Abstract: Multiple factors can lead to treatment failure and death in the patients with intra-abdominal infection. These factors include advanced age, malignancy, significant cardiovascular compromise, significant liver and renal diseases, hypo-albuminemia, diffuse peritonitis, delayed initial source control, delayed and unexpected initial source control, and suspected infection with resistant pathogens. Scoring system such as Mannheim Peritonitis Index (MPI) and complicated intra-abdominal score can also help to evaluate the risk of intra-abdominal infection patients. Sepsis and septic shock are important risk factors. Treatment strategies include prompt resuscitation and organ function support, early appropriate source control measures, effective antibiotics coverage of pathogens, prevention and treatment of resistant bacterial.