CABI Complicated intra-ABdominal Infection in the UK Background - PowerPoint PPT Presentation

CABI Complicated intra-ABdominal Infection in the UK

Background Complicated intra-abdominal infection (CABI) is defined as an infection within the abdomen where there is perforation of a viscus or a collection which is believed to be infected e.g. • Intra-abdominal abscess • Perforated gall bladder • Perforated peptic ulcer • Perforated bowel after ischaemia • Post-operative complication

CABI characteristics CABIs are heterogeneous in: • Size • Number • Location • Loculation • Potential for drainage/washout • Clinical response to antibiotics • Ongoing source e.g. anastomotic leak

CABI management Despite CABI heterogeneity management is based upon • Source control • Antibiotics • Leeds data suggests source control is infrequently performed

Guidelines for management Guidelines are limited in scope and based on limited evidence. National level guidelines – Infectious Disease Society of America: recommend 4- 7days unless source control could not be achieved. Not comment on duration without source control. – Taiwanese guidelines recommend 7-10 days where drainage is achieved, with up to four weeks of intravenous therapy, followed by a prolonged course of oral antibiotics in patients who are more ill.

Research – Short course (4 days) vs. long (till clinical improvement (< 10 days) with source control – No difference in outcomes: High complication rate – Leeds data: High relapse rate-40% – No data on longer course (4 weeks) with or without source control

Current practice • UK practice unknown. • Likely to vary at: – Speciality level: Surgical vs Microbiologist approach – Doctor level: Individual doctor vs. individual doctor – Patient level: Mild vs. moderate vs. severe disease

Research aspiration To optimise the management of CABI

Research hypothesis All patients with CABI, regardless of source control intervention, will have a lower relapse rate when treated with 28 days of antibiotics compared to ≤10 days of antibiotics.

Before a trial • Define the patient population • Define the current management strategies and their successes • Define at risk populations for relapses • Define outcome rates

A collaboratives collaborative CABI Complicated intra-Abdominal Infection in the UK An audit/service evaluation of current UK practice related to CABIs A collaboration between a surgical and an infection collaborative Registered with HQIP (Healthcare Quality Improvement Partnership)

Timelines

Any questions? To register or for a protocol please contact cabi@leeds.ac.uk