NPO
Surgical consult
IV fluid resuscitation
Resuscitation guidelines for sepsis (taken from the Surviving Sepsis Campaign 2016 recommendations):
For sepsis-induced hypoperfusion, administration of 30 mL/kg of IV isotonic crystalloid within first 3 hrs
Additional fluid resuscitation should be guided by frequent reassessment of hemodynamic status
Guide resuscitation to normalize lactate in patients with elevated lactate levels as a marker of tissue hypoperfusion
Initial target mean arterial pressure (MAP) of 65 mmHg in patients with septic shock requiring vasopressors
Resuscitation guidelines for sepsis (taken from the Surviving Sepsis Campaign 2016 recommendations):
For sepsis-induced hypoperfusion, administration of 30 mL/kg of IV isotonic crystalloid within first 3 hrs
Additional fluid resuscitation should be guided by frequent reassessment of hemodynamic status
Guide resuscitation to normalize lactate in patients with elevated lactate levels as a marker of tissue hypoperfusion
Initial target mean arterial pressure (MAP) of 65 mmHg in patients with septic shock requiring vasopressors
For sepsis-induced hypoperfusion, administration of 30 mL/kg of IV isotonic crystalloid within first 3 hrs
Additional fluid resuscitation should be guided by frequent reassessment of hemodynamic status
Guide resuscitation to normalize lactate in patients with elevated lactate levels as a marker of tissue hypoperfusion
Initial target mean arterial pressure (MAP) of 65 mmHg in patients with septic shock requiring vasopressors
Additional fluid resuscitation should be guided by frequent reassessment of hemodynamic status
Start as soon as possible; ideally within the first hour
Community-acquired:
Therapy should target enteric gram-negative aerobic and facultative bacilli, obligate anaerobic bacilli, and enteric gram-positive streptococci
Adult regimen:
Mild to moderate severity community acquired GI<unk> :
Single agent: Cefoxitin, ertapenem, moxifloxacin, tigecycline, or ticarcillin/clavulanic acid
Combination therapy:
Cefazolin, cefuroxime, ceftriaxone, cefotaxime, ciprofloxacin, or levofloxacin -AND-
Metronidazole
High risk/severity community acquired GI<unk> :
Single agent: Imipenem-cilastatin, meropenem, doripenem, or piperacillin/tazobactam
Combination therapy: Cefepime, ceftazidime, ciprofloxacin, or levofloxacin -AND-
Metronidazole
Pediatric regimen:
Community acquired GI<unk> :
Single agent: Ertapenem, meropenem, imipenem-cilastatin, ticarcillin/clavulanate, and piperacillin/tazobactam
Combination therapy:
Ceftriaxone, cefotaxime, cefepime, or ceftazidime, each in combination with metronidazole
Gentamicin or tobramycin, each in combination with metronidazole or clindamycin, and with or without ampicillin
Iatrogenic/hospital-associated<unk> : Therapy should be driven by local microbiologic results.
Drug-resistant bacteria regimen (common in hospital-associated<unk> :
<20% Resistant Pseudomonas aeruginosa, ESBL-producing Enterobacteriaceae, Acinetobacter, or other MDR GNB:
Single agent: Carbapenem, piperacillin-tazobactam
Ceftazidime or cefepime, each in combination with metronidazole
ESBL-producing Enterobacteriaceae: Carbapenem, piperacillin/tazobactam, or aminoglycoside
P. aeruginosa >20% resistant to ceftazidime: Carbapenem, piperacillin/tazobactam, or aminoglycoside
MRSA: Vancomycin only
Fungal infection: Antifungal therapy for patients with severe community-acquired or health care-associated infection is recommended if candida is grown from intra-abdominal cultures (fluconazole; echinocandins for triazole-resistant species)
Therapy should target enteric gram-negative aerobic and facultative bacilli, obligate anaerobic bacilli, and enteric gram-positive streptococci
Adult regimen:
Mild to moderate severity community acquired GI<unk> :
Single agent: Cefoxitin, ertapenem, moxifloxacin, tigecycline, or ticarcillin/clavulanic acid
