Abstract
Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients.The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance.The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria.An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs.
Highlights
Judicious, careful and rational use of antimicrobials is an integral part of good clinical practice
Combined with the four phase 3 and 4 cIAI trials that demonstrated the noninferiority of tigecycline to the comparator regimens, these results suggest that deaths were less related to clinical failure and that other factors or patient co-morbidities were more likely to contribute to death [229]
An optimal antimicrobial approach to treating intra-abdominal infections (IAIs) involves a delicate balance between the optimization of empiric therapy, which improves clinical outcomes, and the reduction of excessive antimicrobial use, which increases the rate of emergence of antimicrobial-resistant strains
Summary
Careful and rational use of antimicrobials is an integral part of good clinical practice. AGORA, (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) was conceived to actively raise the awareness of the rational and judicious use of antimicrobial medications in the treatment of intra-abdominal infections, in modern health care This collaboration involves an international multidisciplinary task force, promoted by the World Society of Emergency Surgery (WSES), and endorsed by: the Surgical Infection Society (SIS), the American Association for the Surgery of Trauma (AAST), the Panamerican Trauma Society (PTS), the Indian Society for Trauma and Acute Care (ISTAC), the Korean Society of Acute Care Surgery (KSACS), the World Society of Abdominal Compartment Syndrome (WSACS), the South African Society of Clinical Microbiology (SASCM), the Hellenic Society for Chemotherapy, the Italian Society of Anti-Infective Therapy (SITA), The Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Therapy (SIAARTI), the Italian Society of Surgery (SIC), the Italian Association of Hospital Surgeons (ACOI), the Italian Society of Emergency Surgery and Trauma (SICUT), the Italian Society of Intensive Care (SITI) and the World Alliance Against Antibiotic Resistance (WAAAR). WAAAR is a non-profit non-governmental organization participating actively in the global fight against antibiotic resistance
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