• Antibiotic therapy
• Antimicrobial stewardship
• Epidemiology
• Intra-abdominal infections
• Surgery

• Humans
• Italy/epidemiology
• Intraabdominal Infections/epidemiology
• Prospective Studies
• Male
• Middle Aged
• Female
• Adult
• Aged
• Registries/statistics & numerical data

• antibiotic
• antimicrobial
• intra-abdominal infections
• peritonitis
• sepsis
• source control

• Adequate empirical therapy
• Empirical antibiotic therapy
• Multidrug-resistant bacteria
• Optimal empirical therapy
• Postoperative peritonitis

• Adult
• Humans
• Retrospective Studies
• Vancomycin/therapeutic use
• Drug Resistance, Multiple, Bacterial
• Anti-Bacterial Agents/therapeutic use
• Cilastatin, Imipenem Drug Combination/therapeutic use
• Peritonitis/drug therapy
• Piperacillin/therapeutic use
• Tazobactam/therapeutic use

• Anti-bacterial agents
• Intraabdominal infections
• Practice guideline

Adequately controlling the source of infection and prescribing appropriately antibiotic therapy are the cornerstones of the management of patients with intra-abdominal infections (IAIs). Correctly classifying patients with IAIs is crucial to assessing the severity of their clinical condition and deciding the strategy of the treatment, including a correct empiric antibiotic therapy. Best practices in prescribing antibiotics may impact patient outcomes and the cost of treatment, as well as the risk of “opportunistic” infections such as Clostridioides difficile infection and the development and spread of antimicrobial resistance. This review aims to identify a correct classification of IAIs, guiding clinicians in the selection of the best antibiotic therapy in patients with IAIs.

• acute care surgery
• antimicrobial resistance
• antimicrobial stewardship
• infection prevention and control
• infections
• source control
• systemic inflammatory response syndrome

Multi-drug resistant organisms (MDR-Os) are emerging as a significant cause of surgical site infections (SSI), but clinical outcomes and risk factors associated to MDR-Os-SSI have been poorly investigated in general surgery. Aims were to investigate risk factors, clinical outcomes and costs of care of multi-drug resistant organisms (MDR-Os-SSI) in general surgery. From January 2018 to December 2019, all the consecutive, unselected patients affected by MDR-O SSI were prospectively evaluated. In the same period, patients with non-MDR-O SSI and without SSI, matched for clinical and surgical data were used as control groups. Risk factors for infection, clinical outcome, and costs of care were compared by univariate and multivariate analysis. Among 3494 patients operated on during the study period, 47 presented an MDR-O SSI. Two control groups of 47 patients with non-MDR-O SSI and without SSI were identified. MDR-Os SSI were caused by poly-microbial etiology, meanly related to Gram negative Enterobacteriales. MDR-Os-SSI were related to major postoperative complications. At univariate analysis, iterative surgery, open abdomen, intensive care, hospital stay, and use of aggressive and expensive therapies were associated to MDR-Os-SSI. At multivariate analysis, only iterative surgery and the need of total parenteral and immune-nutrition were significantly associated to MDR-Os-SSI. The extra-cost of MDR-Os-SSI treatment was 150% in comparison to uncomplicated patients. MDR-Os SSI seems to be associated with major postoperative complications and reoperative surgery, they are demanding in terms of clinical workload and costs of care, they are rare but increasing, and difficult to prevent with current strategies.

• Complications
• Cost of care
• Multi-drug resistance
• Risk factors
• Surgery
• Surgical site infections

• Antibiotic resistance
• Intra-abdominal infections
• Mortality
• Risk factors

To compare patients hospitalised in the intensive care unit (ICU) after surgery for community-acquired intra-abdominal infection (CA-IAI) and hospital-acquired intra-abdominal infection (HA-IAI) in terms of mortality, severity and complications.

Retrospective study including all patients admitted to 2 ICUs within 48 h of undergoing surgery for peritonitis.