Combination therapy:
Cefazolin, cefuroxime, ceftriaxone, cefotaxime, ciprofloxacin, or levofloxacin -AND-
Metronidazole
High risk/severity community acquired GI<unk> :
Single agent: Imipenem-cilastatin, meropenem, doripenem, or piperacillin/tazobactam
Combination therapy: Cefepime, ceftazidime, ciprofloxacin, or levofloxacin -AND-
Metronidazole
Pediatric regimen:
Community acquired GI<unk> :
Single agent: Ertapenem, meropenem, imipenem-cilastatin, ticarcillin/clavulanate, and piperacillin/tazobactam
Combination therapy:
Ceftriaxone, cefotaxime, cefepime, or ceftazidime, each in combination with metronidazole
Gentamicin or tobramycin, each in combination with metronidazole or clindamycin, and with or without ampicillin
Mild to moderate severity community acquired GI<unk> :
Single agent: Cefoxitin, ertapenem, moxifloxacin, tigecycline, or ticarcillin/clavulanic acid
Combination therapy:
Cefazolin, cefuroxime, ceftriaxone, cefotaxime, ciprofloxacin, or levofloxacin -AND-
Metronidazole
High risk/severity community acquired GI<unk> :
Single agent: Imipenem-cilastatin, meropenem, doripenem, or piperacillin/tazobactam
Combination therapy: Cefepime, ceftazidime, ciprofloxacin, or levofloxacin -AND-
Metronidazole
Single agent: Cefoxitin, ertapenem, moxifloxacin, tigecycline, or ticarcillin/clavulanic acid
Combination therapy:
Cefazolin, cefuroxime, ceftriaxone, cefotaxime, ciprofloxacin, or levofloxacin -AND-
Metronidazole
Cefazolin, cefuroxime, ceftriaxone, cefotaxime, ciprofloxacin, or levofloxacin -AND-
Metronidazole
Single agent: Imipenem-cilastatin, meropenem, doripenem, or piperacillin/tazobactam
Combination therapy: Cefepime, ceftazidime, ciprofloxacin, or levofloxacin -AND-
Metronidazole
Community acquired GI<unk> :
Single agent: Ertapenem, meropenem, imipenem-cilastatin, ticarcillin/clavulanate, and piperacillin/tazobactam
Combination therapy:
Ceftriaxone, cefotaxime, cefepime, or ceftazidime, each in combination with metronidazole
Gentamicin or tobramycin, each in combination with metronidazole or clindamycin, and with or without ampicillin
Single agent: Ertapenem, meropenem, imipenem-cilastatin, ticarcillin/clavulanate, and piperacillin/tazobactam
Combination therapy:
Ceftriaxone, cefotaxime, cefepime, or ceftazidime, each in combination with metronidazole
Gentamicin or tobramycin, each in combination with metronidazole or clindamycin, and with or without ampicillin
Ceftriaxone, cefotaxime, cefepime, or ceftazidime, each in combination with metronidazole
Gentamicin or tobramycin, each in combination with metronidazole or clindamycin, and with or without ampicillin
Drug-resistant bacteria regimen (common in hospital-associated<unk> :
<20% Resistant Pseudomonas aeruginosa, ESBL-producing Enterobacteriaceae, Acinetobacter, or other MDR GNB:
Single agent: Carbapenem, piperacillin-tazobactam
Ceftazidime or cefepime, each in combination with metronidazole
ESBL-producing Enterobacteriaceae: Carbapenem, piperacillin/tazobactam, or aminoglycoside
P. aeruginosa >20% resistant to ceftazidime: Carbapenem, piperacillin/tazobactam, or aminoglycoside
MRSA: Vancomycin only
<20% Resistant Pseudomonas aeruginosa, ESBL-producing Enterobacteriaceae, Acinetobacter, or other MDR GNB:
Single agent: Carbapenem, piperacillin-tazobactam
Ceftazidime or cefepime, each in combination with metronidazole
ESBL-producing Enterobacteriaceae: Carbapenem, piperacillin/tazobactam, or aminoglycoside
P. aeruginosa >20% resistant to ceftazidime: Carbapenem, piperacillin/tazobactam, or aminoglycoside
MRSA: Vancomycin only
Single agent: Carbapenem, piperacillin-tazobactam
Ceftazidime or cefepime, each in combination with metronidazole
Bowel perforation
Acute myocardial infarction
Large bowel obstruction
Intestinal obstruction
Intestinal ischemia
Acute mesenteric ischemia
Mesenteric ischemia
Mesenteric venous thrombosis