Decision making in the source control of intra-abdominal infection

Abstract

Source control should be performed as soon as possible once the diagnosis of intra-abdominal infection made. Surgical intervention should be considered when resuscitating the intra-abdominal infection with sepsis or septic shock and percutaneous abscess drainage, laparotomy or open abdominal therapy could be considered according to the sepsis severity. Treatment failure may be diagnosed if there is no any improvement in the systematic inflammatory reaction and multiple organ dysfunction. Interleukin 6 and procalcitonin combined with blood white cell count and C-reactive protein could reflect the systematic inflammatory reaction and Sequential Organ Failure Assessment can evaluate if there is any improvement of organ function. Bilirubin is a sensitive indicator of liver function in intra-abdominal infection and its persistent increasing usually means the deterioration of liver function. Once the treatment failure is made, the re-intervention should be performed as soon as possible and B ultrasound or CT should be done before operation to define the precise infected focus. The bacteria information should be retrieved before or during the intervention to guide the postoperative antibiotics usage. Key words: Infection; Intra-abdominal infection; Source control measures; Percutaneous abscess drainage; Open abdominal therapy