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Intra-abdominal sepsis: controversies and choices in management.

Contamination of the peritoneal cavity may lead to generalized peritonitis or abscess formation. Both aerobic and anaerobic bacteria participate in the infectious process. The concentration and the particular mix of aerobes and anaerobes depends on the site of perforation, with the highest concentrations and greatest predominance of anaerobes in the colon. A number of factors contribute to the risk of infection, and a formula has been devised for calculating a given patient's risk for infection following intestinal perforation secondary to penetrating abdominal trauma. The goal of therapy is to reduce morbidity, mortality, and duration of hospital stay. Specific techniques used to achieve this goal are controversial. In essence, the keys to successful management of intra-abdominal sepsis are early diagnosis and surgical intervention, supplemented by systemic antibiotics that are effective against the aerobic and anaerobic components. Considerations in choosing antibiotics are efficacy, safety, and cost-effectiveness. Some second-generation and third-generation cephalosporins often offer an effective, safer, and more economical alternative to antibiotic combinations.