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Complicated Intra-Abdominal Infection

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onfirmed Complicated Intra-Abdominal Infections Health Care Associated (while awaiting pathogen identity and susceptibilities) Meropenem, imipenem/cilastatin, doripenem, piperacillin/tazobactam, ciprofloxacin4 plus metronidazole, ceftazidime or cefepime plus metronidazole, and aztreonam plus metronidazole plus vancomycin (C-III). > Empiric antibiotic therapy should be guided by knowledge of the flora seen at the particular hospital and their antimicrobial susceptibilities. In general, this will necessitate use of multi-drug regimens with expanded spectra of activity against Gram negative aerobic and facultative bacilli, which may include aminoglycosides or colistin (B-III). > Broad spectrum antimicrobial therapy should be tailored when culture and susceptibility reports become available to reduce the number and spectra of administered agents (B-III). Appropriate Antimicrobial Regimens – Specific Pathogens Anti-Enterococcal Therapy > Empiric coverage of Enterococcus is not necessary in patients with community-acquired intra-abdominal infections (A-I). > Initial empiric anti-enterococcal therapy should be directed against . Antibiotics that can potentially be used against this organism include ampicillin, piperacillin/tazobactam, imipenem/cilastatin, and vancomycin (B-III). Anti-MRSA Therapy > Vancomycin is recommended for treatment of suspected or proven intra-abdominal infections due to methicillin-resistant Staphylococcus aureus (A-III). Antifungal Therapy > Empiric antifungal therapy for Candida is not recommended for adults with community-acquired intra-abdominal infections (B-II). > Fluconazole is an appropriate choice if > For fluconazole-resistant is isolated (B-II). species, therapy with an echinocandin (caspofungin, micafungin, or anidulafungin) is appropriate (B-III). > For the critically ill patient, initial therapy with an echinocandin instead of a triazole is recommended (B-III). > Because of toxicity, amphotericin B is not recommended as initial therapy (B-II). 3• The Expert Panel is also concerned that broad use of ertapenem may hasten the appearance of carbapenem- resistant Enterobacteriacae, Pseudomonas, and Acinetobacter species. 4• Quinolone-resistant E. coli has become common in some communities, and quinolones should not be used unless hospital surveys indicate 90% susceptibility of E. coli to quinolone. 5• Given the very broad spectrum of tigecycline, including activity against MRSA and a wide variety of other gram-positive and gram-negative organisms not commonly seen in appendix-derived infection, there is concern for its use in mild-to-moderate complicated intra-abdominal infection. Recommended empiric regimens En t e ro c o c c u s C f ae c a l is C an d i da an d i da a l b i can s

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