Surgical Infection Society Research Articles

Clinical Update on the Use of Moxifloxacin in the Treatment of Community-Acquired Complicated Intraabdominal Infections

Community-acquired complicated intraabdominal infections (cIAIs) present problems for clinicians and have substantial impact on hospital resources. Because of the polymicrobial nature of these infections, successful management of cIAIs depends on timely and appropriate use of antisepsis and antiinfective strategies. The literature pertinent to this article was reviewed. The Surgical Infection Society and the Infectious Disease Society of America guidelines recommend a variety of single and combined antimicrobial therapies, including fluoroquinolone therapy, for prophylactic and definitive treatment of cIAIs with different severities. Moxifloxacin, a fluoroquinolone, demonstrates a broad spectrum of antimicrobial (including anaerobic) activity, good tissue penetration into the gastrointestinal tract, and a good tolerability profile. Clinical data also have demonstrated that moxifloxacin is effective as monotherapy for patients with cIAIs. This review identifies the clinical issues impacting antimicrobial selection in cIAI and discusses data on the role of moxifloxacin in light of the current guidelines for management of these patients. Moxifloxacin provides clinicians with a convenient monotherapy option for the treatment of mild-to-moderate cIAIs.

Evaluating Evidence and Grading Recommendations: The SIS/IDSA Guidelines for the Treatment of Complicated Intra-Abdominal Infections

Guidelines for the management and treatment of complicated intra-abdominal infections have been generated by a joint effort of the Surgical Infection Society and the Infectious Diseases Society of America. Continued review is needed of the process of these guideline development efforts, the evidence collected, and the recommendations developed by this collaboration. The literature employed in the development of these guidelines and the process for the development of the recommendations was reviewed. The process for the development of the guidelines required providing answers to questions surrounding the type of evidence, the quality of that evidence, and whether the data used were generated from clinical trials with investigators blinded to the randomization scheme. The recommendations most commonly follow randomized comparative trials, with observational reports and expert opinions assuming a lesser role. Sources of bias and conflict of interest considerations also must be important in guideline development, with full disclosure from participants. Standards for the evaluation of data and recommendations in the guidelines for complicated intra-abdominal infection provided a rigorous evaluation of available clinical information. This process serves as a model for the development of additional guidelines for patient care.

Perspectives in Surgical Infections: What Does the Future Hold?

I am honored and humbled to stand before you today, as I follow in the footsteps of the distinguished prior Surgical Infection Society (SIS) Presidents, Doctors Stephen F. Lowry, John C. Marshall, Timothy R. Billiar, Edwin A. Deitch, and Philip S. Barie, who have served in the last five years. As I contemplated the choice of topic for my Presidential Address, I reviewed the addresses of each of these individuals (Fig. 1). I also reviewed the history of the SIS and its first President, Doctor William A. Altemeier, a true pioneer in surgical infectious diseases. The topic of Doctor Altemeier’s presidential address was ‘‘Sepsis in Surgery,’’ and the paper was read at the first annual meeting of the Society in Chicago on April 25, 1981. In this address, he stated: ‘‘Infection has always been a prominent feature of human life, and sepsis in modern surgery continues to be a significant health problem throughout the world. For this reason, the Surgical Infection Society has been formed and is holding its first meeting here today’’ [1]. I hope you will indulge me today, as I have chosen to return to the topic of surgical infections to provide a current perspective and to contemplate what the future holds and the role the SIS may play. I review three categories of surgical infections: (1) surgical site and skin infections; (2) complicated intra-abdominal infections, and (3) nosocomial and other healthcare-associated infections, including ventilator-associated pneumonia (VAP) and catheter-related blood stream infections (CR-BSI). Lastly, I touch on the topic of acute care surgery and discuss the role the SIS may play in the development of this emerging field.

Program of the Thirtieth Annual Meeting of the Surgical Infection Society

Program of the Thirtieth Annual Meeting of the Surgical Infection Society

Diagnosis and Management of Complicated Intra-Abdominal Infection in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America

Evidence-based guidelines for managing patients with intra-abdominal infection were prepared by an Expert Panel of the Surgical Infection Society and the Infectious Diseases Society of America. These updated guidelines replace those previously published in 2002 and 2003. The guidelines are intended for treating patients who either have these infections or may be at risk for them. New information, based on publications from the period 2003-2008, is incorporated into this guideline document. The panel has also added recommendations for managing intra-abdominal infection in children, particularly where such management differs from that of adults; for appendicitis in patients of all ages; and for necrotizing enterocolitis in neonates.

