![]() |
市場調查報告書
商品編碼
1835361
腹腔內感染疾病市場(按抗生素類別、感染類型、病原體類型、患者年齡層和最終用戶分類)—2025-2032 年全球預測Intra-abdominal Infections Market by Antibiotic Class, Infection Type, Pathogen Type, Patient Age Group, End User - Global Forecast 2025-2032 |
||||||
※ 本網頁內容可能與最新版本有所差異。詳細情況請與我們聯繫。
預計到 2032 年,腹腔內感染疾病市場將成長 497 億美元,複合年成長率為 9.20%。
| 主要市場統計數據 | |
|---|---|
| 基準年2024年 | 245.7億美元 |
| 預計2025年 | 268.6億美元 |
| 預測年份:2032年 | 497億美元 |
| 複合年成長率(%) | 9.20% |
腹腔內感染疾病種類繁多,從簡單的局部發炎過程到複雜的、危及生命的多菌性膿毒症,不一而足。臨床醫生面臨社區獲得性感染和院內感染的混合感染,這些感染的來源、宿主因素和微生物學各不相同。因此,早期發現和及時控制感染源仍然是有效管理的基礎,抗生素的選擇必須在經驗性擴大用藥量和根據培養和藥敏數據逐漸減量之間取得平衡。
診斷的複雜性源自於重疊的臨床表現、差異化的培養產量以及不斷變化的抗藥性模式。影像學檢查、手術評估和腹膜培養至關重要,但每種檢查都存在局限性,會影響治療時機。同時,主要病原體中的抗菌藥物抗藥性正在改變經驗性治療方案,促使重症病例依賴更高級的藥物和組合方案。這些變化促使人們需要協調一致的抗菌藥物管理、多學科治療途徑和強力的醫院監測,以保留治療方法方案並最佳化治療結果。
因此,臨床、營運和商業領域的相關人員必須在及時診斷、綜合管理和供應鏈連續性等優先事項上達成一致。透過了解推動治療決策的臨床細微差別和系統壓力,領導者可以更好地設計干預措施,以降低發病率、縮短住院時間,並限制不必要的廣譜抗生素暴露帶來的附帶危害。
由於抗菌藥物抗藥性、技術進步和醫療服務模式的轉變,腹腔內感染管理模式正在發生快速且顯著的變化。抗藥性趨勢正在重塑經驗性處方模式,並提升了那些對多重抗藥性革蘭氏陰性菌具有活性的藥物的臨床和經濟價值。同時,快速診斷和分子病原體檢測的創新正在縮短從就診到標靶治療的間隔時間。
醫療保健服務的轉型同樣影響深遠。門診手術中心的興起,以及向更早出院和門診腸外抗生素治療的轉變,正在改變患者流量和藥物利用,需要住院團隊和社區醫療保健組織之間建立新的合作。監管部門對管理和報告的期望不斷變化,更加重視可衡量的指標和專案課責,這使得這些轉變變得更加複雜。因此,相關人員面臨著這樣一種局面:臨床有效性、供應可靠性和對管理的遵守程度既決定了病人的治療結果,也決定了組織的風險。
這些綜合因素需要適應性策略,整合新的診斷方法、管理通訊協定和供應鏈彈性,同時在關鍵決策點保留臨床醫師的自主權。積極調整臨床路徑、採購慣例和監測能力的組織將更有能力管理複雜性,並長期維持治療方案。
圍繞貿易和關稅的政策環境會對抗生素、生產投入以及腹腔感染治療所必需的醫療用品的成本結構和供應產生重大影響。進口關稅和貿易壁壘的變化會改變原料藥和成品藥的生產經濟性,進而影響醫院和經銷商的籌資策略。實際上,當關稅變化擾亂現有的供應鏈時,採購團隊可能會面臨供應商選擇受限、前置作業時間延長以及某些靜脈注射抗生素和腸外製劑採購成本上升的問題。
臨床醫師和藥局負責人必須預見醫院處方集和治療指引變化所帶來的副作用。當有採購限制或價格壓力時,醫院通常會重新評估處方集中的藥物,替代臨床等效藥物或調整管理政策以維持關鍵庫存。這些營運回應需要明確的臨床管治,以防止意外後果,例如經驗性應用不足或高風險患者替換不當。
