Affiliations: Department of Surgery, Washington University School of
Medicine, Saint Louis, MO, USA
Note: [] Correspondence: John E. Mazuski, MD, PhD, Department of Surgery,
Washington University School of Medicine, Campus Box 8109, 660 S. Euclid
Avenue, Saint Louis, MO 63110-1093, USA. Tel.: +1 314 362 5307; Fax: +1 314 362
5743; E-mail: mazuskij@wustl.edu
Abstract: Complicated intra-abdominal infections are a common problem in
children. The etiology of these infections varies by age, with necrotizing
enterocolitis being the most common cause in neonates, and appendicitis the
most common cause in children. Diagnosis is based on clinical and laboratory
findings as well as appropriate imaging studies. These infections are generally
the result of mixed gastrointestinal flora, most commonly Escherichia
coli and Bacteroides spp. The basic treatment principles for
complicated intra-abdominal infections include adequate hemodynamic
resuscitation, appropriate antimicrobial therapy, and source control.
Antibiotic regimens should include agents effective against common
Gram-negative facultative/aerobic bacilli as well as anaerobes. Increased
antibiotic resistance has developed among several of the pathogens involved in
these infections, which may need to be taken into consideration when selecting
empiric therapy. In addition to appropriate antimicrobial therapy, adequate
source control has been considered essential in the management of these
infections. However, the need for definitive source control procedures in all
patients has been challenged, and it has been demonstrated that deferral of
these procedures or use of drainage instead of definitive procedures may
suffice in selected children and neonates. The advent of laparoscopic
procedures has also allowed less invasive approaches to be used in managing the
nidus of infection. In this review, some aspects of the etiology, diagnosis and
treatment of pediatric intra-abdominal infections will be addressed,
particularly with regard to controversies in the use of antimicrobial therapy
and source control procedures for these infections.
