Intra-abdominal infections survival guide: a position statement by the Global Alliance For Infections In Surgery

Massimo Sartelli¹, Philip Barie², Vanni Agnoletti³, Majdi N Al-Hasan⁴, Luca Ansaloni⁵, Walter Biffl⁶, Luis Buonomo⁷, Stijn Blot⁸, William G Cheadle⁹, Raul Coimbra^{10

11}, Belinda De Simone¹², Therese M Duane¹³, Paola Fugazzola⁵, Helen Giamarellou¹⁴, Timothy C Hardcastle¹⁵, Andreas Hecker¹⁶, Kenji Inaba¹⁷, Andrew W Kirkpatrick¹⁸, Francesco M Labricciosa¹⁹, Marc Leone²⁰, Ignacio Martin-Loeches^{21

22

23

24}, Ronald V Maier²⁵, Sanjay Marwah²⁶, Ryan C Maves²⁷, Andrea Mingoli²⁸, Philippe Montravers²⁹, Carlos A Ordóñez³⁰, Miriam Palmieri³¹, Mauro Podda³², Jordi Rello^{33

34}, Robert G Sawyer³⁵, Gabriele Sganga³⁶, Pierre Tattevin³⁷, Dipendra Thapaliya³⁸, Jeffrey Tessier³⁹, Matti Tolonen⁴⁰, Jan Ulrych⁴¹, Carlo Vallicelli⁴², Richard R Watkins⁴³, Fausto Catena⁴², Federico Coccolini⁴⁴

Affiliations

¹ Department of Surgery, Macerata Hospital, Via Santa Lucia 2, Macerata, 62100, Italy. massimosartelli@gmail.com.
² Department of Surgery, Weill Cornell Medicine, New York, NY, USA.
³ Anesthesia and Intensive Care Unit, Bufalini Hospital - AUSL della Romagna, Cesena, Italy.
⁴ Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA.
⁵ Department of General and Emergency Surgery, Fondazione IRCCS San Matteo, Pavia, Italy.
⁶ Division of Trauma and Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA.
⁷ Emergency, Urgency and Trauma Surgery, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
⁸ Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
⁹ Department of Surgery, School of Medicine, University of Louisville, Louisville, KY, USA.
¹⁰ Comparative Effectiveness and Clinical Outcomes Research Center - CECORC - Riverside University Health System, Moreno Valley, CA, USA.
¹¹ Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA.
¹² Department of Surgery, Rimini "Infermi" Hospital, Rimini, Italy.
¹³ Department of Surgery, Medical City Plano, Plano, TX, USA.
¹⁴ First Department of Internal Medicine-Infectious Diseases, Hygeia General Hospital, Athens, Greece.
¹⁵ Department of Surgical Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, and Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
¹⁶ Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany.
¹⁷ Department of Surgery, University of Southern California, Los Angeles, CA, USA.
¹⁸ Department of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada.
¹⁹ Global Alliance for Infections in Surgery, Macerata, Italy.
²⁰ Department of Anaesthesia and Intensive Care Unit, AP-HM, Aix-Marseille University, North Hospital, Marseille, France.
²¹ Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organisation, St James's Hospital, Dublin, Ireland.
²² Trinity College Dublin, Dublin, Ireland.
²³ Centro de Investigacion Biomedica En Red Entermedades Respiratorias, Institute of Health Carlos III, Madrid, Spain.
²⁴ Pulmonary Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
²⁵ Department of Surgery, Harborview Medical Centre, University of Washington, Seattle, USA.
²⁶ Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India.
²⁷ Section of Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
²⁸ Emergency Department, Policlinico Umberto I, Sapienza University, Rome, Italy.
²⁹ Anesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat Hospital, AP-HP, Université Paris Cité, Paris, France.
³⁰ Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia.
³¹ Department of Surgery, Macerata Hospital, Via Santa Lucia 2, Macerata, 62100, Italy.
³² Department of Surgical Science, University of Cagliari, Cagliari, Italy.
³³ Global Health eCore, Vall d'Hebron University Hospital Campus, Barcelona, 08035, Spain.
³⁴ Medicine Department, Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain.
³⁵ Department of Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA.
³⁶ Emergency Surgery and Trauma, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
³⁷ Infectious Disease and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France.
³⁸ Department of Medicine, MetroHealth Medical Center, Cleveland, OH, USA.
³⁹ Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
⁴⁰ Emergency Surgery department, Meilahti Tower Hospital, HUS Helsinki University Hospital, Haartmaninkatu 4, Helsinki, Finland.
⁴¹ First Department of Surgery, Department of Abdominal, Thoracic Surgery and Traumatology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
⁴² Emergency and General Surgery Department, Bufalini Hospital, Cesena, Italy.
⁴³ Department of Medicine, Division of Infectious Diseases, Northeast Ohio Medical University, Rootstown, OH, USA.
⁴⁴ General, Emergency and Trauma Surgery Unit, Pisa University Hospital, Pisa, Italy.

PMID: 38851700
PMCID: PMC11161965
DOI: 10.1186/s13017-024-00552-9

Review

Intra-abdominal infections survival guide: a position statement by the Global Alliance For Infections In Surgery

Massimo Sartelli et al. World J Emerg Surg. 2024.

. 2024 Jun 8;19(1):22.

doi: 10.1186/s13017-024-00552-9.

