Intra-Abdominal Infections

Intra-Abdominal Infections

Treatment Criteria and Considerations

Source Control

Antimicrobial therapy does not preclude source control (e.g. percutaneous drainage or surgery)

  • Recommend blood, intraoperative and/or abscess fluid cultures in patients with post-operative or healthcare-associated infections; those with treatment failure and/or requiring re-operation; or recently on antimicrobial therapy
  • Blood cultures recommended if patient has sepsis syndrome
  • Reassess initial empiric therapy based on clinical state & results of microbiological analysis
  • acute perforation of the stomach, duodenum and/or proximal jejunum (if no acid-reducing therapy or malignancy; and source control achieved)
  • penetrating bowel trauma repaired within 12 hours
  • intraoperative contamination of a surgical field from enteric contents
  • acute appendicitis without perforation, abscess or local peritonitis
  • patients undergoing cholecystectomy for acute cholecystitis without evidence of infection outside wall of the gallbladder (ex. perforation)


  • gastroduodenal perforation
  • cholangitis
  • cholecystitis
  • appendicitis
  • diverticulitis
  • peritonitis

With no evidence of systemic toxicity (APACHE II score <15)

  • with APACHE II score ≥15
  • signs of systemic toxicity
  • >70 years old
  • immunocompromised
  • secondary peritonitis
  • cancer
  • poor nutritional status
  • incomplete/delayed source control
  • Hospitalized >48 hours at time of onset
  • Recent prolonged hospitalization
  • Post-operative infection
  • Long term care
  • Rehab
  • Dialysis
  • Nursing home
  • Recent antibiotics

More Information

Guideline content derived from:

  • NB Provincial Health Authorities Anti-Infective Stewardship Committee. Antimicrobial Therapy for Intra-Abdominal Infections. 09-2018
  1. Ball, C., Hansen, G., Harding, G., Kirkpatrick, A., Weiss, K. & Zhanel, G. (2010). Canadian practice guidelines for surgical intra-abdominal infections. Canadian Journal of Infectious Disease and Medical Microbiology, 21(1), 11-37.
  2. Doyle, J., Nathens, A., Morris, A., Nelson, S., & McLeod, R. (2011). Best practice in general surgery guideline #4: Management of Intra-abdominal infections. Toronto, ON: University of Toronto, Faculty of Medicine.
  3. INESSS. Antibiotic Treatment Guide: Intra-abdominal Infections in Adults. June 2012
  4. So, M. (2010). Intra-abdominal infections education module. Toronto, ON: Mount Sinai Hospital and University Health Network.
  5. Solomkin, J., Mazuski, J., Bradley, J, et al. (2010). Diagnosis and management of complicated intra-abdominal infections in adults and children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clinical Infectious Disease, 50 (15 January)., 133-163.
  6. Blondel-Hill E. & Fryters S. (2012). Bugs & Drugs. An Antimicrobial/Infectious Diseases Reference. Alberta Health Services.
  7. Young-FAdok, T., & Pemberton, J. (2014). Treatment of acute diverticulitis. UpToDate. Retrieved from
  8. Antimicrobial Stewardship Treatment Guidelines for Common Infections. 1st Edition Vancouver Coastal Health. March 2011
  9. Antimicrobial Handbook – 2012. Editor: Dr Kathy Slayter. Antimicrobial Agents Subcommittee. Capital Health, Nova Scotia
  10. Sawyer RG, Claridge JA, Nathens AB, Rotstein OD, Duane TM et al. Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection. N Engl J Med 2015;372(21):1996
  11. Smith SE, Rumbaugh KA, & May AK. Evaluation of a Short Course of Antimicrobial Therapy for Complicated Intra-Abdominal Infections in Critically Ill Surgical Patients. Surgical Infections 2017; 18 (6): 742-750
  12. Hassinger TE et al. Longer-Duration Antimicrobial Therapy Does Not Prevent Treatment Failure in High-Risk Patients with Complicated Intra-Abdominal Infections. Surgical Infections 2017; 18 (6): 659-663