Immunocompromised patient intraabdominal infections

If symptoms do not improve, the patient should be evaluated for persistent infection. There are many reasons for poor patient outcome with intraabdominal infection improper antimicrobial selection is only one. The patient maybe immunocompromised, which decreases the likelihood of successful outcome with any regimen. It is impossible for antimicrobials to compensate for a nonfunctioning immune system. There may be surgical reasons for poor patient outcome. Failure to identify all intraabdominal foci of infection or leaks from a GI anastomosis may cause continued intraabdominal infection. Even when intraabdominal infection is controlled, accompanying organ system failure, most often renal or respiratory, may lead to patient demise. 

In immunocompromised patients and patients receiving corticosteroids, both the symptoms of intraabdominal infections are attenuated and the resolution of infection is impaired. Patients with poor nutritional status (both over- and under-weight) or other causes of poor wound healing (cigarette smoking) are prone to complications. 

The indications for penicillin-B-lactamase inhibitor combinations are empirical therapy for infections caused by a wide range of potential pathogens in both immunocompromised and immunocompetent patients and treatment of mixed aerobic and anaerobic infections, such as intraabdominal infections. Doses are the same as those used for the single agents except that the recommended dosage of piperacillin in the piperacillin-tazobactam combination is 3 g every 6 hours. This is less than the recommended 3-4 g every 4-6 hours for piperacillin alone, raising concerns about the use of the combination for treatment of suspected pseudomonal infection. Adjustments for renal insufficiency are made based on the penicillin component. 

Enterococcus can be isolated from many intraabdominal infections in humans, but its role as a pathogen is not clear. Enterococ-cal infection occurs more commonly in postoperative peritonitis, in the presence of specific risk factors indicating failure of the host s defenses (immunocompromised patients), or with the use of broad-spectrum antibiotics. ... 

Gastroenteritis infection with non-typhoidal salmonella often results in gastroenteritis indistinguishable from that caused by other bacterial or viral pathogens. It is usually self-limited, and fever and diarrhoea resolve within 3 and 7 days, respectively. In a minority of patients (<5%), particularly neonates, infants, elderly and immunocompromised patients, carriage of the pathogen and/or a bacteraemia is prolonged with endovascular or localised (intraabdominal, central nervous system, pulmonary) infections. 

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