Wound and intraabdominal infections: microbiological considerations and approaches to treatment

Aerobic and anaerobic bacteria normally found in the human endogenous gastrointestinal microflora are the most frequent isolates from both postoperative incisional infections and intraabdominal infections. Experimental and clinical studies of intraabdominal infections have shown that many factors are important for successful treatment. Most important is rapid diagnosis followed by a carefully chosen and performed operation. The initial choice of antibiotics with both aerobic and anaerobic coverage has been associated with a high level of therapeutic success in both clinical and experimental settings. In addition, patients with severe intraabdominal infections appear to benefit from a scheduled postoperative relaparotomy with irrigation and exploration, which is most often done today with a zipper technique and which reduces the bacterial burden within the peritoneal cavity. The use of this approach may facilitate the action of properly chosen and administered parenteral antibiotics.