Diagnosis and Management of Complicated Intra-abdominal Infection in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America

Evidence-based guidelines for managing patients with intra-abdominal infection were prepared by an Expert Panel of the Surgical Infection Society and the Infectious Diseases Society of America. These updated guidelines replace those previously published in 2002 and 2003. The guidelines are intended for treating patients who either have these infections or may be at risk for them. New information, based on publications from the period 2003-2008, is incorporated into this guideline document. The panel has also added recommendations for managing intra-abdominal infection in children, particularly where such management differs from that of adults; for appendicitis in patients of all ages; and for necrotizing enterocolitis in neonates.

Risk factors for multidrug resistant bacteria and optimization of empirical antibiotic therapy in postoperative peritonitis

IntroductionThe main objective was to determine risk factors for presence of multidrug resistant bacteria (MDR) in postoperative peritonitis (PP) and optimal empirical antibiotic therapy (EA) among options proposed by Infectious Disease Society of America and the Surgical Infection Society guidelines.MethodsOne hundred patients hospitalised in the intensive care unit (ICU) for PP were reviewed. Clinical and microbiologic data, EA and its adequacy were analysed. The in vitro activities of 9 antibiotics in relation to the cultured bacteria were assessed to propose the most adequate EA among 17 regimens in the largest number of cases.ResultsA total of 269 bacteria was cultured in 100 patients including 41 episodes with MDR. According to logistic regression analysis, the use of broad-spectrum antibiotic between initial intervention and reoperation was the only significant risk factor for emergence of MDR bacteria (odds ratio (OR) = 5.1; 95% confidence interval (CI) = 1.7 - 15; P = 0.0031). Antibiotics providing the best activity rate were imipenem/cilastatin (68%) and piperacillin/tazobactam (53%). The best adequacy for EA was obtained by combinations of imipenem/cilastatin or piperacillin/tazobactam, amikacin and a glycopeptide, with values reaching 99% and 94%, respectively. Imipenem/cilastin was the only single-drug regimen providing an adequacy superior to 80% in the absence of broad spectrum antibiotic between initial surgery and reoperation.ConclusionsInterval antibiotic therapy is associated with the presence of MDR bacteria. Not all regimens proposed by Infectious Disease Society of America and the Surgical Infection Society guidelines for PP can provide an acceptable rate of adequacy. Monotherapy with imipenem/cilastin is suitable for EA only in absence of this risk factor for MDR. For other patients, only antibiotic combinations may achieve high adequacy rates.

Treatment of Complicated Skin and Soft Tissue Infections

Skin and soft tissue infections (SSTIs) may produce substantial morbidity and mortality rates, particularly those classified as complicated or necrotizing. To weigh the strength of recommendations using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methodology and to provide evidence-based recommendations for diagnosis and management for SSTIs. Computerized identification of published research and review of relevant articles. All published reports on the management of complicated and necrotizing SSTIs were evaluated by an expert panel of members of the Surgical Infection Society according to published guidelines for evidence-based medicine. The quality of the evidence was judged by the GRADE methodology and criteria. Practice surveys, pharmacokinetic studies, and reviews or duplicative publications presenting primary data already considered were excluded from analysis. Information on demographics, study dates, microbiology findings, antibiotic type, surgical interventions, infection-related outcomes, and the methodologic quality of the studies was extracted. Results were submitted to the Therapeutic Agents Committee of the Surgical Infection Society for review prior to creation of the final consensus document. Current surgical and antibiotic management of complicated SSTIs is based on a small number of studies that often have insufficient power to draw well-supported conclusions, with the exception of antimicrobial therapy for non-necrotizing soft tissue infections, for which ample data are available.

Surgical Infection Society and Surgical Infection Society-Europe Abstract Author Index

Surgical Infection Society and Surgical Infection Society-Europe Abstract Author Index

The 3rd Combined Meeting of the Surgical Infection Societies of North America and Europe Oral Poster Presentation Abstracts

Surgical InfectionsVol. 10, No. 2 The 3rd Combined Meeting of the Surgical Infection Societies of North America and Europe Oral Poster Presentation AbstractsPublished Online:23 Apr 2009https://doi.org/10.1089/sur.2009.9944AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetails Volume 10Issue 2Apr 2009 Information© 2009 Mary Ann Liebert, Inc.To cite this article:The 3rd Combined Meeting of the Surgical Infection Societies of North America and Europe Oral Poster Presentation Abstracts.Surgical Infections.Apr 2009.219-222.http://doi.org/10.1089/sur.2009.9944Published in Volume: 10 Issue 2: April 23, 2009PDF download

The 3rd Combined Meeting of the Surgical Infection Societies of North America and Europe Oral Presentation Abstracts

The 3^rd Combined Meeting of the Surgical Infection Societies of North America and Europe Oral Presentation Abstracts

