Comparison of Duration and Empiric Antibiotic Choice of Post-Operative Treatment in Abdominal Sepsis

Surat, Güzin; Meyer-Sautter, Pascal; Rüsch, Jan; Braun-Feldweg, Johannes; Germer, Christoph‐Thomas; Lock, Johan Friso

doi:10.1089/sur.2021.344

Cited by 2 publications

(3 citation statements)

References 30 publications

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“…Therefore, continuous evaluation and surveillance of local epidemiological microbial data are mandatory to enable adaptation of empiric antibiotic therapy. It has been recently shown that the implementation of antimicrobial stewardship programs is a highly effective tool to provide these data mentioned above and to supervise antibiotic treatment in intra-abdominal infections [ 44 , 45 , 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

Microbial Spectrum and Antibiotic Resistance in Patients Suffering from Penetrating Crohn’s Disease

Kusan

Surat

Kelm

et al. 2022

JCM

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Intraabdominal abscess formation occurs in up to 30% of patients suffering from Crohn´s disease (CD). While international guidelines recommend a step-up approach with a combination of empiric antibiotic therapy and percutaneous drainage to delay or even avoid surgery, evidence about microbial spectrum in penetrating ileitis is sparse. We retrospectively assessed outcomes of 46 patients with terminal penetrating Ileitis where microbial diagnostics have been performed and compared microbial spectrum and antibiotic resistance profile of CD patients with patients suffering from diverticulitis with intraabdominal abscess formation. In both groups, the most frequently isolated pathogen was the gram-negative bacterium E. coli belonging to the family of Enterobacterales. However, overall Enterobacterales were significantly more often verifiable in the control group than in CD patients. Furthermore, microbial analysis showed significant differences regarding isolation of anaerobic pathogens with decreased frequency in patients with CD. Subgroup analysis of CD patients to evaluate a potential influence of immunosuppressive therapy on microbial spectrum only revealed that Enterobacterales was less frequently detected in patients treated with steroids. Immunosuppressive therapy did not show any impact on all other groups of pathogens and did not change antibiotic resistance profile of CD patients. In conclusion, we were able to demonstrate that the microbial spectrum of CD patients does differ only for some pathogen species without increased rate of antibiotic resistance. However, the empiric antibiotic therapy for CD-associated intra-abdominal abscess remains challenging since different points such as local epidemiological and microbiological data, individual patient risk factors, severity of infection, and therapy algorithm including non-surgical and surgical therapy options should be considered before therapeutical decisions are made.

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Section: Discussionmentioning

confidence: 99%

Microbial Spectrum and Antibiotic Resistance in Patients Suffering from Penetrating Crohn’s Disease

Kusan

Surat

Kelm

et al. 2022

JCM

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“…In the setting of complicated IAIs, a short-course antimicrobial therapy following an adequate SC intervention is a proper strategy for complicated IAIs, while it is not required for uncomplicated IAIs, such as uncomplicated cholecystitis or appendicitis [ 106 , 137 , 138 , 139 , 140 ]. The empiric antimicrobial therapy for complicated IAIs should be started as soon as possible and drug choice should be based on local ecology and AMR data, preferring antimicrobials with a spectrum of action against Enterobacteriaceae, enteric streptococci and obligate enteric anaerobes [ 79 , 106 , 112 , 113 , 119 , 141 ]: Amoxicillin/clavulanate should be considered for empiric therapy in accordance with local AMR epidemiology, because the emergence of extended-spectrum beta-lactamases (ESBL) producing Enterobacteriaceae has reduced its efficacy [ 142 , 143 , 144 , 145 , 146 ]; Piperacillin/tazobactam is considered the optimal option for the treatment of complicated IAIs due to its broad spectrum of efficacy against Enterobacteriaceae, Pseudomonas, anaerobes, non-resistant Enterococci and certain classes of ESBL [ 145 , 147 , 148 ]; Third-generation cephalosporines (e.g., cefotaxime, ceftriaxone, ceftazidime) in combination with metronidazole are active against Enterobacteriaceae and may be considered for uncomplicated IAIs [ 146 , 149 ]. Recently, two fifth-generation cephalosporines, namely ceftolozane/tazobactam and ceftazidime/avibactam, have been approved as treatments for complicated IAIs in combination with metronidazole, given to their action against several multidrug resistant bacteria [ 150 , 151 , 152 ]; Carbapenems (imipenem, meropenem, ertapenem) have a broad spectrum of action and represent a useful resource against ESBL [ 146 , 153 , 154 ]; Aminoglycosides (e.g., amikacin, tigecyclin) should be considered in case of beta-lactam allergy due to controversies on their toxic sid...…”

Section: The Management Of Infections In Acute Care Surgerymentioning

confidence: 99%

“…Piperacillin/tazobactam is considered the optimal option for the treatment of complicated IAIs due to its broad spectrum of efficacy against Enterobacteriaceae, Pseudomonas, anaerobes, non-resistant Enterococci and certain classes of ESBL [ 145 , 147 , 148 ];…”

Section: The Management Of Infections In Acute Care Surgerymentioning

confidence: 99%

Antimicrobial Challenge in Acute Care Surgery

Schena¹,

de’Angelis

Carra

et al. 2022

Antibiotics

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The burden of infections in acute care surgery (ACS) is huge. Surgical emergencies alone account for three million admissions per year in the United States (US) with estimated financial costs of USD 28 billion per year. Acute care facilities and ACS patients represent boost sanctuaries for the emergence, development and transmission of infections and multi-resistant organisms. According to the World Health Organization, healthcare-associated infections affected around 4 million cases in Europe and 1.7 million in the US alone in 2011 with 39,000 and 99,000 directly attributable deaths, respectively. In this scenario, antimicrobial resistance arose as a public-health emergency that worsens patients’ morbidity and mortality and increases healthcare costs. The optimal patient care requires the application of comprehensive evidence-based policies and strategies aiming at minimizing the impact of healthcare associated infections and antimicrobial resistance, while optimizing the treatment of intra-abdominal infections. The present review provides a snapshot of two hot topics, such as antimicrobial resistance and systemic inflammatory response, and three milestones of infection management, such as source control, infection prevention, and control and antimicrobial stewardship.

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Comparison of Duration and Empiric Antibiotic Choice of Post-Operative Treatment in Abdominal Sepsis

Cited by 2 publications

References 30 publications

Microbial Spectrum and Antibiotic Resistance in Patients Suffering from Penetrating Crohn’s Disease

Microbial Spectrum and Antibiotic Resistance in Patients Suffering from Penetrating Crohn’s Disease

Antimicrobial Challenge in Acute Care Surgery

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