Surgical Infection Society Guidelines on the Prevention and Management of Pediatric Intra-Abdominal Infection: 2025 Update

Abstract

Background: The Surgical Infection Society (SIS) published evidence-based guidelines for prevention and management of pediatric intra-abdominal infection (IAI). Here we present updated guidelines on the basis of a systematic review of current literature. Methods: The writing group included members of SIS' Therapeutics and Guidelines Committee, other SIS members with content or guideline expertise, and a professional medical librarian. A systematic literature review using PubMed®/MEDLINE, the Cochrane Library, Embase, and Web of Science^TM was performed from January 2016 to October 2024. Keyword descriptors combined "surgical site infections" or "intra-abdominal infections" in pediatric patients limited to randomized controlled trials, systematic reviews, or meta-analyses. Additional relevant publications identified during literature review were included. Publications were evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. The strength of each recommendation was rated strong (1) or weak (2). Quality of the evidence was rated high (A), moderate (B), or weak (C). Final recommendations were developed by an iterative review process. All writing group members voted to accept each recommendation included in the final article. Results: This updated SIS guideline contains evidence-based recommendations for prevention and management of IAI in children. Recommendations include selection of preferred antimicrobial agents; timing and route of administration; duration of therapy; treatment of specific pathogens; treatment of specific intra-abdominal disease processes; implementation of hospital-based infection control and prevention tactics; and implementation of hospital-based antimicrobial stewardship programs. Summary: Herein are the most current recommendations for prevention and treatment of IAI in pediatric patients.

Keywords: antibiotic; antimicrobial; evidence; guideline; intra-abdominal infection; pediatric; pharmacotherapy.