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.
Keywords
Intra-abdominal infection - secondary peritonitis - intra-abdominal abscess - appendicitis - necrotizing enterocolitis - antimicrobial therapy