Two hundred twenty-six patients were enrolled during the study period. Patients with CA-IAI had an increased 28-day mortality rate compared to those with HA-IAI (30% vs 15%, respectively (p = 0.009)). At 90 days, the mortality rates were 36.7 and 37.5% in the CA-IAI group and HA-IAI group, respectively, with a similar APACHE II score on admission (median: 21 [15–25] vs. 21 [15–24] respectively, p = 0.63). The patients with HA-IAI had prolonged ICU and hospital stays (median: 17 [7–36] vs. 6[3–12] days, p < 0.001 and 41 [24–66] vs. 17 [7–32] days, p = 0.001), and experienced more complications (reoperation and reintubation) than those with CA-IAI.

CA-IAI group had higher 28-day mortality rate than HA-IAI group. Mortality was similar at 90 days but those with HA-IAI had a prolonged ICU and hospital stay. In addition, they developed more complications.

• Intensive care unit
• Intra-abdominal infection
• Microbiology
• Outcome
• Peritonitis

• antibiotherapy
• nosocomial infections
• peritonitis

• Abdominal infections
• Antimicrobial resistance
• Candidiasis
• IAI
• Peritonitis
• Source control

• Gram stain examination
• Postoperative peritonitis

Background: Procalcitonin (PCT), an important biomarker, can be used for the guidance of antibiotic therapy in respiratory infection. However, it has been a problem that some patients might need antibiotic therapy restart because of infection recurrence after antibiotic discontinuation. To date, there are very few literature on the study of risk factors accounting for infection recurrence. Purpose of this clinical study: 1) To study on antibiotic discontinuation in ventilator-associated pneumonia (VAP) under the guidance of PCT; 2) To evaluate the possible risk factors leading to infection recurrence and antibiotic reuse.

Methods: Antibiotic discontinuation was performed when patients met the following criteria: (i) serum PCT<0.5 μg/L, (ii) temperature<38.5℃ and (iii) leukocyte count<15×10⁹/L. Next, the patients were divided into infection recurrence group (infection recurring within 7 days after antibiotic discontinuation) or infection controlled group (no infection recurring after antibiotic discontinuation). Possible risk factors accounting for infection recurrence were evaluated using logistic regression analysis.

Results: Of the eligible 51 patients with VAP, 20 patients suffered infection recurrence. Clinical pulmonary infection score (CPIS) and characteristics of tracheal secretions were the independent risk factors (P=0.045 and P=0.041, respectively), accounting for infection recurrence. Simplified CPIS≥5 served a certain predictive value for infection recurrence in VAP when physicians considered antibiotic discontinuation (The area under the receiver operating characteristic curve 0.781, specificity 90.3%, sensitivity 55.0%, positive predictive value 78.6% and negative predictive value 75.7%). At the time of antibiotic discontinuation, differences between the two groups were not statistically significant in the proportion of patients with a tracheotomy and in the culture results of endotracheal aspirates (including semi-quantitative results and whether pathogens were multidrug-resistant [MDR] strains).

Conclusion: Simplified CPIS and characteristics of tracheal secretions can be used to predict infection recurrence following PCT-guided antibiotic discontinuation in VAP. These findings are important because physicians may not need to put too much care on semi-quantitative culture results of endotracheal aspirates and whether pathogens are MDRstrains.

Trial registration: The registration number of this clinical trial is: ChiCTR-OPC-17011228 (Trial registry name: Chinese Clinical Trial Registry; URL: http://www.chictr.org.cn).

