Intraabdominal Infections (IAIs)


Infection involving any of the organs or organ spaces in the abdominal cavity

Acquired outside the healthcare setting

  • More than 48 hours after admission, recent hospitalization, dialysis, or resident of long term care facility

  • Late onset (more than 5 days after admission) is associated with more resistant microorganisms


Modality depends on the clinical diagnosis

  • If a perforated viscus is suspected, plain X-ray (supine, upright, and lateral decubitus) should be done to look for free air

  • Ultrasound or CT is usually required to diagnose or characterize organ infections (e.g. cholecystitis, cholangitis, liver abscess) and abscesses

  • Blood cultures (2 aerobic & anaerobic sets) if patient is septic or immune-compromised

  • Intra-operative abscess/tissue samples or percutaneous aspirates for culture, even if the patient has been on antimicrobials. For increased yield, purulent fluid and/or tissue in a sterile container are preferred over swabs of fluid and tissue

  • Avoid taking cultures from drains/fistulae; the microbes isolated are likely to represent colonization and not clinical infection


Source control is necessary; if symptoms present for a few days, can delay antibiotics if stable and pending source control procedure/specimen collection

Lack of clinical improvement should prompt further source control, rather than prolonging or changing antimicrobial therapy in the absence of culture results to support a change in antimicrobial management

Consider Candida coverage when:

  • Yeast are the only microorganism identified on Gram stain/culture from infected peritoneal fluid or tissue

  • Persistent intra-abdominal collections/infection and has had a prolonged course of antibiotics (tertiary peritonitis)

    • Fluconazole preferred in most cases
    • Echinocandin if non-albicans yeast or fluconazole exposure within past 30 days

Empiric Treatment

Additional Information

  1. Mazuski JE, Tessier JM, May AK, et al. The Surgical Infection Society Revised Guidelines on the Management of Intra-Abdominal Infection. Surg Infect (Larchmt). 2017 Jan;18(1):1-76.
  2. Sawyer RG, Claridge JA, Nathens AB, et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med. 2015 May 21;372(21):1996-2005.
  3. Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and Management of Complicated Intra-abdominal Infection in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 2010; 50: 133-64.
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