1. CABI (Complicated intra-ABdominal Infection) national prospective audit & service evaluation
Mr Dermot Burke, Dr Rachel Hyland, Dr Andrew Kirby,
Dr Anne Melhuish, Dr Shafaque Shaikh
&
National Infection Trainee Collaborative for Audit and Research
Yorkshire Surgical Research Collaborative

2. Complicated intra-abdominal infection (CABI) =
infection within the abdomen where there is perforation of a viscus or a collection which is believed to be infected, e.g.
Intra-abdominal abscess
Perforated bowel after ischaemia
Post-operative complication

3. CABI characteristics Occur across a wide range of specialties
Associated with significant morbidity and mortality
Heterogeneous in:
Size, number, location, loculation, potential for drainage/washout, ongoing source e.g. anastomotic leak
Treatment is based on:
Source control
Antibiotics

4. Management of CABI UK practice unknown
Current practice likely to vary at:
Speciality level: surgical vs. microbiologist approach
Doctor level: individual doctor vs. individual doctor
Patient level: mild vs. moderate vs. severe disease
Management difficulties compounded by:
Lack of evidence
No comprehensive evidence-based guidelines

5. Current guidelines Existing guidelines: National level guidelines:
limited in scope
largely based on expert opinion
National level guidelines:
Infectious Disease Society of America (IDSA): recommend 4-7 days antibiotics unless source control not achieved – no comment on duration without source control
Taiwanese guidelines recommend 7-10 days antibiotics where drainage is achieved, with up to four weeks of intravenous therapy, followed by a prolonged course of oral antibiotics in patients who are more ill.

6. Proposed trial & audit
Short course (≤10 days) vs. long course (28 days) antibiotic therapy for the treatment of CABI
In order to inform trial, baseline data needed
CABI audit designed
Presented to NITCAR February 2016 meeting, accepted as a project

7. CABI audit & service evaluation
Multi-centre participation, each site collects data on a minimum of 7 patients
Aim to:
Define the patient population
Define the pathology (site, type)
Define the current management strategies and their successes
Compare these to guidelines
Define at risk populations for relapses
Define outcome rates

8. Timelines

9. So far... 40 sites signed up Data submitted from 4 sites
Closing date for data submission = end of May 2017
Data analysis planned June to August 2017