[Antibiotic therapy of intra-abdominal infections in the era of multiresistance]

Abstract

Recommendations for the treatment of intra-abdominal infections (IAI) caused by drug-resistant bacteria often fail to mention the bacteria of concern (e.g. vancomycin-resistant enterococci, extended spectrum beta-lactamase-producing (ESBL) Enterobacteriaceae, multi-drug resistant Pseudomonas spp., carbapenem-resistant organisms and Acinetobacter spp.) and all available drugs. The group of patients suffering from IAI due to resistant bacteria includes the entire group of postoperative and tertiary peritonitis and necrotizing pancreatitis. This article provides information for the management of a very important group of diseases with a substantial morbidity and mortality. An individual patient-centered approach is mandatory to evaluate the optimal antimicrobial treatment regimen. Especially in gram-negative bacteria, which are the predominant cause only a few options remain for treatment. Clinical data with a high level of evidence are very limited. Future studies should focus on pharmacokinetic and pharmakodynamic aspects in critically ill patients, in the sense of antibiotic stewardship in order to elucidate the real life efficacy and safety of antibiotics for the treatment of life-threatening IAI.

Keywords: Beta-lactamase; Intra-abdominal infections; Postoperative peritonitis; Resistant bacteria; Tertiary peritonitis.