The Surgical Infection Society (SIS) published evidence-based guidelines for prevention and management of pediatric intra-abdominal infection (IAI). Here we present updated guidelines on the basis of a systematic review of current literature.
Methods:
The writing group included members of SIS’ Therapeutics and Guidelines Committee, other SIS members with content or guideline expertise, and a professional medical librarian. A systematic literature review using PubMed®/MEDLINE, the Cochrane Library, Embase, and Web of ScienceTM was performed from January 2016 to October 2024. Keyword descriptors combined “surgical site infections” or “intra-abdominal infections” in pediatric patients limited to randomized controlled trials, systematic reviews, or meta-analyses. Additional relevant publications identified during literature review were included. Publications were evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. The strength of each recommendation was rated strong (1) or weak (2). Quality of the evidence was rated high (A), moderate (B), or weak (C). Final recommendations were developed by an iterative review process. All writing group members voted to accept each recommendation included in the final article.
Results:
This updated SIS guideline contains evidence-based recommendations for prevention and management of IAI in children. Recommendations include selection of preferred antimicrobial agents; timing and route of administration; duration of therapy; treatment of specific pathogens; treatment of specific intra-abdominal disease processes; implementation of hospital-based infection control and prevention tactics; and implementation of hospital-based antimicrobial stewardship programs.
Summary:
Herein are the most current recommendations for prevention and treatment of IAI in pediatric patients.
RhodesA, PhillipsG, BealeR, et al.The Surviving Sepsis Campaign bundles and outcome: Results from the International Multicentre Prevalence Study on Sepsis (the IMPreSS study). Intensive Care Med, 2015; 41(9):1620–1628; doi: 10.1007/s00134-015-3906-y
2.
SakrY, JaschinskiU, WitteboleX, et al.; ICON Investigators. Sepsis in intensive care unit patients: Worldwide data from the Intensive Care over Nations Audit. Open Forum Infect Dis, 2018; 5(12):ofy313; doi: 10.1093/ofid/ofy313
3.
VincentJL, RelloJ, MarshallJ, et al.; EPIC II Group of Investigators. International study of the prevalence and outcomes of infection in intensive care units. JAMA, 2009; 302(21):2323–2329; doi: 10.1001/jama.2009.1754
4.
van de GroepK, VerhoeffT, VerboomDM, et al.; MARS Consortium. Epidemiology and outcomes of source control procedures in critically ill patients with intra-abdominal infection. J Crit Care, 2019; 52:258–264; doi: 10.1016/j.jcrc.2019.02.029
5.
BohnenJM, SolomkinJS, DellingerEP, et al.Guidelines for clinical care: Anti-infective agents for intra-abdominal infection. A Surgical Infection Society policy statement. Arch Surg, 1992; 127(1):83–89; discussion 89; doi: 10.1001/archsurg.1992.01420010097015
6.
MazuskiJE, SawyerRG, NathensAB, et al.; Therapeutic Agents Committee of the Surgical Infection Society. The Surgical Infection Society guidelines on antimicrobial therapy for intra-abdominal infections: Evidence for the recommendations. Surg Infect (Larchmt), 2002; 3(3):175–233; doi: 10.1089/109629602761624180
7.
MazuskiJE, SawyerRG, NathensAB, et al.; Therapeutic Agents Committee of the Surgical Infection Society. The Surgical Infection Society guidelines on antimicrobial therapy for intra-abdominal infections: An executive summary. Surg Infect (Larchmt), 2002; 3(3):161–173; doi: 10.1089/109629602761624171
8.
SolomkinJS, MazuskiJE, BradleyJS, et al.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. Clin Infect Dis, 2010; 50(2):133–164; doi: 10.1086/649554
9.
SolomkinJS, MazuskiJE, BradleyJS, et al.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. Surg Infect (Larchmt), 2010; 11(1):79–109; doi: 10.1089/sur.2009.9930
10.
