Guidelines for management of intra-abdominal infections.
Fiche publication
Date publication
avril 2015
Journal
Anaesthesia, critical care & pain medicine
Auteurs
Membres identifiés du Cancéropôle Est :
Pr BRIGAND Cécile
Tous les auteurs :
Montravers P, Dupont H, Leone M, Constantin JM, Mertes PM, , , Laterre PF, Misset B, , Bru JP, Gauzit R, Sotto A, , Brigand C, Hamy A, , Tuech JJ
Lien Pubmed
Résumé
Intra-abdominal infections are one of the most common gastrointestinal emergencies and a leading cause of septic shock. A consensus conference on the management of community-acquired peritonitis was published in 2000. A new consensus as well as new guidelines for less common situations such as peritonitis in paediatrics and healthcare-associated infections had become necessary. The objectives of these Clinical Practice Guidelines (CPGs) were therefore to define the medical and surgical management of community-acquired intra-abdominal infections, define the specificities of intra-abdominal infections in children and describe the management of healthcare-associated infections. The literature review was divided into six main themes: diagnostic approach, infection source control, microbiological data, paediatric specificities, medical treatment of peritonitis, and management of complications. The GRADE(®) methodology was applied to determine the level of evidence and the strength of recommendations. After summarising the work of the experts and application of the GRADE(®) method, 62 recommendations were formally defined by the organisation committee. Recommendations were then submitted to and amended by a review committee. After 2 rounds of Delphi scoring and various amendments, a strong agreement was obtained for 44 (100%) recommendations. The CPGs for peritonitis are therefore based on a consensus between the various disciplines involved in the management of these patients concerning a number of themes such as: diagnostic strategy and the place of imaging; time to management; the place of microbiological specimens; targets of empirical anti-infective therapy; duration of anti-infective therapy. The CPGs also specified the value and the place of certain practices such as: the place of laparoscopy; the indications for image-guided percutaneous drainage; indications for the treatment of enterococci and fungi. The CPGs also confirmed the futility of certain practices such as: the use of diagnostic biomarkers; systematic relaparotomies; prolonged anti-infective therapy, especially in children.
Mots clés
Community-Acquired Infections, diagnosis, Cross Infection, diagnosis, Humans, Intraabdominal Infections, diagnosis, Postoperative Complications, diagnosis
Référence
Anaesth Crit Care Pain Med. 2015 Apr;34(2):117-30