Surgical Management of Complicated Intra-Abdominal Infections: A Literature Review

• DOI: https://doi.org/10.22533/at.ed.1595332528103

• Palavras-chave: infecção intra-abdominal; controle de foco; sepse abdominal; abdome aberto; uso racional de antimicrobianos; manejo pós-operatório; cuidado multidisciplinar

• Keywords: intra-abdominal infection; source control; abdominal sepsis; open abdomen; antimicrobial stewardship; postoperative management; multidisciplinary care

• Abstract: Abstract Background: Complicated intra-abdominal infections (cIAIs) remain a major challenge in emergency and critical care surgery, representing a complex interplay between microbial virulence, host response, and surgical timing. Mortality remains high despite modern advances, highlighting the crucial importance of timely source control, multidisciplinary collaboration, and optimized postoperative care. Objective: To synthesize the current literature on the surgical management of cIAIs, emphasizing the principles of source control, antimicrobial stewardship, prognostic factors, and strategies to prevent postoperative recurrence. Methods: A narrative literature review was conducted through PubMed, Scopus, Cochrane, and Web of Science databases. Fourteen peer-reviewed articles, clinical trials, and international guidelines published up to 2025 were selected for relevance and scientific rigor. The discussion integrates surgical, clinical, and critical care perspectives. Results: Timely and adequate source control was consistently identified as the strongest determinant of survival. Delays beyond 24 hours significantly increased mortality. Minimally invasive drainage is suitable for localized abscesses, while diffuse peritonitis often requires open or staged laparotomy. Damage control and open abdomen techniques remain life-saving in physiologically unstable patients. Short-course, targeted antibiotic therapy after adequate debridement achieved similar outcomes to prolonged regimens. Prognosis depends on host factors, infection severity, and multidisciplinary coordination. Nutritional optimization, early mobilization, and structured postoperative surveillance reduce recurrence and late morbidity. Conclusion: The management of cIAIs demands far more than surgical skill; it requires a synchronized, multidisciplinary effort that unites operative precision, antimicrobial stewardship, and sustained critical care. Future progress will depend on precision-guided, data-driven strategies that personalize intervention, reduce variability, and ensure that recovery extends beyond mere survival toward functional restoration and improved quality of life.