此外,製造商和契約製造製造商可以透過轉移生產地點、重新設計供應合約以及加快對區域製造業的投資來緩解關稅的影響,以應對利潤壓力。此類策略調整將提升長期韌性,但會帶來短期波動。因此,在關稅導致供應鏈中斷的情況下,結合採購預測、庫存緩衝和持續臨床監測的跨職能規劃對於維持藥品供應和臨床完整性至關重要。
細緻的細分視角揭示了治療方法選擇、感染疾病格局、病原體概況、患者人口統計特徵和醫療保健環境如何相互交織,共同塑造臨床和商業動態。根據抗生素類別,臨床醫生使用卡巴培南類、頭孢菌素類和青黴素類抗生素來涵蓋廣泛的腹膜內病原體。在卡巴培南類抗生素中,根據病原體疑似情況、組織穿透需求和抗藥性模式,使用多利培南、厄他培南、Imipenem/西司他丁和美Meropenem等藥物。頭孢菌素類藥物分為第三代頭孢菌素(例如頭孢噻肟和頭孢曲松)和第四代頭孢菌素,每種藥物的選擇都基於其對特定革蘭氏陰性菌的覆蓋能力,以及在必要時穿透中樞神經系統的能力。青黴素組合藥物,例如Ampicillin/舒巴坦和哌拉西林/他唑巴坦,在社區獲得性病菌感染的經驗性治療和許多機構方案中發揮重要作用。
社區型感染和院內獲得性感染分為複雜感染和非複雜感染,因此治療需求也不同。社區型感染通常分為複雜感染和非複雜感染,對於近期無醫療保健暴露的患者,經驗性治療的範圍通常較小。相反,無論是在 ICU 還是手術後,院內感染疾病都需要更廣泛的經驗性治療方案,因為多重抗藥性細菌的風險增加。主導病原體的見解區分了厭氧菌(如脆弱擬桿菌屬和梭菌屬)、革蘭氏陰性菌(如腸桿菌科和銅綠假單胞菌)和革蘭氏陽性菌(如腸球菌屬和金黃色葡萄球菌),每種細菌都帶來不同的經驗性和確定性治療選擇和管理挑戰。
成人、老年人和兒童的藥物動力學和安全性考量各不相同,這些因素會影響劑量、製劑選擇和監測。最後,雖然醫院分為二級和三級醫療機構,但門診醫療中心和醫院之間最終用戶的細分決定了資源的可用性、高級診斷服務的可及性以及源頭管理的程序能力。這些相互交叉的細分領域需要量身定做的臨床路徑、籌資策略和教育計劃,以確保每個患者群體都能獲得最佳的、針對特定情況的照護。
區域差異對臨床實務、供應鏈物流和政策環境有著重大影響,決定醫療服務提供者和衛生系統應對腹腔內感染的方式。在美洲,治療方案和管理框架越來越強調實證經驗性治療方法選擇以及在高級急診中心整合快速診斷技術,而供應鏈整合和集團採購組織則影響著處方決策和價格談判。這些動態正在推動臨床領導層和採購部門之間的協調,以確保關鍵藥物的持續供應。
歐洲、中東和非洲地區醫療基礎設施、法律規範和抗菌藥物抗藥性狀況各異,導致其優先事項也各有不同。資源豐富的機構專注於快速分子診斷和先進的管理項目,而資源匱乏的機構則優先考慮獲得基本抗生素、基本影像和手術能力。政策層面的干涉措施和區域合作在支持這一多元化地區的抗菌藥物管理和抗藥性監測方面發揮更大的作用。
亞太地區臨床需求旺盛,技術應用迅速,國內生產能力多樣化。雖然區域製造商可以在一定程度上緩解供應中斷的影響,但需求壓力和韌性趨勢需要協調一致的國家管理和採購策略。在所有地區,監管、生產地理和臨床實踐之間的相互作用將決定短期營運選擇以及供應和治療方法方案的長期韌性。
腹腔內感染疾病相關治療方法和服務的競爭格局呈現出老牌製藥商、契約製造製造商、診斷創新者和臨床服務供應商的混合格局。老牌製藥商通常專注於維護可靠的供應線、延長產品生命週期,並透過教育和處方支援來支援舉措計劃。契約製造製造商和專業的無菌注射生產設施在確保腸外抗生素的供應方面發揮著至關重要的作用,為策略夥伴關係關係和產能投資創造了機會。
