Treatment Modalities and Antimicrobial Stewardship Initiatives in the Management of Intra-Abdominal Infections.

Charles Hoffmann,Matthew Zak,Jack Brown,Lisa Avery

doi:10.3390/antibiotics5010011

Abstract

Antimicrobial stewardship programs (ASPs) focus on improving the utilization of broad spectrum antibiotics to decrease the incidence of multidrug-resistant Gram positive and Gram negative pathogens. Hospital admission for both medical and surgical intra-abdominal infections (IAIs) commonly results in the empiric use of broad spectrum antibiotics such as fluoroquinolones, beta-lactam beta-lactamase inhibitors, and carbapenems that can select for resistant organisms. This review will discuss the management of uncomplicated and complicated IAIs as well as highlight stewardship initiatives focusing on the proper use of broad spectrum antibiotics.

Highlights

Intra-abdominal infections (IAIs) are the second most common cause of infection-related mortality in intensive care units [1]
Authors commented that this finding may be due to the fact that appendicitis-associated pathogens generally arise from normal bowel flora and do not reflect the higher extended-spectrum beta-lactamase (ESBL) rates found in health care-associated
Patients randomized to antibiotic therapy had significantly higher rates of 30 day post-intervention peritonitis compared with the appendectomy group (8% vs. 2%, treatment difference 5.8; 95% CI, 0.3–12.1)

Summary

Introduction

Intra-abdominal infections (IAIs) are the second most common cause of infection-related mortality in intensive care units [1]. Common IAIs include appendicitis, diverticulitis and cholecystitis [1,2]. Recommendations for the diagnosis and management of complicated IAIs are reviewed in the Surgical Infection Society and the Infectious Diseases Society of America (SIS-IDSA). Tokyo Guidelines (TG13) for acute cholangitis and acute cholecystitis in 2013 [2,3,4]. These guidelines recommend antimicrobial therapy based on the severity and etiology of infection as well as the presence of underlying medical conditions. The treatment of IAIs involves a balance between optimizing antimicrobial therapy and reducing collateral damage of antimicrobial use, including emerging resistance and Clostridium difficile infections (CDI) [5,6].

Microbiology

Treatment

Conclusion

Diverticulitis

Cholecystitis

Antimicrobial Stewardship Initiatives

Findings

Conclusions