• antibiotic discontinuation
• antibiotic therapy
• infection recurrence
• procalcitonin
• ventilator-associated pneumonia

• Antibiotics
• Infection control
• Prevention
• Staphylococci
• Surgical site infection

• Antibiotic Prophylaxis
• Bacterial Infections/microbiology
• Bacterial Infections/prevention & control
• Bacterial Infections/transmission
• Candidiasis/microbiology
• Candidiasis/prevention & control
• Candidiasis/transmission
• Drug Resistance, Multiple, Bacterial
• General Surgery
• Humans
• Methicillin-Resistant Staphylococcus aureus
• Risk Factors
• Surgical Wound Infection/microbiology
• Surgical Wound Infection/prevention & control
• Surgical Wound Infection/transmission
• Surgical Wound Infection/virology
• Vancomycin-Resistant Enterococci
• Virus Diseases/prevention & control
• Virus Diseases/transmission
• Virus Diseases/virology

Bloodstream infections of abdominal origin are usually associated with poor prognosis. We assessed the clinical and microbiological characteristics of critically ill patients admitted to the intensive care unit (ICU) for postoperative intra-abdominal infection (PIAI) and analysed the influence of bacteraemia on their outcome.

All consecutive PIAI patients admitted to the ICU between 1999 and 2014 were prospectively analysed. Bacteraemic patients (at least one positive blood culture in the 24 h preceding/following surgery) were compared with non-bacteraemic patients. Demographic characteristics, underlying disease, severity scores at the time of reoperation, microbiological results, therapeutic management, outcome, and survival were recorded. Results are expressed as median (interquartile range (IQR)) or proportions.

Overall, 343 patients (54% male, 62 (49–73) years old) with PIAI were analysed, including 64 (19%) bacteraemic patients. Immunosuppression and cancer were more frequent in bacteraemic patients (p < 0.001 in both cases). No difference between groups was observed for the characteristics of initial surgery. Time to reoperation, site, and cause of PIAI were similar in both groups. At the time of reoperation, Sequential Organ Failure Assessment (SOFA) score was higher in bacteraemic patients (8 (6–10) versus 7 (4–10); p < 0.05). A predominance of Gram-positive (34%) and Gram-negative (47%) bacteria were recovered from blood cultures (polymicrobial bacteraemia in 9 (14%) patients and bacteraemia involving multidrug-resistant organisms in 14 (22%) patients). In multivariate analysis, risk factors for bacteraemia were immunosuppression or cancer, high SOFA score, and E. coli in peritoneal samples. Bacteraemia did not impact the management (with similar results for the adequacy of antibiotic therapy, anti-infective agents used, de-escalation or duration of therapy in both groups). Neither hospital mortality nor morbidity criteria differed between groups. Risk factors for mortality in multivariate analysis were urgent initial surgery, high Simplified Acute Physiology Score (SAPS) II score and documented antifungal therapy, but not perioperative bacteraemia.

In this ICU population, bacteraemia did not change the overall management of patients with PIAI. Our data suggest that bacteraemic patients do not require a specific management.

• Bacteraemia
• Intra-abdominal infection
• Outcome
• Postoperative infection

• Abdominal Cavity/diagnostic imaging
• Disease Management
• Disease Progression
• Early Medical Intervention/methods
• Humans
• Peritonitis/diagnosis
• Peritonitis/etiology
• Peritonitis/physiopathology
• Peritonitis/therapy
• Sepsis/etiology
• Sepsis/prevention & control

• T32 DK007573 NIDDK NIH HHS
• R37 HL051856 NHLBI NIH HHS

• Antibiotic therapy
• Duration of therapy
• Multidrug-resistant bacteria
• Peritonitis
• Postoperative intra-abdominal infection

• Aged
• Aged, 80 and over
• Anti-Bacterial Agents/therapeutic use
• Critical Illness
• Female
• France
• Humans
• Intensive Care Units
• Intraabdominal Infections/drug therapy
• Male
• Middle Aged
• Obesity, Morbid
• Prospective Studies

• AOM-09024 French Ministery of Health-Programme Hospitalier de Recherche Clinique 2009

• abdominal infection
• antimicrobial management
• empiric antimicrobial therapy
• health-care–associated infection
• multi-drug–resistant

• Intra-abdominal infections
• adequacy
• candida
• de-escalation
• enterococcus
• multidrug-resistant bacteria
• peritonitis
• postoperative infections

This paper reports on the consensus conference on the management of intra-abdominal infections (IAIs) which was held on July 23, 2016, in Dublin, Ireland, as a part of the annual World Society of Emergency Surgery (WSES) meeting. This document covers all aspects of the management of IAIs. The Grading of Recommendations Assessment, Development and Evaluation recommendation is used, and this document represents the executive summary of the consensus conference findings.

