Abstract
Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in hospitals worldwide. The cornerstones of effective treatment of IAIs include early recognition, adequate source control, appropriate antimicrobial therapy, and prompt physiologic stabilization using a critical care environment, combined with an optimal surgical approach. Together, the World Society of Emergency Surgery (WSES), the Global Alliance for Infections in Surgery (GAIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), and the American Association for the Surgery of Trauma (AAST) have jointly completed an international multi-society document in order to facilitate clinical management of patients with IAIs worldwide building evidence-based clinical pathways for the most common IAIs. An extensive non-systematic review was conducted using the PubMed and MEDLINE databases, limited to the English language. The resulting information was shared by an international task force from 46 countries with different clinical backgrounds. The aim of the document is to promote global standards of care in IAIs providing guidance to clinicians by describing reasonable approaches to the management of IAIs.
Highlights
Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in emergency surgical units worldwide.The cornerstone of effective treatment of IAIs includes early recognition, adequate source control, appropriate antimicrobial therapy, and prompt physiologic stabilization using intravenous fluid therapy in critically ill patients
Patients with IAIs enrolled in clinical trials have often an increased likelihood of cure and survival. This is due to the fact that selective trial eligibility criteria usually exclude patients with comorbid diseases and other factors which are associated with death from IAI [1]. Affecting both high-income countries and low- and middle-income countries (LMICS), IAIs are a tremendous source of lost life, livelihood, and resources
Intermediate-risk patients randomized to the imaging and observation strategies had the same proportion of negative appendectomies (6.4% versus 6.7%, p = 0.884), number of hospital admissions, rates of perforation, and length of hospital stay, but routine imaging was associated with an increased proportion of patients treated for Acute appendicitis (AA) (53.4% versus 46.3%, p = 0.020) [75]
Summary
Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in emergency surgical units worldwide. Basing on pharmacokinetics/pharmacodynamics principles the traditional intermittent dosing of each agent may be replaced with prolonged infusions of certain beta-lactam antibiotics especially in those critically ill patients with infections caused by Gram-negative bacilli that have elevated but susceptible MICs to the chosen agent [55] Antibiotics such as aminoglycosides exhibit concentration-dependent activity and should be administered in a once-daily manner (or with the least possible number of daily administrations) in order to achieve high peak plasma concentrations. The high morbidity and occasional mortality associated with acute appendicitis are mostly related to the delay in the presentation by patients or delay in diagnosis by the clinician These delays may result in complications like gangrene, perforation, appendiceal mass, and generalized peritonitis, all of which would prolong hospital stay and increase the cost of treatment. In patients with documented beta-lactam allergy, consider the use of antibiotic combinations with Amikacin 15–20 mg/kg daily
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
