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

• f 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