MazuskiJE, TessierJM, MayAK, et al.The Surgical Infection Society revised guidelines on the management of intra-abdominal infection. Surg Infect (Larchmt), 2017; 18(1):1–76; doi: 10.1089/sur.2016.261
11.
HustonJM, BariePS, DellingerEP, et al.; Therapeutics and Guidelines Committee. The Surgical Infection Society guidelines on the management of intra-abdominal infection: 2024 update. Surg Infect (Larchmt), 2024; 25(6):419–435; doi: 10.1089/sur.2024.137
12.
GBD 2021 Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance 1990–2021: A systematic analysis with forecasts to 2050. Lancet, 2024; 404(10459):1199–1226; doi: 10.1016/S0140-6736(24)01867-1
13.
LobSH, BadalRE, HackelMA, et al.Epidemiology and antimicrobial susceptibility of gram-negative pathogens causing intra-abdominal infections in pediatric patients in Europe-SMART 2011–2014. J Pediatric Infect Dis Soc, 2017; 6(1):72–79; doi: 10.1093/jpids/piv109
14.
Van der MierdenS, TsaiounK, BleichA, et al.Software tools for literature screening in systematic reviews in biomedical research. Altex, 2019; 36(3):508–517; doi: 10.14573/altex.1902131
15.
GuyattGH, OxmanAD, KunzR, et al.; GRADE Working Group. What is “quality of evidence” and why is it important to clinicians? Bmj, 2008; 336(7651):995–998; doi: 10.1136/bmj.39490.551019.BE
16.
MagiorakosA-P, SrinivasanA, CareyRP, et al.Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect, 2012; 18(3):268–281; doi: 10.1111/j.1469-0691.2011.03570.x
17.
MontraversP, LepapeA, DubreuilL, et al.Clinical and microbiological profiles of community-acquired and nosocomial intra-abdominal infections: Results of the French prospective, observational EBIIA study. J Antimicrob Chemother, 2009; 63(4):785–794; doi: 10.1093/jac/dkp005
18.
SartelliM, CatenaF, AnsaloniL, et al.Complicated intra-abdominal infections in Europe: A comprehensive review of the CIAO study. World J Emerg Surg, 2012; 7(1):36; doi: 10.1186/1749-7922-7-36
19.
BlotS, AntonelliM, ArvanitiK, et al.; Abdominal Sepsis Study (AbSeS) group on behalf of the Trials Group of the European Society of Intensive Care Medicine. Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group project. Intensive Care Med, 2019; 45(12):1703–1717; doi: 10.1007/s00134-019-05819-3
20.
GuyattGH, OxmanAD, VistGE, et al.; GRADE Working Group. GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. Bmj, 2008; 336(7650):924–926; doi: 10.1136/bmj.39489.470347.AD
21.
PageMJ, McKenzieJE, BossuytPM, et al.The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Bmj, 2021; 372:n71; doi: 10.1136/bmj.n71
22.
AndrewsJ, GuyattG, OxmanAD, et al.GRADE guidelines: 14. Going from evidence to recommendations: The significance and presentation of recommendations. J Clin Epidemiol, 2013; 66(7):719–725; doi: 10.1016/j.jclinepi.2012.03.013
23.
AndrewsJC, SchünemannHJ, OxmanAD, et al.GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation’s direction and strength. J Clin Epidemiol, 2013; 66(7):726–735; doi: 10.1016/j.jclinepi.2013.02.003
24.
JacksonC-CA, NewlandJ, DementievaN, et al.Safety and efficacy of ceftolozane/tazobactam plus metronidazole versus meropenem from a phase 2, randomized clinical trial in pediatric participants with complicated intra-abdominal infection. Pediatr Infect Dis J, 2023; 42(7):557–563; doi: 10.1097/inf.0000000000003911
25.
BradleyJS, BroadhurstH, ChengK, et al.Safety and efficacy of ceftazidime-avibactam plus metronidazole in the treatment of children ≥3 months to <18 years with complicated intra-abdominal infection: Results from a phase 2, randomized, controlled trial. Pediatr Infect Dis J, 2019; 38(8):816–824; doi: 10.1097/inf.0000000000002392
26.
