Management of Intra-Abdominal Infection Patients with Septic Shock in the ICU

Geeta Maharani Ariaty; Budiana Rismawan

doi:10.71197/jsocmed.v4i9.238

Management of Intra-Abdominal Infection Patients with Septic Shock in the ICU

Geeta Maharani Ariaty
Intensive Care Trainee, Faculty of Medicine Padjadjaran University / Hasan Sadikin General Hospital Bandung, Indonesia
Budiana Rismawan
Consultant Intensive Care, Faculty of Medicine Padjadjaran University / Hasan Sadikin General Hospital Bandung, Indonesia

Abstract

Introduction: Intra-abdominal infections (IAIs) complicated by septic shock pose a critical challenge in intensive care units (ICUs) due to high morbidity and mortality. Effective management requires rapid diagnosis, source control, and optimized antimicrobial therapy. This case report describes the multidisciplinary approach to managing IAI with septic shock, highlighting evidence-based strategies.

Case Description: A 59-year-old male presented with septic shock secondary to generalized peritonitis caused by an incarcerated hernia. Initial management included fluid resuscitation with 1,500 mL Ringer’s lactate, norepinephrine, and broad-spectrum antibiotics (meropenem and metronidazole). Emergency laparotomy within 4.5 hours achieved source control by evacuating 300 mL of purulent peritoneal fluid. ICU care involved mechanical ventilation, analgesia (fentanyl, paracetamol), sedation (midazolam, transitioned to dexmedetomidine), and enteral nutrition starting on day three. Multidisciplinary collaboration facilitated hemodynamic stabilization, extubation on day five, and transfer to the high-care unit on day six, with significant clinical improvement.

Conclusion: Successful management of IAI with septic shock hinges on timely source control, appropriate antimicrobial therapy, and comprehensive ICU care. The absence of microbiological cultures, a key limitation, underscores the need for improved diagnostic access in resource-limited settings. Adherence to evidence-based protocols and multidisciplinary expertise are critical to improving survival. Future efforts should focus on enhancing diagnostics to optimize therapy and reduce antimicrobial resistance.

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Published at

30. September 2025
https://doi.org/10.71197/jsocmed.v4i9.238
Issue:

Vol. 4 No. 9 (2025): September
Section:

Articles
Keywords:

Intra-Abdominal Infection Septic Shock Intensive Care Unit Source Control Antimicrobial Therapy Multidisciplinary Care
References:

Singer M, Deutschman CS, Seymour C, Shankar-Hari M, Annane D, Bauer M, et al. Third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801-10.

Pangalila FJV, Soepandi PZ, Albandjar CA, Sukesih L, Enty. Pedoman Antibiotik Empirik di Unit Rawat Intensif. Jakarta: Perhimpunan Dokter Intensive Care Indonesia (PERDICI); 2019.

Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181-247. doi:10.1007/s00134-021-06506-y

Sartelli M, Coccolini F, Kluger Y, Agastra E, Abu-Zidan FM, Abbas AES, et al. WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections. World J Emerg Surg. 2021;16:49. doi:10.1186/s13017-021-00387-8

Moenadjat Y, Lalisang TJ, Saunar RS, Usman N, Handaya AY, Iswanto J, et al. Epidemiology of microorganisms in intraabdominal infection/complicated intraabdominal infections in six centers of surgical care in Indonesia: a preliminary study. New Ropanasuri J Surg. 2017;2(2):46-53.

Pangalila FJV. Penatalaksanaan Infeksi pada Penderita Penyakit Kritis. Jakarta: Perhimpunan Dokter Intensive Care Indonesia (PERDICI); 2013.

Sartelli M, Catena F, Di Saverio S, Ansaloni L, Malangoni M, Moore EE. Current concept of abdominal sepsis: WSES position paper. World J Emerg Surg. 2014;9:22.

Friedrich AKU, Cahan M. Intraabdominal infections in the intensive care unit. J Intensive Care Med. 2014;29(5):247-54.

Sartelli M, Catena F, Di Saverio S, Ansaloni L, Malangoni M, Moore EE. Current concept of abdominal sepsis: WSES position paper. World J Emerg Surg. 2014;9:22.

Emmi V, Sganga G. Diagnosis of intra-abdominal infections: Clinical findings and imaging. Infez Med. 2008;16(Suppl 1):19-25.

LaRosa SP. Sepsis: menu of new approaches replaces one therapy for all. Cleve Clin J Med. 2002;69(1):65-73.

Hecker A, Reichert M, Reuß CJ, Schmoch T, Riedel JG, Schneck E, et al. Intra-abdominal sepsis: new definitions and current clinical standards. Langenbecks Arch Surg. 2019;404(3):257-71.

Kuttab HI, Lykins JD, Hughes MD, Wroblewski K, Keast EP, Kukoyi O, et al. Evaluation and predictors of fluid resuscitation in patients with severe sepsis and septic shock. Crit Care Med. 2019;47(11):1582-90.

Cherpanath TGV, Hirsch A, Geerts BF, Lagrand WK, Leeflang MM, Schultz MJ, et al. Predicting fluid responsiveness by passive leg raising: a systematic review and meta-analysis of 23 clinical trials. Crit Care Med. 2016;44(5):981-91.

