Antimicrobial Therapy—Health Care-Associated Infection
ÎHealth care-associated infection is commonly caused by a more resistant flora, which may include the nonfermenting gram-negative P. aeruginosa and Acinetobacter species, extended-spectrum [beta]-lactamase-producing Klebsiella and E. coli, Enterobacter species, Proteus species, MRSA, enterococci, and Candida species.
ÎEmpiric antibiotic therapy for hospital-acquired intra-abdominal infections should be driven by local microbiologic results (A-II).
Source Control
ÎAn appropriate source control procedure is recommended for nearly all patients with intra-abdominal infection.
Duration of Therapy
ÎAntimicrobial therapy of established infections should be limited to no more than four to seven days unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome (B-III).For children and adults whose signs and symptoms of infection are resolved, no further antibiotic therapy is required (B-III).
Failure of Initial Therapy
ÎIn patients who have persistent or recurrent clinical evidence of intra- abdominal infection after four to seven days of therapy, appropriate diagnostic investigation should be undertaken. This should include CT or ultrasound imaging, and antimicrobial therapy effective against the organisms initially identified should be continued (A-III).
ÎExtra-abdominal sources of infection and non-infectious inflammatory conditions should also be investigated if the patient is not making a satisfactory clinical response to a microbiologically adequate initial empiric antimicrobial regimen (A-II).