• Antibiotics
• Intra-abdominal infections
• Peritonitis
• Sepsis

To identify the risk factors for mortality in intensive care patients with postoperative peritonitis (POP).

This was a retrospective analysis using a prospective database that includes all patients hospitalized in a surgical intensive care unit for POP from September 2006 to August 2011. The data collected included demographics, comorbidities, postoperative severity parameters, bacteriological findings, adequacy of antimicrobial therapy and surgical treatments. Adequate source control was defined based on a midline laparotomy, infection source control and intraoperative peritoneal lavage. The number of reoperations needed was also recorded.

A total of 201 patients were included. The overall mortality rate was 31%. Three independent risk factors for mortality were identified: The Simplified Acute Physiological II Score (OR = 1.03; 95%CI: 1.02-1.05, P < 0.001), postoperative medical complications (OR = 6.02; 95%CI: 1.95-18.55, P < 0.001) and the number of reoperations (OR = 2.45; 95%CI: 1.16-5.17, P = 0.015). Surgery was considered as optimal in 69% of the cases, but without any significant effect on mortality.

The results from the large cohort in this study emphasize the role of the initial postoperative severity parameters in the prognosis of POP. No predefined criteria for optimal surgery were significantly associated with increased mortality, although the number of reoperations appeared as an independent risk factor of mortality.

• Mortality
• Postoperative peritonitis
• Risk factors
• Surgery

• ESBL
• Mwanza
• Secondary peritonitis
• Tanzania

• Anti-Infective Agents/pharmacology
• Drug Resistance, Microbial
• Humans
• International Cooperation
• Intraabdominal Infections/diagnosis
• Intraabdominal Infections/drug therapy
• Intraabdominal Infections/microbiology
• Microbial Sensitivity Tests
• Prognosis

• G12 MD007595 NIMHD NIH HHS
• R01 AI117211 NIAID NIH HHS

• Fungal infection
• Intra-abdominal hypertension
• Multidrug-resistant bacteria
• Peritonitis
• Postoperative complications
• Source control

• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents/standards
• Anti-Bacterial Agents/therapeutic use
• Critical Care/standards
• Critical Illness/therapy
• Female
• Humans
• Male
• Middle Aged
• Peritonitis/drug therapy
• Practice Guidelines as Topic

Persistent peritonitis is a frequent complication of secondary peritonitis requiring additional reoperations and antibiotic therapy. This situation raises specific concerns due to microbiological changes in peritoneal samples, especially the emergence of multidrug-resistant (MDR) strains. Although this complication has been extensively studied, the rate and dynamics of MDR strains have rarely been analysed.

We compared the clinical, microbiological and therapeutic data of consecutive ICU patients admitted for postoperative peritonitis either without subsequent reoperation (n = 122) or who underwent repeated surgery for persistent peritonitis with positive peritoneal fluid cultures (n = 98). Data collected on index surgery for the treatment of postoperative peritonitis were compared between these two groups. In the patients with persistent peritonitis, the data obtained at the first, second and third reoperations were compared with those of index surgery. Risk factors for emergence of MDR strains were assessed.

At the time of index surgery, no parameters were able to differentiate patients with or without persistent peritonitis except for increased severity and high proportions of fungal isolates in the persistent peritonitis group. The mean time to reoperation was similar from the first to the third reoperation (range: 5 to 6 days). Septic shock was the main clinical expression of persistent peritonitis. A progressive shift of peritoneal flora was observed with the number of reoperations, comprising extinction of susceptible strains and emergence of 85 MDR strains. The proportion of patients harbouring MDR strains increased from 41% at index surgery, to 49% at the first, 54% at the second (P = 0.037) and 76% at the third reoperation (P = 0.003 versus index surgery). In multivariate analysis, the only risk factor for emergence of MDR strains was time to reoperation (OR 1.19 per day, 95%CI (1.08 to 1.33), P = 0.0006).

