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Intra-abdominal infections in children. Pathogenesis, diagnosis and management
1Department of Pediatrics, School of Medicine, Georgetown University, Washington, DC.
Insights
Intra-abdominal infections in children involve gut bacteria. Effective treatment requires antimicrobials targeting both Enterobacteriaceae and the Bacteroides fragilis group, crucial for managing peritonitis and abscess stages.
Area of Science:
- Microbiology
- Pediatric Infectious Diseases
- Surgical Infections
Background:
- Intra-abdominal infections (IAIs) in children often stem from gastrointestinal viscus perforation.
- These infections involve a complex interplay of aerobic and anaerobic gastrointestinal bacterial flora.
- Bacterial virulence factors and synergistic interactions contribute to disease progression.
Purpose of the Study:
- To elucidate the distinct roles of bacterial pathogens in the biphasic progression of IAIs.
- To highlight the importance of targeting specific bacterial groups in pediatric IAIs.
- To inform antimicrobial therapy strategies for IAIs following viscus perforation.
Main Methods:
- Review of existing literature on pediatric IAIs and microbial flora.
- Analysis of pathogen prevalence in different stages of infection (peritonitis vs. abscess).
- Consideration of animal models and clinical patient data regarding treatment efficacy.
Main Results:
- Enterobacteriaceae are identified as primary pathogens during the peritonitis stage.
- The Bacteroides fragilis group emerges as the predominant pathogen in the abscess stage.
- Evidence supports the need for broad-spectrum antimicrobial coverage.
Conclusions:
- Pediatric IAIs exhibit a biphasic pattern with distinct dominant pathogens.
- Antimicrobial therapy must effectively target both Enterobacteriaceae and the Bacteroides fragilis group.
- Combined or single-agent antimicrobial therapy is essential for successful treatment outcomes.
Abstract:
Intra-abdominal infections in children that follow perforation of viscus often involve the gastrointestinal aerobic and anaerobic bacterial flora. These organisms possess various virulence factors and exhibit potential synergy. The intra-abdominal infection is biphasic, with the Enterobacteriaceae as the major pathogens in the peritonitis stage, and the Bacteroides fragilis group predominating in the abscess stage. Experiments with animals and experience in patients support the need to use single or combined antimicrobial agent therapy that is effective against both Enterobacteriaceae and the B. fragilis group.