Postoperative infections at the site of an operation often have serious consequences. This is particularly true of postoperative intra-abdominal infections, in which the identified organisms are typically multiresistant Gram negatives, Gram positives, and yeast. There is considerable evidence that the adequacy of empiric therapy will have a substantial impact on the outcome.
Complicated intra-abdominal infections include a wide range of infectious processes and are an important cause of healthcare-associated infection. Common sources of infection are biliary obstruction, gallbladder, gastroduodenal, appendiceal or small and large bowel perforations. For severely ill patients, those with peritonitis and those with sepsis syndromes, patient outcomes in complicated intra-abdominal infections are particularly poor, with high mortality rates.
Intra-abdominal infections can be community-acquired or hospital-acquired and are often polymicrobial; the most common pathogens are Escherichia coli, Klebsiella spp. and Pseudomonasspp. Other Gram-negative pathogens include Proteus mirabilis, Enterobacter spp.,Bacteroides spp., which are isolated in > 80% of patients with distal bowel infection sources. Streptococcus spp. are the most commonly isolated Gram-positive pathogens. Optimal management of these patients involves a combination of source control and adjunctive broad-spectrum antimicrobial therapy.
In this lecture, professor Joseph S. Solomkin reviews the clinical and epidemiological impact of resistance in surgical patients, focusing on complicated intra-abdominal infections and the factors that can limit the consequences of the different types of antimicrobial resistance in these patients.