Initial severity, presence of Candida in surgical samples and inadequate source control are the major risk factors for persistent peritonitis. Emergence of MDR bacteria is frequent and increases progressively with the number of reoperations. No link was demonstrated between emergence of MDR strains and antibiotic regimens, while source control and its timing appeared to be major determinants of emergence of MDR strains.

The prevalence of extensively drug resistant gram negative bacilli (XDR-GNB) is rapidly progressing; however in Egypt data are sparse. We conducted the present study to quantify the incidence, risk factors and outcome of patients harboring XDR-GNB.

A one year prospective study was done by collecting all the bacteriological reports for cultures sent from the surgical intensive care unit, Cairo university teaching hospital. XDR-GNB were defined as any gram negative bacilli resistant to three or more classes of antimicrobial agents. Patients with XDR-GNB compared with those sustaining non extensively drug-resistant infection. A multivariate logistic regression model was created to identify independent predictors of multi-resistance.

During one-year study period, a total of 152 samples (65%) out of 234 gram negative bacilli samples developed extensively drug resistant infection. XDR strains were significantly higher in Acinetobacterspp (86%), followed by Pseudomonas (63%), then Proteus (61%), Klebsiella (52%), and E coli (47%). Fourth generation cephalosporine (Cefipime) had the lowest susceptibility (10%) followed by third generation cephalosporines (11%), Quinolones (31%), Amikacin (42%), Tazobactam (52%), Carbapinems (52%), and colistin (90%). Relaparotomy was the only significant risk factor for acquisition of XDR infection.

Extensively drug-resistant gram negative infections are frequent in our ICU. This is an alarming health care issue in Egypt which emphasizes the need to rigorously implement infection control practices.

• Extensive drug resistance
• critically ill patients
• gram negative bacilli

• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents/therapeutic use
• Bacteremia/drug therapy
• Bacteremia/immunology
• Bacteremia/microbiology
• Drug Hypersensitivity/drug therapy
• Drug Hypersensitivity/etiology
• Drug Hypersensitivity/immunology
• Drug Hypersensitivity/microbiology
• Drug Resistance, Multiple, Bacterial
• Drug Therapy, Combination
• Empirical Research
• Female
• Fluoroquinolones/therapeutic use
• Gram-Negative Bacteria/drug effects
• Gram-Negative Bacteria/growth & development
• Gram-Negative Bacterial Infections/drug therapy
• Gram-Negative Bacterial Infections/immunology
• Gram-Negative Bacterial Infections/microbiology
• Humans
• Middle Aged
• Pneumonia, Bacterial/drug therapy
• Pneumonia, Bacterial/immunology
• Pneumonia, Bacterial/microbiology
• Retrospective Studies
• Risk
• Tetracycline/therapeutic use
• Urinary Tract Infections/drug therapy
• Urinary Tract Infections/immunology
• Urinary Tract Infections/microbiology
• beta-Lactams/adverse effects

• bariatric surgery
• morbid obesity
• postoperative peritonitis
• sepsis
• multidrug-resistant bacteria
• antibiotic adequacy
• antibiotic de-escalation

• Adult
• Age Distribution
• Aged
• Anti-Bacterial Agents/therapeutic use
• Bariatric Surgery/adverse effects
• Comorbidity
• Female
• France/epidemiology
• Gram-Negative Bacterial Infections/etiology
• Gram-Positive Bacterial Infections/etiology
• Hospital Mortality
• Humans
• Intensive Care Units
• Male
• Middle Aged
• Obesity, Morbid/complications
• Obesity, Morbid/mortality
• Obesity, Morbid/surgery
• Patient Selection
• Peritonitis/etiology
• Peritonitis/microbiology
• Peritonitis/mortality
• Prospective Studies
• Reoperation/statistics & numerical data
• Risk Factors
• Treatment Outcome

• neurocritical care
• sepsis
• septic shock