A focus on intra-abdominal infections

Abstract

Complicated intra-abdominal infections are an important cause of morbidity and are frequently associated with poor prognosis, particularly in higher risk patients.Well defined evidence-based recommendations for intra-abdominal infections treatment are partially lacking because of the limited number of randomized-controlled trials.Factors consistently associated with poor outcomes in patients with intra-abdominal infections include increased illness severity, failed source control, inadequate empiric antimicrobial therapy and healthcare-acquired infection.Early prognostic evaluation of complicated intra-abdominal infections is important to select high-risk patients for more aggressive therapeutic procedures.The cornerstones in the management of complicated intra-abdominal infections are both source control and antibiotic therapy.The timing and the adequacy of source control are the most important issues in the management of intra-abdominal infections, because inadequate and late control of septic source may have a negative effect on the outcomes.Recent advances in interventional and more aggressive techniques could significantly decrease the morbidity and mortality of physiologically severe complicated intra-abdominal infections, even if these are still being debated and are yet not validated by limited prospective trials.Empiric antimicrobial therapy is nevertheless important in the overall management of intra-abdominal infections. Inappropriate antibiotic therapy may result in poor patient outcomes and in the appearance of bacterial resistance.Antimicrobial management is generally standardised and many regimens, either with monotherapy or combination therapy, have proven their efficacy. Routine coverage especially against Enterococci and candida spp is not always recommended, but can be useful in particular clinical conditions. A de escalation approach may be recommended in patients with specific risk factors for multidrug resistant infections such as immunodeficiency and prolonged antibacterial exposure.Therapy should focus on the obtainment of adequate source control and adequate use of antimicrobial therapy dictated by individual patient risk factors. Other critical issues remain debated and more controversies are still open mainly because of the limited number of randomized controlled trials.

Efficacy and Safety of Moxifloxacin in Hospitalized Patients with Secondary Peritonitis: Pooled Analysis of Four Randomized Phase III Trials

“…The APACHE II scoring system was used to describe the severity of the disease in this analysis, as it was in most other studies in this field. Originally devised as a score to predict mortality upon ICU admission and generally considered a good marker of severity in these patients, its value in peritonitis has recently been questioned because it does not take into account the effect of interventions that may alter physiologic paramaters [8]. Patients with mild-to-moderate cIAIs generally have APACHE II scores of < 10 that are not associated with high mortality risk [25,44].…”

“…Adequate source control and prompt, appropriate empiric treatment is essential to improve outcome [3,4,8] and to reduce mortality [9]. Fluoroquinolones, which are broad-spectrum antibiotics with favorable efficacy and safety profiles for the management of mild-to-moderate cIAIs either as monotherapy (moxifloxacin) or in combination therapy (levofloxacin, ciprofloxacin), are recommended in the latest Surgical Infection Society (SIS)/ Infection Infectious Diseases Society of America (IDSA) guidelines for the treatment of mild-to-moderate infections [3,4].…”

Recommendations for Intra-abdominal Infections “Consensus Report”

“…Lokalizasyona göre İAE'ye neden olan etkenler, çok ilaca dirençli mikroorganizmalar ve spesifik dirençli mikroorganizmalar için risk faktörleri Tablo 2, 3 ve 4'te verilmiştir [13][14][15][16] . Tablo 2.…”

“…Tablo 2. Lokalizasyona göre intra-abdominal enfeksiyonlar ve etkenler [13][14][15][16] Enfeksiyon Etken [9] . Tüm hastalarda DM, ciddi kardiyopulmoner hastalık, immünsüpresyon, hastane başvurusundan önceki üç ay içinde beş gün ve daha uzun süre hastane yatışı ve/veya iki günden fazla antibiyotik kullanımı ve/ veya abdominal girişim varlığı mutlaka sorgulanmalıdır (AMMI, A-II) [6] .…”

Relationship between the probiotic Lactobacillus rhamnosus and Enterococcus faecalis during the biofilm formation

“…This bacterium, is known by its natural resistance to some antibiotics; large (Arias and Murray, 2012;Heintz et al, 2010;Sartelli, 2010). The biogenesis and biofilm formation ability also contribute to the treatment of infections caused by E. faecalis.…”