The 3rd Combined Meeting of the Surgical Infection Societies of North America and Europe Program

Surgical InfectionsVol. 10, No. 2 The 3rd Combined Meeting of the Surgical Infection Societies of North America and Europe ProgramPublished Online:23 Apr 2009https://doi.org/10.1089/sur.2009.9947AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetails Volume 10Issue 2Apr 2009 Information© 2009 Mary Ann Liebert, Inc.To cite this article:The 3rd Combined Meeting of the Surgical Infection Societies of North America and Europe Program.Surgical Infections.Apr 2009.167-186.http://doi.org/10.1089/sur.2009.9947Published in Volume: 10 Issue 2: April 23, 2009PDF download

The 3rd Combined Meeting of the Surgical Infection Societies of North America and Europe Poster Presentation Abstracts

Surgical InfectionsVol. 10, No. 2 The 3rd Combined Meeting of the Surgical Infection Societies of North America and Europe Poster Presentation AbstractsPublished Online:23 Apr 2009https://doi.org/10.1089/sur.2009.9943AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byComparing Mechanical Bowel Preparation With Both Oral and Systemic Antibiotics Versus Mechanical Bowel Preparation and Systemic Antibiotics Alone for the Prevention of Surgical Site Infection After Elective Colorectal SurgeryDiseases of the Colon & Rectum, Vol. 59, No. 1 Volume 10Issue 2Apr 2009 Information© 2009 Mary Ann Liebert, Inc.To cite this article:The 3rd Combined Meeting of the Surgical Infection Societies of North America and Europe Poster Presentation Abstracts.Surgical Infections.Apr 2009.223-254.http://doi.org/10.1089/sur.2009.9943Published in Volume: 10 Issue 2: April 23, 2009PDF download

2008 Surgical Infection Society Presidential Address The Value of Connections

Surgical InfectionsVol. 10, No. 1 2008 SURGICAL INFECTION SOCIETY PRESIDENTIAL ADDRESS2008 Surgical Infection Society Presidential Address The Value of ConnectionsStephen F. LowryStephen F. LowrySearch for more papers by this authorPublished Online:19 Mar 2009https://doi.org/10.1089/sur.2009.004AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byAn Analysis of Past Surgical Infection Society Award Recipients Jeffrey A. Claridge, Aman Banerjee, Brenda M. Zosa, Lynn J. Hydo, Pamela A. Lipsett, and Philip S. Barie20 May 2016 | Surgical Infections, Vol. 17, No. 3Never Say Never Again! The Thirty-third Presidential Address to the Surgical Infection Society William G. Cheadle and Rebecca Barnett19 June 2014 | Surgical Infections, Vol. 15, No. 3Passing in the Night: A Tipping Point in Surgical Training Pamela A. Lipsett5 March 2012 | Surgical Infections, Vol. 13, No. 1 Volume 10Issue 1Feb 2009 Information© 2009 Mary Ann Liebert, Inc.To cite this article:Stephen F. Lowry.2008 Surgical Infection Society Presidential Address The Value of Connections.Surgical Infections.Feb 2009.1-8.http://doi.org/10.1089/sur.2009.004Published in Volume: 10 Issue 1: March 19, 2009PDF download

Survey of Surgical Infections Currently Known (SOSICK): A Multicenter Examination of Antimicrobial Use from the Surgical Infection Society Scientific Studies Committee

The Scientific Studies Committee of the Surgical Infection Society undertook the present study to examine the prevalence of and indications for antimicrobial use in intensive care units where members of the Society practice. Information and data collection sheets were posted on the Internet for download by members interested in participating. All centers were required to obtain approval from their local human subjects research office or equivalent. A one-week time was set during which the center could collect information on any one day, at the center's convenience. Data collection sheets were then sent to the lead author for analysis. Seventeen centers reported data for 371 patients in 22 intensive care units. Trauma and general surgical patients comprised 224 of the patients (60%). The indications for anti-infective agents were prophylactic (22%), empiric (27%), therapeutic with known pathogen (41%), therapeutic without known pathogen (e.g., cellulitis) (4%), insistence of influential practitioner (4%), or non-anti-infective purposes (e.g., erythromycin for gastric motility) (2%). Only 44%, 29%, and 54% of the orders for prophylactic, empiric, and therapeutic antibiotics, respectively, had date-certain stop dates. The antimicrobial drugs most commonly used were vancomycin, piperacillin-tazobactam, and fluconazole. Most patients were receiving antimicrobial agents. Polypharmacy was common. Most patients did not have a date-certain stop date. This study sets the benchmark for future study regarding antibiotic prescribing behavior in surgical intensive care units.

