Postoperative bacterial/fungal infections: a challenging problem in critically ill patients after abdominal surgery

Critically ill patients after extended surgical procedures are at high risk for postoperative infections. The overall incidence of sepsis increased constantly over the last decade, whereas sepsis-related mortality decreased, due to new intensive care options. After extended intra-abdominal surgery the abdomen is the predominant focus of sepsis, followed by respiratory tract infections. Unspecific clinical signs lead to the diagnosis of postoperative sepsis. Early focus identification by clinical, laboratory and radiologic examination is of major importance for a promising therapy, followed by immediately initiated procedures for source control and an adequate anti-infective drug therapy. For nosocomial sepsis, the use of antimicrobial regimens with extended spectra and potent activity against both Gram-negative and Gram-positive bacterial pathogens are warranted. Fungal infections play a great role for immunocompromized patients, e.g. after solid organ transplantation or under chronic corticoid therapy. An increasing incidence of multi-drug resistance in bacterial and fungal isolates has been observed in the last years. This is becoming a growing problem also for critically ill patients after abdominal surgery. Standardized treatment protocols including supportive and adjunctive therapy and the use of modern anti-infective agents may lead to a decrease in postoperative mortality due to sepsis.