Peritonitis

- All abscess collections require drainage if practical.

- Blood and peritoneal cultures recommended for any high-risk (ICU/critically ill, diffuse peritonitis, delayed or inadequate source control) community-acquired peritonitis and all cases of healthcare-associated peritonitis. If source control achieved, cultures of perforated or gangrenous appendix offer no benefit.

- Duration of therapy:

   Peri-operative therapy ≤ 24h:

• Bowel injuries due to penetrating, blunt, or iatrogenic trauma with surgery within 12 hours of injury; acute perforations of stomach, duodenum, and proximal jejunum in absence of antacid therapy or malignancy with surgery within 24 hours; or acute appendicitis without perforation, abscess, or peritonitis; and ischemic, non-perforated bowel.

   Adequate source control - 5 days; 7 days if bacteremic

   Source control delayed or not performed - ID consult suggested:

• Monitor the following to determine when antimicrobial therapy can be discontinued
  • fever
  • WBC/differential
  • return of GI function
• Persistent clinical evidence of infection after 5-7 days warrants diagnostic investigations (CT, US).