostic Imaging for Appendicitis:

– In non-pregnant adults, CT is suggested as the initial imaging modality for suspected acute appendicitis.

– For children, an abdominal ultrasound (US) is preferred initially, with MRI or CT recommended if the US is inconclusive.

– In pregnant individuals, US or MRI can be considered, with MRI suggested if initial US results are inconclusive.

3 – Imaging for Acute Cholecystitis and Cholangitis:

– For non-pregnant adults, US is recommended initially. If inconclusive, a CT scan is suggested.

– For pregnant individuals, US or MRI can be used, but the guidelines do not specify a preferred modality due to a knowledge gap.

4 – Blood Cultures:

– Blood cultures are recommended in adults and children with suspected intra-abdominal infections presenting with severe symptoms such as hypotension or tachypnea, especially when antibiotic-resistant organisms are a concern.

– Routine blood cultures are not recommended for patients without these risk factors.

5 – Intra-abdominal Fluid Cultures:

– In complicated intra-abdominal infections requiring source control procedures, obtaining intra-abdominal cultures is advised to guide antimicrobial therapy.

– In uncomplicated appendicitis cases, routine cultures are not recommended unless the patient is immunocompromised or complicated disease is suspected during surgery.

Conclusion: These guidelines provide evidence-based recommendations to improve the management of complicated intra-abdominal infections, emphasizing appropriate risk stratification, targeted diagnostic imaging, and the selective use of cultures to guide therapy.

Reference: Bonomo, R. A., et al. (2024). “2024 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Complicated Intra-abdominal Infections: Risk Assessment, Diagnostic Imaging, and Microbiological Evaluation in Adults, Children, and Pregnant People.” Clinical Infectious Diseases. DOI: 10.1093/cid/ciae346.

 


Stay Updated in Your Specialty

Telegram Channels
Free

WhatsApp alerts 10-day free trial

No spam, just news.