Coming of Age

Surgical InfectionsVol. 9, No. 2 SURGICAL INFECTION SOCIETY PRESIDENTIAL ADDRESSComing of AgeJohn C. MarshallJohn C. MarshallSearch for more papers by this authorPublished Online:21 Apr 2008https://doi.org/10.1089/sur.2008.9971AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byThe 38th Surgical Infection Society Presidential Address: Just Advance the Needle! Addison K. May1 August 2018 | Surgical Infections, Vol. 19, No. 6Never Say Never Again! The Thirty-third Presidential Address to the Surgical Infection Society William G. Cheadle and Rebecca Barnett19 June 2014 | Surgical Infections, Vol. 15, No. 3Passing in the Night: A Tipping Point in Surgical Training Pamela A. Lipsett5 March 2012 | Surgical Infections, Vol. 13, No. 12008 Surgical Infection Society Presidential Address The Value of Connections Stephen F. Lowry19 March 2009 | Surgical Infections, Vol. 10, No. 1 Volume 9Issue 2Apr 2008 Information© 2008 Mary Ann Liebert, Inc.To cite this article:John C. Marshall.Coming of Age.Surgical Infections.Apr 2008.111-120.http://doi.org/10.1089/sur.2008.9971Published in Volume: 9 Issue 2: April 21, 2008PDF download

Surgical Infection Society–Europe Abstracts

Surgical Infection Society–Europe Abstracts

The Surgical Infection Society Guidelines on Antimicrobial Therapy for Children with Appendicitis

The Surgical Infection Society published their most recent recommendations for antimicrobial therapy in patients with intra-abdominal infections in 2002. These guidelines outlined several important considerations for the treatment of such infections, including which patients require antimicrobial agents, the appropriate duration of treatment, which antimicrobial regimens are appropriate, and the risk factors and indications for intensified regimens. However, the applicability of these recommendations to the pediatric population is not entirely clear. Systematic review of all literature regarding antimicrobial therapy in the most common intra-abdominal infection in children, appendicitis, with the goal of establishing guidelines for use. Children with uncomplicated (acute or gangrenous), but not perforated, appendicitis can be treated with prophylactic antimicrobial agents for 24 h or less. Children with perforated appendicitis can be treated after appendectomy in the same manner as adults with established intra-abdominal infections; i.e., with therapeutic antibiotics until no clinical evidence of infection exists. This is true after both laparoscopic and open operations. Whereas "triple" antibiotic therapy has been the gold standard in pediatric patients, monotherapy with broad-spectrum agents is equally effective and possibly more cost-effective. The nonoperative management of perforated appendicitis with interval appendectomy represents a unique problem, and guidelines for therapy are less well established. The evidence supports using guidelines in the pediatric population similar to those suggested for the adult population for the management of acute appendicitis.

Empiric Antimicrobial Therapy in Critical Illness: Results of a Surgical Infection Society Survey

Antibiotics are prescribed commonly in the intensive care unit (ICU). Often, therapy is initiated empirically; practice patterns are not well characterized. We documented approaches to empiric antibiotic therapy among members of the Surgical Infection Society (SIS). We sent a scenario-based questionnaire to all SIS members. The hypothetical cases addressed empiric broad-spectrum therapy for a patient with pyrexia and leukocytosis and the use of vancomycin for central venous catheter infection. The 113 respondents were primarily surgeons (96%) with a university-based practice (92%). Most attended in the ICU (72%), and they had practiced for 14 +/- 8 years. Whereas 63% of the respondents identified overuse of antibiotics as a problem in their ICU, only 19% said inadequate treatment of infection was a concern. For a febrile patient with negative cultures who was receiving antibiotics, estimates of the likelihood of infection increased across the three scenarios as the degree of organ failure increased (p < 0.0001; chi-square test). Deteriorating organ function was associated with a decision to broaden empiric therapy (58% vs. 33%; p < 0.0001) and to initiate anti-fungal therapy (27% vs. 9%; p < 0.0001) rather than to stop antibiotics and re-culture (15% vs. 51%; p < 0.0001). There was considerable variability in management strategy across the scenarios: Even in the face of organ dysfunction, 58% of physicians would add or change empiric therapy, whereas 30% would not. For each scenario, 23 to 25 antibiotic regimens were designated as optimal therapy. Only 45% of the respondents would initiate empiric vancomycin for suspected central line infection. Variability in approach was not explained by critical care practice, academic position, or country. Clinical deterioration is a strong determinant of a decision to initiate or broaden empiric antibiotic therapy during critical illness. The substantial variability in approach suggests a state of clinical equipoise that calls for more rigorous evaluation through a randomized controlled trial.

Surgical Infection Society Abstract Author Index

Surgical Infection Society Abstract Author Index