隨著快速識別技術和藥敏平台直接改變處方行為並縮短最佳治療時間,診斷公司和醫院實驗室網路的影響力日益增強。診斷供應商與臨床領導者之間的合作可以帶來路徑層面的改進,從而減少不適當的頻譜使用並加快標靶治療。此外,支持門診腸外抗生素治療和出院後監測的服務供應商延長了護理的連續性,使其能夠在不犧牲安全性的情況下更早地從住院過渡。
製藥商、診斷公司和醫療保健系統之間的策略聯盟可以提供將可靠的抗生素供應與診斷管理相結合的綜合服務。此類合作也支持透過數據共用、處方最佳化以及針對處方醫生和護理團隊的有針對性的教育,共同應對抗生素抗藥性問題。
醫療保健領導者應採取一系列切實可行的優先行動,以提升臨床療效、維持治療可近性並降低供應風險。首先,協調採購和臨床管治,並定期對處方集選擇、庫存風險和臨床可接受的替代治療方法進行跨職能審查,以確保在供應波動的情況下保持連續性。其次,加速採用快速診斷工具,並將明確的降階梯方案納入護理路徑,以便在適當的情況下快速確定經驗性頻譜治療方案,降低抗藥性選擇壓力,並節省更高級的通訊協定。
第三,我們將擴大門診腸外抗生素治療,並加強出院協調,以在確保安全的同時縮短住院時間。第四,我們將實施分級管理指標,考慮感染疾病類型、病原體風險和患者年齡,並將教育和審核工作重點放在臨床影響最大的領域。第五,我們將透過多年期合約、盡可能的雙重採購以及緊急時應對計畫,積極與製造商和委託製造合作,以緩解關稅和中斷相關的短缺。最後,我們將投資於勞動力發展,使外科團隊、加護治療醫師、藥劑師和感染疾病專家具備實施快速供應管理、劑量最佳化和協調追蹤的技能。
這些行動共同平衡了當前的營運彈性和長期管理目標,使組織能夠提供高品質的護理,同時保持治療效果。
本執行摘要所依據的研究採用混合方法,整合了原始臨床數據、機構層面的營運數據和全面的二次研究,以確保得出可靠且基於具體情況的結論。原始數據是透過與外科、重症監護、感染疾病和藥學專業的臨床醫生進行結構化訪談和諮詢討論收集的,並輔以採購和供應鏈專家的協助,以構建營運藍圖。這些第一手觀點有助於制定圍繞藥物選擇、管理實踐和供應應急的方案。
二次研究整合了同行評審文獻、臨床指南、監管文件以及衛生部門公開的監測數據,以基於既定證據得出研究結果。分析了真實世界數據,包括醫院用藥模式、抗生素使用記錄和實驗室藥敏報告,以識別實踐差異和抗藥性趨勢。在適用的情況下,使用資料三角檢驗法,根據可觀察的營運指標檢驗定性見解。
分析方法包括比較臨床路徑圖譜繪製、供應中斷情境敏感度分析以及相關人員影響評估,以確定建議的優先順序。在整個過程中,我們專注於資料來源、調查方法透明度和同儕檢驗,以確保結論反映臨床實際情況並具有操作可行性。
本執行摘要強調了一系列趨同的優先事項:保障有效抗生素的可近性,加速診斷主導醫療服務,以及增強系統層面對供應和政策波動的抵禦能力。臨床上,快速的供應管理和個人化的抗生素治療顯然可以挽救生命,但要持續實現這一目標,需要在診斷、管理基礎設施和跨部門合作方面進行投資。在營運方面,採購和藥房負責人必須預測供應鏈衝擊,並保持靈活的策略,在不損害臨床標準的前提下保護關鍵藥物。
從策略角度來看,市場環境將有利於那些將診斷與治療計劃相結合,並與製造商和服務供應商建立持久夥伴關係以確保供應可靠性的組織。包括關稅調整和不斷變化的監管預期在內的政策變化,持續帶來風險和機會。最終,將洞察轉化為改善患者預後,對於協調臨床路徑、管理目標和採購慣例至關重要,從而使它們在日常護理和危機應對中相輔相成。
將這些優先事項付諸實施的領導者不僅可以減輕眼前的風險,還可以為維持抗生素有效性和改善腹腔內感染患者預後的更廣泛努力做出貢獻。
The Intra-abdominal Infections Market is projected to grow by USD 49.70 billion at a CAGR of 9.20% by 2032.
