At the 2025 NAPNAP National Conference in Chicago, Danielle Van Damme, DNP, CPNP-AC, a pediatric nurse practitioner specializing in acute and critical care at the Infectious Diseases Department of C.S. Mott Children's Hospital, discussed the updated 2024 Infectious Diseases Society of America (IDSA) guidelines on complicated intra-abdominal infections (cIAIs). Her session focused on risk assessment, diagnostic imaging, and microbiological evaluation.¹

“Intra-abdominal infections, are the second leading cause of morbidity and mortality in ICUs, and this affects adults and children,” Van Damme explained. “Understanding what the current literature and recommendations are is very important when taking care of these patients.”

The 2024 guideline differs from its 2010 predecessor. While the previous version covered both diagnosis and management, the latest iteration is the first in a series of guidelines focusing on diagnosis and risk assessment.

Shift in Diagnostic Imaging Recommendations

One of the most significant changes in the guideline is the recommendation to move away from computed tomography (CT) as the primary imaging modality.

“There has been a shift away from CT as the first-line imaging modality to help diagnose that and really overwhelmingly has supported the use of abdominal ultrasound to diagnose complicated intra-abdominal infection,” Van Damme stated.

Ultrasound is now the conditional recommendation from IDSA because of its accessibility, and no sedation requirement for the child, where with an MRI, sedation could be required. Additionally, unlike CT, ultrasound does not expose patients to ionizing radiation or contrast agents, making it a safer option for pediatric populations.²

From a practical standpoint, ultrasound offers greater feasibility across various healthcare settings.

“Ultrasound is more readily available. And it does not expose the patient to contrast, doesn't expose the patient to the large amounts of radiation that CT does, and doesn't require the patient to travel,” Van Damme noted.

The Need for Further Research

Despite these advancements, Van Damme highlighted a critical limitation in the current literature.

“All of these guidelines really are graded as conditional recommendations and almost all of them with low certainty of evidence,” she said.

Because of limited high-quality studies on pediatric intra-abdominal infections, these recommendations serve as guidance rather than definitive protocols, reinforcing the need for further research (IDSA, 2024).

Conclusion

Van Damme encouraged pediatric healthcare providers to stay informed about forthcoming guideline updates, which will address the management of cIAIs following diagnosis.

“The fact that they have separated out [the guidelines]… providers should look out for the subsequent publications that will continue to guide the management after we've made a diagnosis of intra-abdominal infection.”

References:

1. Van Damme D, Madden MA, Spruit JL. Pediatric clinical guidelines update. Presented at: NAPNAP. March 10-13, 2025. Chicago, Illinois.

2. Bonomo RA, Hemphries R, Abrahamian FM, et al. 2024 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Complicated Intra-abdominal Infections: Utility of Intra-abdominal Fluid Cultures in Adults, Children, and Pregnant People. Clinical Infectious Diseases.Volume 79. Issue Supplement_3. October, 2024. doi:10.1093/cid/ciae353