A critical analysis of recent innovations in the treatment of intra-abdominal infection.

Toward the end of the last decade, clinical trial results in the surgical literature reported a major improvement in survival from serious intra-abdominal infection. Mortality rates for certain complex infections, such as necrotizing pancreatitis and postoperative abscess, decreased by almost 50 percent when compared with both hospital controls and the predicted mortality rate according to severity of illness (1-3). This remarkable improvement in outcome can be attributed to innovations in perioperative methods, image-guided therapy for management of postoperative abscesses and other complications and more effective antimicrobial therapy. Advances in each area, along with supporting data and the limitations of therapy, will be reviewed critically. Methods that have been proved by clinical trial will be emphasized.