Authors

Affiliations

¹ Department of Surgery, Macerata Hospital, Via Santa Lucia 2, Macerata, 62100, Italy. massimosartelli@gmail.com.
² Department of Surgery, Weill Cornell Medicine, New York, NY, USA.
³ Anesthesia and Intensive Care Unit, Bufalini Hospital - AUSL della Romagna, Cesena, Italy.
⁴ Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA.
⁵ Department of General and Emergency Surgery, Fondazione IRCCS San Matteo, Pavia, Italy.
⁶ Division of Trauma and Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA.
⁷ Emergency, Urgency and Trauma Surgery, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
⁸ Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
⁹ Department of Surgery, School of Medicine, University of Louisville, Louisville, KY, USA.
¹⁰ Comparative Effectiveness and Clinical Outcomes Research Center - CECORC - Riverside University Health System, Moreno Valley, CA, USA.
¹¹ Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA.
¹² Department of Surgery, Rimini "Infermi" Hospital, Rimini, Italy.
¹³ Department of Surgery, Medical City Plano, Plano, TX, USA.
¹⁴ First Department of Internal Medicine-Infectious Diseases, Hygeia General Hospital, Athens, Greece.
¹⁵ Department of Surgical Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, and Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
¹⁶ Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany.
¹⁷ Department of Surgery, University of Southern California, Los Angeles, CA, USA.
¹⁸ Department of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada.
¹⁹ Global Alliance for Infections in Surgery, Macerata, Italy.
²⁰ Department of Anaesthesia and Intensive Care Unit, AP-HM, Aix-Marseille University, North Hospital, Marseille, France.
²¹ Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organisation, St James's Hospital, Dublin, Ireland.
²² Trinity College Dublin, Dublin, Ireland.
²³ Centro de Investigacion Biomedica En Red Entermedades Respiratorias, Institute of Health Carlos III, Madrid, Spain.
²⁴ Pulmonary Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
²⁵ Department of Surgery, Harborview Medical Centre, University of Washington, Seattle, USA.
²⁶ Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India.
²⁷ Section of Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
²⁸ Emergency Department, Policlinico Umberto I, Sapienza University, Rome, Italy.
²⁹ Anesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat Hospital, AP-HP, Université Paris Cité, Paris, France.
³⁰ Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia.
³¹ Department of Surgery, Macerata Hospital, Via Santa Lucia 2, Macerata, 62100, Italy.
³² Department of Surgical Science, University of Cagliari, Cagliari, Italy.
³³ Global Health eCore, Vall d'Hebron University Hospital Campus, Barcelona, 08035, Spain.
³⁴ Medicine Department, Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain.
³⁵ Department of Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA.
³⁶ Emergency Surgery and Trauma, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
³⁷ Infectious Disease and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France.
³⁸ Department of Medicine, MetroHealth Medical Center, Cleveland, OH, USA.
³⁹ Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
⁴⁰ Emergency Surgery department, Meilahti Tower Hospital, HUS Helsinki University Hospital, Haartmaninkatu 4, Helsinki, Finland.
⁴¹ First Department of Surgery, Department of Abdominal, Thoracic Surgery and Traumatology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
⁴² Emergency and General Surgery Department, Bufalini Hospital, Cesena, Italy.
⁴³ Department of Medicine, Division of Infectious Diseases, Northeast Ohio Medical University, Rootstown, OH, USA.
⁴⁴ General, Emergency and Trauma Surgery Unit, Pisa University Hospital, Pisa, Italy.

PMID: 38851700
PMCID: PMC11161965
DOI: 10.1186/s13017-024-00552-9

Abstract

Intra-abdominal infections (IAIs) are an important cause of morbidity and mortality in hospital settings worldwide. The cornerstones of IAI management include rapid, accurate diagnostics; timely, adequate source control; appropriate, short-duration antimicrobial therapy administered according to the principles of pharmacokinetics/pharmacodynamics and antimicrobial stewardship; and hemodynamic and organ functional support with intravenous fluid and adjunctive vasopressor agents for critical illness (sepsis/organ dysfunction or septic shock after correction of hypovolemia). In patients with IAIs, a personalized approach is crucial to optimize outcomes and should be based on multiple aspects that require careful clinical assessment. The anatomic extent of infection, the presumed pathogens involved and risk factors for antimicrobial resistance, the origin and extent of the infection, the patient's clinical condition, and the host's immune status should be assessed continuously to optimize the management of patients with complicated IAIs.

Keywords: Antimicrobial resistance; Antimicrobial therapy; Intra-abdominal infections; Source control.

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Conflict of interest statement

A.W.K. serves as the PI of the COOL trial, which previously was partially supported by the 3 M/Acelity Corporation until Aug 2022. A.W.K. is also a member of the Canadian Forces Medical Services and has consulted for the 3 m/Acelity Corporation, Zoll Medical, Innovative Trauma Care, and CSL Behring. A.W.K. is the Director of the TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research group and serves in the Canadian Forces Medical Services.R.G.S conflicts are on Data Management and Safety Board for Advarra.R.C.M. received research support (paid to Institution) from AiCuris, GeoVax and Biotest. He received honoraria for participation in a scientific advisory board organized by Shionogi.All the other authors declare that they have no competing interests. R.G.S conflicts are on Data Management and Safety Board for Advarra. R.C.M. received research support (paid to Institution) from AiCuris, GeoVax and Biotest. He received honoraria for participation in a scientific advisory board organized by Shionogi. All the other authors declare that they have no competing interests.

References

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1. Sartelli M, Coccolini F, Kluger Y, Agastra E, Abu-Zidan FM, Abbas AES, WSES/GAIS/SIS, et al. E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections. World J Emerg Surg. 2021;16(1):49. doi: 10.1186/s13017-021-00387-8. - DOI - PMC - PubMed
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Intra-abdominal infections survival guide: a position statement by the Global Alliance For Infections In Surgery

Affiliations

Intra-abdominal infections survival guide: a position statement by the Global Alliance For Infections In Surgery

Authors

Affiliations

Abstract

Conflict of interest statement

References

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