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

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.

Antimicrobial Stewardship: A Call to Action for Surgeons

“…A growing body of evidence demonstrates that hospital based programs dedicated to improving antibiotic useASPs-can both optimize the management of infections and reduce adverse events associated with antibiotic use [19][20][21][22]. Ten years after the jointly published guidelines by the Centers for Disease Control and Prevention, Society for Healthcare Epidemiology of America, and Infectious Diseases Society of America, however, many acute care centers worldwide do not have any type of antimicrobial improvement program [23].…”

“…Hoffmann et al [20] published a review focusing on treatment modalities and antimicrobial stewardship initiatives in the management of IAIs. The authors concluded that to prevent the overuse of broad-spectrum agents, ASPs should work with their microbiology department.…”

Intra-abdominal infections: the role of different classifications on the selection of the best antibiotic treatment.

“…Clostridium difficile and organ damage. 6,8,10,14,51 The use of antibiotics impacts not only the individual recipient, but also others that may be colonized or infected by resistant bacteria. 50,52 The gain of constitutionally resistant pathogens and selective pressure for resistance in the unit, hospital or community is of rising consideration.…”

“…56 Due to the limited development of new antibiotics, particularly for gram-negative microorganisms, the careful use of antibiotic therapy is essential to hold the resistance rates and preserve the existent antibiotics. 10,52,55,57 Antimicrobial stewardship programs (ASP) can promote a better use of antibiotic therapy, de-escalation and reduce unsuitable prolonged durations of treatment, 8,18 being vital to hold and control resistance. 10,52,57 They are also important to promote public understanding of the danger of antimicrobial resistance.…”

“…52,56 In light of the promising complexity of choosing suitable antibiotic therapy, local and regional protocols must be settled on the support of community root, patient comorbidities, clinical severity, existence of recorded beta-lactam allergy and by assessing local bacterial resistance data, which must be developed by multidisciplinary teams (anesthetists-intensive care physicians, microbiologists, surgeons, infectious disease specialists and pharmacists). 7,8 Published articles have proven an improvement in antibiotic prescription practices after the implementation of antibiotic prescription protocols. 18,56,59 The misuse of antibiotics is a leading worldwide issue with an extensive economic influence on rising healthcare costs, due to the selection of MDR bacteria, culminating in extended hospital stay and a greater mortality, improving its use would probably lead to lower costs and better outcomes.…”