Fluid collections are aspirated and cultured. Optimal treatment requires specific pathogen identification by culture of purulent secretions, fluid collections, and blood and antimicrobial susceptibility testing. If an abscess is confirmed, drainage, whether surgical or CT/US-guided, is necessary to achieve an appropriate therapeutic response. Antimicrobial regimens are tailored to the specific pathogen isolated, and empiric coverage for known colonizing flora is appropriate in seriously ill patients while awaiting final culture results. The use of cephalospor-ins, fluoroquinolones, carbapenems and beta-lactam+beta-lactamase inhibitor combinations are appropriate choices for complicated intra-abdominal and surgical wound infections.

Cholangitis is managed medically with intravenous antibiotics if there is adequate biliary flow. When obstruction of the biliary tree is present, a therapeutic procedure, such as ERCP with dilatation, is performed.

Again, third- and sometimes second-generation cephalosporins, as well as the other antibiotics mentioned above, are reasonable antimicrobial choices depending on the culture results.

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