WirthS, EmilSGS, EngelisA, et al.; MOXIPEDIA Study Group. Moxifloxacin in pediatric patients with complicated intra-abdominal infections: Results of the MOXIPEDIA randomized controlled study. Pediatr Infect Dis J, 2018; 37(8):e207–e213; doi: 10.1097/inf.0000000000001910
27.
ZhaoR, LongX, WangJ, et al.Effectiveness of ertapenem for treatment of infections in children: An evidence mapping and meta-analysis. Front Pediatr, 2022; 10:982179; doi: 10.3389/fped.2022.982179
28.
CommanderSJ, GaoJ, ZinkhanEK, et al.; Best Pharmaceuticals for Children Act-Pediatric Trials Network Steering Committee. Safety of metronidazole in late pre-term and term infants with complicated intra-abdominal infections. Pediatr Infect Dis J, 2020; 39(9):e245–e248; doi: 10.1097/inf.0000000000002698
29.
SmithMJ, BoutzoukasA, AutmizguineJ, et al.; Best Pharmaceuticals for Children Act-Pediatric Trials Network Steering Committee. Antibiotic safety and effectiveness in premature infants with complicated intraabdominal infections. Pediatr Infect Dis J, 2021; 40(6):550–555; doi: 10.1097/inf.0000000000003034
30.
ZhangJ, YuWQ, ChenW, et al.Systematic review and meta-analysis of the efficacy of appropriate empiric anti-enterococcal therapy for intra-abdominal infection. Surg Infect (Larchmt), 2021; 22(2):131–143; doi: 10.1089/sur.2020.001
31.
AdamD, LinglöfT, FloretD, et al.; Tazocin Pediatric Infection Study Group. Piperacillin/tazobactam versus cefotaxime plus metronidazole for the treatment of severe intra-abdominal infection in hospitalized pediatric patients. Curr Ther Res, 2001; 62(6):488–502; doi: 10.1016/S0011-393X(01)80059-X
32.
MaltezouH, NikolaidisP, LebesiiE, et al.Piperacillin/tazobactam versus cefotaxime plus metronidazole for treatment of children with intra-abdominal infections requiring surgery. Eur J Clin Microbiol Infect Dis, 2001; 20(9):643–646; doi: 10.1007/s100960100581
33.
LeeJ, GarveyEM, BundrantN, et al.IMPPACT (Intravenous Monotherapy for Postoperative Perforated Appendicitis in Children Trial): Randomized clinical trial of monotherapy versus multi-drug antibiotic therapy. Ann Surg, 2021; 274(3):406–410; doi: 10.1097/sla.0000000000005006
34.
ArnoldMR, WormerBA, KaoAM, et al.Home intravenous versus oral antibiotics following appendectomy for perforated appendicitis in children: A randomized controlled trial. Pediatr Surg Int, 2018; 34(12):1257–1268; doi: 10.1007/s00383-018-4343-0
35.
WangC, LiY, JiY. Intravenous versus intravenous/oral antibiotics for perforated appendicitis in pediatric patients: A systematic review and meta-analysis. BMC Pediatr, 2019; 19(1):407; doi: 10.1186/s12887-019-1799-6
36.
LammR, KumarSS, CollingsAT, et al.Diagnosis and treatment of appendicitis: Systematic review and meta-analysis. Surg Endosc, 2023; 37(12):8933–8990; doi: 10.1007/s00464-023-10456-5
37.
LambaV, D’souzaS, CarafaC, et al.Standardizing the approach to late onset sepsis in neonates through antimicrobial stewardship: A quality improvement initiative. J Perinatol, 2020; 40(9):1433–1440; doi: 10.1038/s41372-019-0577-5
38.
RavalMV, KwanAB, TraversCD, et al.Importance of compliance audits for a pediatric complicated appendicitis clinical practice guideline. J Med Syst, 2018; 42(12):257; doi: 10.1007/s10916-018-1117-0
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