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Journal Article Review Epublish 3 citations

PubMed: 38851757 DOI: 10.1186/s13017-024-00551-w

Management of intra-abdominal infections: recommendations by the Italian council for the optimization of antimicrobial use.

World J Emerg Surg 19(1):23

Authors: Massimo Sartelli, Carlo Tascini, Federico Coccolini, Fabiana Dellai, Luca Ansaloni, Massimo Antonelli, Michele Bartoletti, Matteo Bassetti, Federico Boncagni, Massimo Carlini, Anna Maria Cattelan, Arturo Cavaliere, Marco Ceresoli, Alessandro Cipriano, Andrea Cortegiani, Francesco Cortese, Francesco Cristini, Eugenio Cucinotta, Lidia Dalfino, Gennaro De Pascale, Francesco Giuseppe De Rosa, Marco Falcone, Francesco Forfori, Paola Fugazzola, Milo Gatti, Ivan Gentile, Lorenzo Ghiadoni, Maddalena Giannella, Antonino Giarratano, Alessio Giordano, Massimo Girardis, Claudio Mastroianni, Gianpaola Monti, Giulia Montori, Miriam Palmieri, Marcello Pani, Ciro Paolillo, Dario Parini, Giustino Parruti, Daniela Pasero, Federico Pea, Maddalena Peghin, Nicola Petrosillo, Mauro Podda, Caterina Rizzo, Gian Maria Rossolini, Alessandro Russo, Loredana Scoccia, Gabriele Sganga, Liana Signorini … and 12 other authors

Affiliations

  • Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100, Macerata, Italy.
  • Infectious Diseases Clinic, Santa Maria Della Misericordia University Hospital of Udine, ASUFC, Udine, Italy.
  • Infectious Diseases Clinic, Department of Medicine (DAME), University of Udine, Udine, Italy.
  • Department of General, Emergency and Trauma Surgery, Azienda Ospedaliero Universitaria Pisana, University Hospital, Pisa, Italy.
  • Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
  • Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
  • Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.
  • Dipartimento di Scienze Dell'Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Department of Biomedical Sciences, Humanitas University, Milan, Italy.
  • Infectious Disease Unit, IRCCS Humanitas Research Hospital, Milan, Italy.
  • Division of Infectious Diseases, Department of Health Sciences, University of Genova, Genoa, Italy.
  • Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
  • Anesthesiology and Intensive Care Unit, Macerata Hospital, Macerata, Italy.
  • Department of General Surgery, S. Eugenio Hospital, Rome, Italy.
  • Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy.
  • Department of Molecular Medicine, University of Padua, Padua, Italy.
  • Unit of Hospital Pharmacy, Viterbo Local Health Authority, Viterbo, Italy.
  • General and Emergency Surgery, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy.
  • Department of Emergency Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy.
  • Department of Precision Medicine in Medical Surgical and Critical Care, University of Palermo, Palermo, Italy.
  • Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy.
  • Emergency Surgery Unit, San Filippo Neri Hospital, Rome, Italy.
  • Infectious Diseases Unit, AUSL Romagna, Forlì and Cesena Hospitals, Forlì, Italy.
  • Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
  • Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Section of General Surgery, University of Messina, Messina, Italy.
  • Anesthesia and Intensive Care Unit, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University of Bari, Bari, Italy.
  • Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy.
  • Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy.
  • Anesthesia and Intensive Care, Anesthesia and Resuscitation Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy.
  • Clinical Pharmacology Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
  • Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
  • Department on Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
  • Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
  • Unit of Emergency Surgery, Careggi University Hospital, Florence, Italy.
  • Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.
  • Department of Public Health and Infectious Diseases, AOU Policlinico Umberto 1, Sapienza University of Rome, Rome, Italy.
  • Department of Anesthesia and Intensive Care, ASST GOM Niguarda Ca' Granda, Milan, Italy.
  • Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Vittorio Veneto, Italy.
  • Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100, Macerata, Italy.
  • Hospital Pharmacy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Emergency Department, University of Verona, Verona, Italy.
  • General Surgery Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy.
  • Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy.
  • Department of Emergency, Anaesthesia and Intensive Care Unit, ASL1 Sassari, Sassari, Italy.
  • Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
  • Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy.
  • Infection Prevention and Control Service, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
  • Department of Surgical Science, University of Cagliari, Cagliari, Italy.
  • Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
  • Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
  • Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy.
  • Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.
  • Infectious and Tropical Disease Unit, "Renato Dulbecco" Teaching Hospital, Catanzaro, Italy.
  • Hospital Pharmacy Unit, Macerata Hospital, AST Macerata, Macerata, Italy.
  • Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.
  • Department of Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, Rome, Italy.
  • Unit of Infectious and Tropical Diseases, ASST Spedali Civili Di Brescia, Brescia, Italy.

Abstract

Intra-abdominal infections (IAIs) are common surgical emergencies and are an important cause of morbidity and mortality in hospital settings, particularly if poorly managed. The cornerstones of effective IAIs management include early diagnosis, adequate source control, appropriate antimicrobial therapy, and early physiologic stabilization using intravenous fluids and vasopressor agents in critically ill patients. Adequate empiric antimicrobial therapy in patients with IAIs is of paramount importance because inappropriate antimicrobial therapy is associated with poor outcomes. Optimizing antimicrobial prescriptions improves treatment effectiveness, increases patients' safety, and minimizes the risk of opportunistic infections (such as Clostridioides difficile) and antimicrobial resistance selection. The growing emergence of multi-drug resistant organisms has caused an impending crisis with alarming implications, especially regarding Gram-negative bacteria. The Multidisciplinary and Intersociety Italian Council for the Optimization of Antimicrobial Use promoted a consensus conference on the antimicrobial management of IAIs, including emergency medicine specialists, radiologists, surgeons, intensivists, infectious disease specialists, clinical pharmacologists, hospital pharmacists, microbiologists and public health specialists. Relevant clinical questions were constructed by the Organizational Committee in order to investigate the topic. The expert panel produced recommendation statements based on the best scientific evidence from PubMed and EMBASE Library and experts' opinions. The statements were planned and graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence. On November 10, 2023, the experts met in Mestre (Italy) to debate the statements. After the approval of the statements, the expert panel met via email and virtual meetings to prepare and revise the definitive document. This document represents the executive summary of the consensus conference and comprises three sections. The first section focuses on the general principles of diagnosis and treatment of IAIs. The second section provides twenty-three evidence-based recommendations for the antimicrobial therapy of IAIs. The third section presents eight clinical diagnostic-therapeutic pathways for the most common IAIs. The document has been endorsed by the Italian Society of Surgery.

MeSH

Surgical Procedures, Operative, Diagnosis, Emergencies, Therapeutics, Gram-Negative Bacteria, Intraabdominal Infections

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