Canadian guidelines recommend targeting 'core' pathogens for initial empirical therapy in intra-abdominal infections and suggest routine cultures are optional for mild-to-moderate community-acquired cases.
Guides empirical therapy to core pathogens with optional cultures in mild community-acquired cases; extends A-2 evidence into updated Canadian stewardship guidelines.
Recommendation 4. Due to the predominance of certain virulent pathogens in IAIs, the concept of 'core' pathogens is recommended for planning initial empirical antimicrobial therapy (A-2 evidence). Recommendation 5. The microbiology of community-acquired IAIs in the absence of previous antimicrobial exposure generally consists of 'core' pathogens that are readily predictable (A-2 evidence). In such patients and particularly those with mild to moderate severity of illness, routine bacteriological cultures of abdominal fluid or pus and antibiotic susceptibility testing of intra-abdominal isolates are optional and not routinely required to guide empirical antimicrobial therapy. However, such cultures may be useful for ongoing surveillance studies and generating local epidemiological data regarding antimicrobial susceptibility profiles and emerging resistance (A-2 evidence). Recommendation 6. Patients with health care-associated IAIs who have prolonged previous hospitalization (five days or more), are severely ill (APACHE II score of 15 or greater) or have received previous antimicrobial therapy (more than two days) are at a greater risk for antimicrobial-resistant pathogens. In AMMI CAnAdA guIdelInes 2010 Pulsus Group Inc.
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