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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
Joseph S. Solomkin,1 John E. Mazuski,2 John S. Bradley,3 Keith A. Rodvold,7,8 Ellie J. C. Goldstein,5 Ellen J. Baron,6 Patrick J. O’Neill,9 Anthony W. Chow,16 E. Patchen Dellinger,10 Soumitra R.Eachempati,11 Sherwood Gorbach,12 Mary Hilfiker,4 Addison K. May,13 Avery B. Nathens,17 Robert G. Sawyer,14 and John G. Bartlett15

Department of Surgery, the University of Cincinnati College of Medicine, Cincinnati, Ohio; 2Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri; Departments of 3Pediatric Infectious Diseases and 4Surgery, Rady Children’s Hospitalof San Diego, San Diego, 5R. M. Alden Research Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, 6Department of Pathology, Stanford University School of Medicine, Palo Alto, California; Departments of 7Pharmacy Practice and 8Medicine, University of Illinois at Chicago, Chicago; 9 Department of Surgery, The Trauma Center at Maricopa Medical Center, Phoenix, Arizona; 10Department ofSurgery, University of Washington, Seattle; 11Department of Surgery, Cornell Medical Center, New York, New York; 12Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts; 13Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; 14Department of Surgery, University of Virginia, Charlottesville; 15Department of Medicine, Johns Hopkins UniversitySchool of Medicine, Baltimore, Maryland; and 16Department of Medicine, University of British Columbia, Vancouver, British Columbia, and 17St Michael’s Hospital, Toronto, Ontario, Canada

Evidence-based guidelines for managing patients with intra-abdominal infection were prepared by an Expert Panel of the Surgical Infection Society and the Infectious Diseases Society of America. These updatedguidelines replace those previously published in 2002 and 2003. The guidelines are intended for treating patients who either have these infections or may be at risk for them. New information, based on publications from the period 2003–2008, is incorporated into this guideline document. The panel has also added recommendations for managing intra-abdominal infection in children, particularly where suchmanagement differs from that of adults; for appendicitis in patients of all ages; and for necrotizing enterocolitis in neonates. EXECUTIVE SUMMARY The 2009 update of the guidelines contains evidencebased recommendations for the initial diagnosis and subsequent management of adult and pediatric patients with complicated and uncomplicated intra-abdominal infection. The multifaceted nature of theseinfections has led to collaboration and endorsement of these recommendations by the following organizations: American Society for Microbiology, American Society of Health-System Pharmacists, Pediatric Infectious Diseases Society, and Society of Infectious Diseases Pharmacists. These guidelines make therapeutic recommendations on the basis of the severity of infection, which is defined for theseguidelines as a composite of patient age, physiologic derangements, and background medical conditions. These values are captured by severity scoring systems, but for the individual patient, clinical judgment is at least as accurate as a numerical score [1–4]. “High risk” is intended to describe patients with a range

Received 7 October 2009; accepted 9 October 2009; electronically published 23December 2009. Reprints or correspondence: Dr Joseph S. Solomkin, Dept of Surgery, University of Cincinnati College of Medicine, 231 Albert B. Sabin Way, Cincinnati OH 452670558 (joseph.solomkin@uc.edu). Clinical Infectious Diseases 2010; 50:133–64 2009 by the Infectious Diseases Society of America. All rights reserved. 1058-4838/2010/5002-0001$15.00 DOI: 10.1086/649554

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