| KEY MARKET STATISTICS | |
|---|---|
| Base Year [2024] | USD 24.57 billion |
| Estimated Year [2025] | USD 26.86 billion |
| Forecast Year [2032] | USD 49.70 billion |
| CAGR (%) | 9.20% |
Intra-abdominal infections represent a heterogeneous group of conditions that span simple localized inflammatory processes to complex, life-threatening polymicrobial sepsis. Clinicians confront a mix of community-acquired and hospital-acquired presentations that vary by source, host factors, and microbiology. As a result, early recognition and rapid source control remain the cornerstones of effective management, while antimicrobial selection must balance empiric breadth with de-escalation guided by culture and sensitivity data.
Diagnostic complexity stems from overlapping clinical presentations, variable culture yields, and evolving resistance patterns. Imaging, surgical assessment, and peritoneal cultures are critical, yet each has limitations that influence therapeutic timing. Concurrently, antimicrobial resistance among key pathogens has altered empirical therapy algorithms, prompting greater reliance on higher-tier agents and combination regimens in severe cases. These changes amplify the need for coordinated antimicrobial stewardship, multidisciplinary care pathways, and robust hospital surveillance to preserve therapeutic options and optimize outcomes.
Stakeholders across clinical, operational, and commercial domains must therefore align on priorities that include timely diagnostics, stewardship integration, and supply chain continuity. By understanding the clinical nuances and system pressures that drive treatment decisions, leaders can better design interventions that reduce morbidity, shorten hospital stays, and limit the collateral harm of unnecessary broad-spectrum antibiotic exposure.
The landscape of intra-abdominal infection management is undergoing rapid and consequential shifts driven by antimicrobial resistance, technological advances, and changes in care delivery models. Resistance trends are reshaping empiric prescribing patterns and elevating the clinical and economic value of agents with retained activity against multidrug-resistant Gram-negative organisms. Simultaneously, innovations in rapid diagnostics and molecular pathogen detection are beginning to shorten the interval between presentation and targeted therapy, enabling faster de-escalation when appropriate and reducing unnecessary exposure to broad-spectrum agents.
Care delivery transformations are equally impactful. Growth in ambulatory surgical centers and shifts toward earlier discharge and outpatient parenteral antimicrobial therapy have altered patient flows and medication utilization, requiring new coordination between inpatient teams and community providers. These transitions are compounded by evolving regulatory expectations for stewardship and reporting, which place a premium on measurable metrics and program accountability. As a result, stakeholders face a landscape where clinical efficacy, supply reliability, and stewardship compliance converge to determine both patient outcomes and organizational risk.
Taken together, these forces demand adaptive strategies that integrate novel diagnostics, stewardship protocols, and supply chain resilience while maintaining clinician autonomy in critical decision moments. Organizations that proactively align clinical pathways, procurement practices, and surveillance capabilities will be better positioned to manage complexity and sustain therapeutic options over the long term.
The policy environment surrounding trade and tariffs can materially influence the cost structure and availability of antimicrobial agents, manufacturing inputs, and medical supplies integral to intra-abdominal infection care. Changes to import duties and trade barriers alter manufacturing economics for active pharmaceutical ingredients and finished dosage forms, which in turn affect procurement strategies for hospitals and distributors. In practical terms, procurement teams may experience narrower supplier options, increased lead times, and higher acquisition costs for select intravenous antibiotics and parenteral formulations when tariffs disrupt established supply chains.
Clinicians and pharmacy leaders should anticipate secondary effects that manifest as alterations in hospital formularies and therapeutic guidelines. When sourcing constraints or price pressures exist, hospitals commonly reassess formulary inclusions and may substitute clinically equivalent agents or adjust stewardship policies to preserve critical stock. These operational responses require clear clinical governance to prevent unintended consequences such as suboptimal empiric coverage or inappropriate substitution in high-risk patients.
Moreover, manufacturers and contract manufacturers may respond to tariff-driven margin pressures by relocating production, redesigning supply agreements, or accelerating investments in regional manufacturing to mitigate exposure. Such strategic adaptations can improve long-term resilience but create short-term volatility. Therefore, cross-functional planning that combines procurement forecasting, inventory buffering, and continual clinical oversight is essential to maintain access and clinical integrity in the face of tariff-induced supply chain disruption.
