Prise en charge des infections intra-abdominales

Intra-abdominal infections are among the most frequent abdominal emergencies and one of the first causes of septic shock. A Consensus Conference focusing on the management of community-acquired peritonitis was published in 2000. An update of these recommendations became essential combined to an extension of the guidelines to less frequently observed situations, such as peritonitis in paediatrics and heath care associated infections. The aims of these Expert Panel Guidelines were to clarify the medical and surgical management of community-acquired intra-abdominal infections, to define the specificities of intra-abdominal infections in children, and to describe the management of heath care associated infections. Analysis of the literature addressed six key issues: diagnostic procedure, source control of infection, microbiologic data, paediatric specificities, medical care of peritonitis and management of complications. GRADE® methodology was applied to determine the level of evidence and the strength of recommendation. After synthesis of the experts's work using GRADE® method, 62 recommendations were edited by the organizing committee. The recommendations were analysed and modified by a group of reviewers. After two rounds of Delphi quotes, a strong agreement was obtained for 44 (100%) recommendations. The Expert Panel Guidelines led to a consensus among all the medical specialities involved in the management of these cases on a number of approaches, such as: (i) diagnostic strategies and the role of imaging techniques; (ii) delay of management; (iii) role of microbiologic samples; (iv) targets of empiric anti-infective therapies. The panel also clarified the value and place of several approaches, such as: (i) place for laparoscopic surgery; (ii) indications of percutaneous drainage; (iii) indications of therapy of enterococci and fungi. The panel also confirmed the futility of some approaches, such as: (i) use of biomarkers for diagnosis of intra-abdominal infections; (ii) systematic relaparotomies; (iii) prolonged anti-infective therapies, especially in children.