World Journal of Emergency Surgery (Jun 2024)
Management of intra-abdominal infections: recommendations by the Italian council for the optimization of antimicrobial use
- 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,
- Stefania Stefani,
- Mario Tumbarello,
- Fabio Tumietto,
- Massimo Valentino,
- Mario Venditti,
- Bruno Viaggi,
- Francesca Vivaldi,
- Claudia Zaghi,
- Francesco M. Labricciosa,
- Fikri Abu-Zidan,
- Fausto Catena,
- Pierluigi Viale
Affiliations
- Massimo Sartelli
- Department of Surgery, Macerata Hospital
- Carlo Tascini
- Infectious Diseases Clinic, Santa Maria Della Misericordia University Hospital of Udine, ASUFC
- Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Azienda Ospedaliero Universitaria Pisana, University Hospital
- Fabiana Dellai
- Infectious Diseases Clinic, Department of Medicine (DAME), University of Udine
- Luca Ansaloni
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo
- Massimo Antonelli
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore
- Michele Bartoletti
- Department of Biomedical Sciences, Humanitas University
- Matteo Bassetti
- Division of Infectious Diseases, Department of Health Sciences, University of Genova
- Federico Boncagni
- Anesthesiology and Intensive Care Unit, Macerata Hospital
- Massimo Carlini
- Department of General Surgery, S. Eugenio Hospital
- Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital
- Arturo Cavaliere
- Unit of Hospital Pharmacy, Viterbo Local Health Authority
- Marco Ceresoli
- General and Emergency Surgery, Milano-Bicocca University, School of Medicine and Surgery
- Alessandro Cipriano
- Department of Emergency Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa
- Andrea Cortegiani
- Department of Precision Medicine in Medical Surgical and Critical Care, University of Palermo
- Francesco Cortese
- Emergency Surgery Unit, San Filippo Neri Hospital
- Francesco Cristini
- Infectious Diseases Unit, AUSL Romagna, Forlì and Cesena Hospitals
- Eugenio Cucinotta
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, Section of General Surgery, University of Messina
- Lidia Dalfino
- Anesthesia and Intensive Care Unit, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University of Bari
- Gennaro De Pascale
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore
- Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin
- Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa
- Francesco Forfori
- Anesthesia and Intensive Care, Anesthesia and Resuscitation Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa
- Paola Fugazzola
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo
- Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna
- Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II
- Lorenzo Ghiadoni
- Department of Emergency Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa
- Maddalena Giannella
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna
- Antonino Giarratano
- Department of Precision Medicine in Medical Surgical and Critical Care, University of Palermo
- Alessio Giordano
- Unit of Emergency Surgery, Careggi University Hospital
- Massimo Girardis
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia
- Claudio Mastroianni
- Department of Public Health and Infectious Diseases, AOU Policlinico Umberto 1, Sapienza University of Rome
- Gianpaola Monti
- Department of Anesthesia and Intensive Care, ASST GOM Niguarda Ca’ Granda
- Giulia Montori
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital
- Miriam Palmieri
- Department of Surgery, Macerata Hospital
- Marcello Pani
- Hospital Pharmacy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS
- Ciro Paolillo
- Emergency Department, University of Verona
- Dario Parini
- General Surgery Department, Santa Maria Della Misericordia Hospital
- Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital
- Daniela Pasero
- Department of Emergency, Anaesthesia and Intensive Care Unit
- Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna
- Maddalena Peghin
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi
- Nicola Petrosillo
- Infection Prevention and Control Service, Fondazione Policlinico Universitario Campus Bio-Medico
- Mauro Podda
- Department of Surgical Science, University of Cagliari
- Caterina Rizzo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa
- Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence
- Alessandro Russo
- Department of Medical and Surgical Sciences, “Magna Graecia” University
- Loredana Scoccia
- Hospital Pharmacy Unit, Macerata Hospital, AST Macerata
- Gabriele Sganga
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario A Gemelli IRCCS
- Liana Signorini
- Unit of Infectious and Tropical Diseases, ASST Spedali Civili Di Brescia
- Stefania Stefani
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania
- Mario Tumbarello
- Department of Medical Biotechnologies, University of Siena
- Fabio Tumietto
- UO Antimicrobial Stewardship-AUSL Bologna
- Massimo Valentino
- Radiology Department, Sant’Antonio Abate Hospital
- Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome
- Bruno Viaggi
- Intensive Care Department, Careggi Hospital
- Francesca Vivaldi
- Hospital Pharmacy Unit, Asl Toscana Nord Ovest
- Claudia Zaghi
- General, Emergency and Trauma Surgery Department, Vicenza Hospital
- Francesco M. Labricciosa
- Global Alliance for Infections in Surgery
- Fikri Abu-Zidan
- Statistics and Research Methodology, The Research Office, College of Medicine and Health Sciences, United Arab Emirates University
- Fausto Catena
- Emergency and General Surgery Department, Bufalini Hospital
- Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna
- DOI
- https://doi.org/10.1186/s13017-024-00551-w
- Journal volume & issue
-
Vol. 19,
no. 1
pp. 1 – 36
Abstract
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.
Keywords