A nuanced segmentation lens reveals how therapeutic choices, infection contexts, pathogen profiles, patient demographics, and care settings intersect to shape clinical and commercial dynamics. By antibiotic class, clinicians rely on carbapenems, cephalosporins, and penicillins to cover the broad spectrum of intra-abdominal pathogens. Within carbapenems, agents such as doripenem, ertapenem, imipenem/cilastatin, and meropenem are deployed based on pathogen suspicion, tissue penetration requirements, and resistance patterns. Cephalosporin use differentiates between third-generation options like cefotaxime and ceftriaxone and fourth-generation cefepime, each selected for specific Gram-negative coverage and central nervous system penetration when indicated. Penicillin-based combinations, including ampicillin/sulbactam and piperacillin/tazobactam, retain an important role for community-acquired polymicrobial infections and as empiric therapy in many institutional protocols.
Infection type segmentation between community-acquired and hospital-acquired presentations changes therapeutic imperatives. Community-acquired cases, subdivided into complicated and uncomplicated forms, often permit narrower empiric coverage when patients present without recent healthcare exposure. Conversely, hospital-acquired infections, whether associated with ICU care or post-surgical settings, demand broader empiric regimens because of increased risk of multidrug-resistant organisms. Pathogen-driven insight distinguishes anaerobic organisms such as Bacteroides fragilis and Clostridium species from Gram-negative pathogens including Enterobacteriaceae and Pseudomonas aeruginosa, and from Gram-positive agents like Enterococcus species and Staphylococcus aureus, each of which drives different empiric and definitive therapy choices and stewardship challenges.
Patient age group further modulates therapeutic decisions, as adult, geriatric, and pediatric populations present distinct pharmacokinetic and safety considerations that affect dosing, formulation selection, and monitoring. Finally, end user segmentation between ambulatory care centres and hospitals, with hospitals split into secondary and tertiary care, determines resource availability, access to advanced diagnostics, and procedural capabilities for source control. Collectively, these intersecting segments demand tailored clinical pathways, procurement strategies, and education programs to ensure that each patient cohort receives optimal, context-appropriate care.
Regional variation exerts a profound influence on clinical practice, supply chain logistics, and policy environments, shaping how providers and health systems approach intra-abdominal infections. In the Americas, treatment protocols and stewardship frameworks increasingly emphasize evidence-based empiric selection and the integration of rapid diagnostics in high-acuity centers, while supply chain consolidation and group purchasing organizations influence formulary decisions and pricing negotiations. These dynamics encourage coordination between clinical leaders and procurement to ensure consistent access to critical agents.
In Europe, Middle East & Africa, heterogeneity in healthcare infrastructure, regulatory oversight, and antimicrobial resistance profiles creates divergent priorities. High-resource centers may focus on rapid molecular diagnostics and advanced stewardship programs, whereas resource-constrained settings prioritize access to essential antibiotics, basic imaging, and surgical capacity. Policy-level interventions and regional collaborations play a larger role in supporting antimicrobial stewardship and addressing resistance surveillance in this diverse region.
Asia-Pacific presents a combination of high-volume clinical demand, rapid technological adoption, and varied domestic manufacturing capacity. Regional manufacturers can mitigate some supply disruptions, but demand pressures and resistance trends necessitate coordinated national strategies for stewardship and procurement. Across all regions, the interplay between regulation, manufacturing geography, and clinical practice determines both short-term operational choices and long-term resilience of supply and therapeutic options.
The competitive landscape for therapies and services relevant to intra-abdominal infections is characterized by a mix of established pharmaceutical manufacturers, contract producers, diagnostic innovators, and clinical service providers. Established drug producers often focus on maintaining reliable supply lines, extending product lifecycles, and supporting stewardship initiatives through education and formulary support. Contract manufacturers and specialized sterile injectable plants play a pivotal role in ensuring availability of parenteral antibiotics, creating opportunities for strategic partnerships and capacity investments.