Misango D, Pattnaik R, Baker T, Dünser MW, Dondorp AM, Schultz MJ. Haemodynamic assessment and support in sepsis and septic shock in resource-limited settings. Trans R Soc Trop Med Hyg. 2017;111(11):483-9.

Levy B. Lactate and shock state: the metabolic view. Curr Opin Crit Care. 2006;12(4):315-21.

Delaney A, Finnis M, Bellomo R, Udy A, Jones D, Keijzers G, et al. Initiation of vasopressor infusions via peripheral versus central access in patients with early septic shock: a retrospective cohort study. Emerg Med Australas. 2020;32(2):210-9.

Lara B, Enberg L, Ortega M, Leon P, Kripper C, Aguilera P, et al. Capillary refill time during fluid resuscitation in patients with sepsis-related hyperlactatemia at the emergency department is related to mortality. PLoS One. 2017;12(11):e0188548.

Cecconi M, Hernandez G, Dunser M, Antonelli M, Baker T, Bakker J, et al. Fluid administration for acute circulatory dysfunction using basic monitoring: narrative review and expert panel recommendations from an ESICM task force. Intensive Care Med. 2019;45(1):21-32.

Marshall JC, Al Naqbi A. Principles of source control in the management of sepsis. Crit Care Clin. 2009;25(4):753-68.

Bloos F, Rüddel H, Thomas-Rüddel D, Schwarzkopf D, Pausch C, Harbarth S, et al. Effect of a multifaceted educational intervention for anti-infectious measures on sepsis mortality: a cluster randomised trial. Intensive Care Med. 2017;43(11):1602-12.

Sartelli M, Weber DG, Ruppé E, Bassetti M, Wright BJ, Ansaloni L, et al. Antimicrobials: A Global Alliance for Optimising the Rational Use of Antimicrobials in Intra-Abdominal Infections (AGORA). World J Emerg Surg. 2016;11:33.

Hawkins WA, Smith SE, Newsome AS, Carr JR, Bland CM, Branan TN. Fluid stewardship during critical illness: a call to action. J Pharm Pract. 2020;33(6):863-73.

Jiang Z, Ren J, Hong Z, Ren H, Wang G, Gu G, et al. Deresuscitation in patients with abdominal sepsis is associated with a lower mortality rate and less organ dysfunction than conservative fluid management. Surg Infect (Larchmt). 2021;22(3):288-95.

McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the provision and assessment of nutrition support therapy in adult critically ill patients: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). J Parenter Enteral Nutr. 2016;40(2):159-211.

Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, Camilo M, Richardson R, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321-36.

Heyland DK, Dhaliwal R, Jiang X, Day AG. Identifying critically ill patients who benefit the most from nutrition therapy: development and initial validation of a novel risk assessment tool. Crit Care. 2011;15(6):R268.

Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):e825-73.

Davidson JE, Winkelman C, Gélinas C, Dermenchyan A. Pain, agitation, and delirium guidelines: Nurses’ involvement in development and implementation. Crit Care Nurse. 2015;35(3):16-22.

Minet C, Potton L, Bonadona A, Hamidfar-Roy R, Somohano CA, Lugosi M, et al. Venous thromboembolism in the ICU: main characteristics, diagnosis, and thromboprophylaxis. Crit Care. 2015;19:287.

Cade JF. High risk of venous thromboembolism in critically ill patients. Crit Care Med. 1982;10(7):448-50.

Fraisse F, Holzapfel L, Coulaud JM, Simonneau G, Bedock B, Feissel M, et al. Nadroparin in the prevention of deep vein thrombosis in acute decompensated COPD. Am J Respir Crit Care Med. 2000;161(4 Pt 1):1109-14.

Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest. 2008;133(6 Suppl):381S-453S.

Barbar S, Noventa F, Rossetto V, Ferrari A, Brandolin B, Perlati M, et al. A risk assessment model for the identification of hospitalised medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost. 2010;8(11):2450-7.

Rosenberg D, Eichorn A, Alarcon M, McCullagh L, McGinn T, Spyropoulos AC. External validation of the risk assessment model of the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) for medical patients in a tertiary health system. J Am Heart Assoc. 2014;3(6):e001152.

Skeik N, Westergard E. Recommendations for VTE prophylaxis in medically ill patients. Ann Vasc Dis. 2020;13(1):10-8.

Saeed M, Bass S, Chaisson NF. Which ICU patients need stress ulcer prophylaxis? Cleve Clin J Med. 2022;89(7):363-7.

Meade MO, Cook DJ, Guyatt GH, Slutsky AS, Arabi YM, Cooper DJ, et al. Ventilation strategy using low tidal volumes, recruitment manoeuvres, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: A randomised controlled trial. JAMA. 2008;299(6):637-45.
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Ariaty, G. M., & Rismawan, B. (2025). Management of Intra-Abdominal Infection Patients with Septic Shock in the ICU. Journal of Society Medicine, 4(9), 298–304. https://doi.org/10.71197/jsocmed.v4i9.238