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Anaesth Crit Care Pain Med. 2015 Apr;34(2):117-30. doi: 10.1016/j.accpm.2015.03.005. Epub 2015 Apr 24.

Guidelines for management of intra-abdominal infections.

Author information

Département d'anesthésie-réanimation, CHU Bichat-Claude-Bernard, AP-HP, université Paris VII Sorbonne Cité, 46, rue Henri-Huchard, 75018 Paris, France. Electronic address:
Pôle anesthésie-réanimation, CHU d'Amiens, 80054 Amiens, France.
Département d'anesthésie-réanimation, CHU Nord, 13915 Marseille, France.
Service d'anesthésie-réanimation, CHU Estaing, 63003 Clermont-Ferrand, France.
Service d'anesthésie-réanimation, CHU de Strasbourg, Nouvel Hopital Civil, BP 426, 67091 Strasbourg, France.
Service de soins intensifs, cliniques universitaires Saint-Luc, Bruxelles, Belgium.
Réanimation polyvalente, hôpital Saint-Joseph, 75014 Paris, France.
Service des maladies infectieuses, centre hospitalier de la région d'Annecy, 74374 Pringy, France.
Réanimation thoracique Ollier, CHU Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
Service des maladies infectieuses et tropicales, CHRU de Nîmes, Nîmes, France.
Service de chirurgie générale et digestive, hôpital Hautepierre, CHU de Strasbourg, Strasbourg, France.
Service de chirurgie viscérale, CHU d'Angers, Angers, France.
Service de chirurgie générale et digestive, CHU Charles-Nicolle, Rouen, France.


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.

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