Diagnostic companies and hospital laboratory networks are increasingly influential, as rapid identification technologies and susceptibility platforms directly change prescribing behavior and reduce time to optimal therapy. Collaboration between diagnostic vendors and clinical leaders can yield pathway-level improvements that reduce inappropriate broad-spectrum use and speed targeted therapy. Additionally, service providers that support outpatient parenteral antimicrobial therapy and post-discharge monitoring are expanding the continuum of care, enabling earlier transition from inpatient settings without sacrificing safety.
Strategic alliances between pharmaceutical manufacturers, diagnostic firms, and healthcare systems can create integrated offerings that pair reliable antimicrobial supply with diagnostic stewardship. Such collaboration also supports joint efforts to address antimicrobial resistance through data sharing, formulary optimization, and targeted education for prescribers and care teams.
Healthcare leaders should adopt a set of practical, prioritized actions to strengthen clinical outcomes, maintain therapeutic access, and mitigate supply risks. First, align procurement and clinical governance by instituting regular cross-functional reviews of formulary choices, inventory exposure, and clinically acceptable therapeutic alternatives to ensure continuity in the face of supply variability. Second, accelerate adoption of rapid diagnostic tools and embed explicit de-escalation protocols into care pathways so that empiric broad-spectrum therapy is narrowed promptly when appropriate, reducing resistance selection pressure and conserving higher-tier agents.
Third, expand outpatient parenteral antimicrobial therapy frameworks and strengthen discharge coordination to reduce inpatient length of stay while maintaining safety. Fourth, implement tiered stewardship metrics that account for infection type, pathogen risk, and patient age to target education and audit efforts where they will have the greatest clinical impact. Fifth, engage manufacturers and contract manufacturers proactively through multi-year agreements, dual-sourcing where feasible, and contingency planning to alleviate tariff- or disruption-related scarcity. Finally, invest in workforce training that equips surgical teams, intensivists, pharmacists, and infectious disease specialists with the skills to execute rapid source control, optimized dosing, and coordinated follow-up care.
Taken together, these actions balance immediate operational resilience with long-term stewardship objectives, positioning organizations to deliver high-quality care while preserving therapeutic effectiveness.
The research underpinning this executive summary uses a mixed-methods approach that integrates primary clinical inputs, facility-level operational data, and comprehensive secondary research to ensure robust, context-sensitive conclusions. Primary inputs were gathered through structured interviews and advisory discussions with clinicians across surgical, critical care, infectious disease, and pharmacy disciplines, complemented by procurement and supply chain professionals to capture operational realities. These firsthand perspectives informed scenario building around drug selection, stewardship practices, and supply contingencies.
Secondary research synthesized peer-reviewed literature, clinical guidelines, regulatory documents, and publicly available surveillance data from health authorities to ground findings in established evidence. Real-world data sources such as hospital utilization patterns, antimicrobial consumption records, and laboratory susceptibility reports were analyzed to identify practice variation and resistance trends. Where applicable, data triangulation validated qualitative insights against observable operational metrics.
Analytical methods included comparative clinical pathway mapping, sensitivity analysis of supply disruption scenarios, and stakeholder impact assessments to prioritize recommendations. Throughout the process, attention to data provenance, methodological transparency, and expert validation ensured that conclusions reflect clinical reality and operational feasibility.
This executive synthesis highlights a set of converging priorities: protect access to effective antimicrobials, accelerate diagnostic-driven therapy, and reinforce system-level resilience against supply and policy volatility. Clinically, the imperative is clear-prompt source control and tailored antimicrobial therapy save lives, but achieving this consistently requires investments in diagnostics, stewardship infrastructure, and cross-disciplinary coordination. Operationally, procurement and pharmacy leaders must anticipate supply chain shocks and maintain flexible strategies that safeguard critical agents without compromising clinical standards.
Strategically, the market environment rewards organizations that integrate diagnostics with therapeutic planning and that form durable partnerships with manufacturers and service providers to ensure supply reliability. Policy changes, including tariff adjustments and evolving regulatory expectations, will continue to create both risks and opportunities; responsive systems will be those that combine clinical rigor with agile contracting and contingency planning. Ultimately, translating insight into improved patient outcomes depends on aligning clinical pathways, stewardship goals, and procurement practices so that each reinforces the others in routine care and crisis response.
Leaders who operationalize these priorities will not only mitigate immediate risks but also contribute to broader efforts to preserve antimicrobial effectiveness and improve outcomes for patients with intra-abdominal infections.