WSES consensus conference: Guidelines for first-line management of intra-abdominal infections

Abstract

Intra-abdominal infections are still associated with high rate of morbidity and mortality.A multidisciplinary approach to the management of patients with intra-abdominal infections may be an important factor in the quality of care. The presence of a team of health professionals from various disciplines, working in concert, may improve efficiency, outcome, and the cost of care.A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bologna on July 2010, during the 1st congress of the WSES, involving surgeons, infectious disease specialists, pharmacologists, radiologists and intensivists with the goal of defining recommendations for the early management of intra-abdominal infections.This document represents the executive summary of the final guidelines approved by the consensus conference.

Antimicrobial Stewardship: A Call to Action for Surgeons

“…A number of guidelines have been published evaluating antimicrobial management of IAIs [13,[40][41][42][43][44][45][46][47]. Only few studies have documented the impact of ASPs in the management of IAIs, however.…”

Antibiotic Management in Acute Care Surgery

“…The efficacy of time-dependent antibacterial agents in critically ill patients is based on the constant maintenance of suprainhibitory drug concentrations [13] and should be administered in multiple doses per day or in continuous infusion. For these antibiotics the use of intravenous continuous infusion, which ensures the highest steady-state concentration under the same total daily dosage, may be the most effective way of maximizing pharmacodynamic exposure [12] …”

“…Different approaches should be pursued according to the mechanism of antimicrobial activity exhibited by each antibiotic [12].…”

Antibiotics in interventional radiology

“…67 In liver abscesses, the most common organisms are Enterobacter species, Streptococcus species, Escherichia species, Staphylococcus species, Klebsiella species, anaerobes including Bacteroides species and Pseudomonas species. 68e71 There are many recommended antibiotic regimens, but the most common are third-generation cephalosporins (e.g., ceftriaxone) 70 to which Webb et al 68 and Pang et al 71 recommend adding metronidazole. Liu et al 70 also recommend a carbapenem (e.g., imipenem or meropenem), an anti-pseudomonal penicillin with a b-lactamase inhibitor (e.g., piperacillinetazobactam) and a fluoroquinolone (e.g., ciprofloxacin) with or without an aminoglycoside.…”

“…To each of these, Webb et al 68 recommend the addition of metronidazole to ensure coverage of anaerobic organisms. Other regimens include ampicillin, gentamicin, and metronidazole 68,71 and vancomycin, gentamicin, and metronidazole. 68 In the abdomen, the most common organisms involved in community-acquired infection are Enterobacteriaceae, Streptococcus species and anaerobes, in particular Bacteroides fragilis.…”