Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Jun 8;19(1):23.
doi: 10.1186/s13017-024-00551-w.

Management of intra-abdominal infections: recommendations by the Italian council for the optimization of antimicrobial use

Massimo Sartelli  1 , Carlo Tascini  2   3 , Federico Coccolini  4 , Fabiana Dellai  3 , Luca Ansaloni  5   6 , Massimo Antonelli  7   8 , Michele Bartoletti  9   10 , Matteo Bassetti  11   12 , Federico Boncagni  13 , Massimo Carlini  14 , Anna Maria Cattelan  15   16 , Arturo Cavaliere  17 , Marco Ceresoli  18 , Alessandro Cipriano  19 , Andrea Cortegiani  20   21 , Francesco Cortese  22 , Francesco Cristini  23   24 , Eugenio Cucinotta  25 , Lidia Dalfino  26 , Gennaro De Pascale  7   8 , Francesco Giuseppe De Rosa  27 , Marco Falcone  28 , Francesco Forfori  29 , Paola Fugazzola  5   6 , Milo Gatti  24   30 , Ivan Gentile  31 , Lorenzo Ghiadoni  19   32 , Maddalena Giannella  24   33 , Antonino Giarratano  20   21 , Alessio Giordano  34 , Massimo Girardis  35 , Claudio Mastroianni  36 , Gianpaola Monti  37 , Giulia Montori  38 , Miriam Palmieri  39 , Marcello Pani  40 , Ciro Paolillo  41 , Dario Parini  42 , Giustino Parruti  43 , Daniela Pasero  44   45 , Federico Pea  24   30 , Maddalena Peghin  46 , Nicola Petrosillo  47 , Mauro Podda  48 , Caterina Rizzo  49 , Gian Maria Rossolini  50   51 , Alessandro Russo  52   53 , Loredana Scoccia  54 , Gabriele Sganga  55   56 , Liana Signorini  57 , Stefania Stefani  58 , Mario Tumbarello  59   60 , Fabio Tumietto  61 , Massimo Valentino  62 , Mario Venditti  63 , Bruno Viaggi  64 , Francesca Vivaldi  65 , Claudia Zaghi  66 , Francesco M Labricciosa  67 , Fikri Abu-Zidan  68 , Fausto Catena  69 , Pierluigi Viale  24   33
Affiliations
Review

Management of intra-abdominal infections: recommendations by the Italian council for the optimization of antimicrobial use

Massimo Sartelli et al. World J Emerg Surg. .

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

PubMed Disclaimer

Conflict of interest statement

M.B. received payment or honoraria for lectures, presentations, speaker’s bureaus, manuscript writing or educational events from Angelini, Biomerieux, Cidara, Gilead, Menarini, MSD, Pfizer, and Shionogi. M.B. participated on data safety monitoring board or advisory board of Angelini, Biomerieux, Cidara, Gilead, Menarini, MSD, Pfizer, and Shionogi. A.C. received fees for lectures or advisory board membership by Gilead, MSD, Mundipharma, Pfizer, Shionogi. F.P. participated in the speaker’s bureau for Angelini, Gilead, Menarini, InfectoPharm, Merck Sharp & Dohme, Pfizer, Shionogi and on the advisory board for Advanz Pharma, Gilead, Merck Sharp & Dohme, Pfizer and Viatris. All the other authors declare that they have no competing interests.

Similar articles

  • Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA).
    Sartelli M, Weber DG, Ruppé E, Bassetti M, Wright BJ, Ansaloni L, Catena F, Coccolini F, Abu-Zidan FM, Coimbra R, Moore EE, Moore FA, Maier RV, De Waele JJ, Kirkpatrick AW, Griffiths EA, Eckmann C, Brink AJ, Mazuski JE, May AK, Sawyer RG, Mertz D, Montravers P, Kumar A, Roberts JA, Vincent JL, Watkins RR, Lowman W, Spellberg B, Abbott IJ, Adesunkanmi AK, Al-Dahir S, Al-Hasan MN, Agresta F, Althani AA, Ansari S, Ansumana R, Augustin G, Bala M, Balogh ZJ, Baraket O, Bhangu A, Beltrán MA, Bernhard M, Biffl WL, Boermeester MA, Brecher SM, Cherry-Bukowiec JR, Buyne OR, Cainzos MA, Cairns KA, Camacho-Ortiz A, Chandy SJ, Che Jusoh A, Chichom-Mefire A, Colijn C, Corcione F, Cui Y, Curcio D, Delibegovic S, Demetrashvili Z, De Simone B, Dhingra S, Diaz JJ, Di Carlo I, Dillip A, Di Saverio S, Doyle MP, Dorj G, Dogjani A, Dupont H, Eachempati SR, Enani MA, Egiev VN, Elmangory MM, Ferrada P, Fitchett JR, Fraga GP, Guessennd N, Giamarellou H, Ghnnam W, Gkiokas G, Goldberg SR, Gomes CA, Gomi H, Guzmán-Blanco M, Haque M, Hansen S, Hecker A, Heizmann WR, Herzog T, Hodonou AM, Hong SK, Kafka-Ritsch R, Kaplan LJ, Kapoor G, Karamarkovic A, Kees MG, Kenig J, Kiguba R, Kim PK, Kluger Y, Khokha V, Koike… See abstract for full author list ➔ Sartelli M, et al. World J Emerg Surg. 2016 Jul 15;11:33. doi: 10.1186/s13017-016-0089-y. eCollection 2016. World J Emerg Surg. 2016. PMID: 27429642 Free PMC article. Review.
  • WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections.
    Sartelli M, Coccolini F, Kluger Y, Agastra E, Abu-Zidan FM, Abbas AES, Ansaloni L, Adesunkanmi AK, Atanasov B, Augustin G, Bala M, Baraket O, Baral S, Biffl WL, Boermeester MA, Ceresoli M, Cerutti E, Chiara O, Cicuttin E, Chiarugi M, Coimbra R, Colak E, Corsi D, Cortese F, Cui Y, Damaskos D, De' Angelis N, Delibegovic S, Demetrashvili Z, De Simone B, de Jonge SW, Dhingra S, Di Bella S, Di Marzo F, Di Saverio S, Dogjani A, Duane TM, Enani MA, Fugazzola P, Galante JM, Gachabayov M, Ghnnam W, Gkiokas G, Gomes CA, Griffiths EA, Hardcastle TC, Hecker A, Herzog T, Kabir SMU, Karamarkovic A, Khokha V, Kim PK, Kim JI, Kirkpatrick AW, Kong V, Koshy RM, Kryvoruchko IA, Inaba K, Isik A, Iskandar K, Ivatury R, Labricciosa FM, Lee YY, Leppäniemi A, Litvin A, Luppi D, Machain GM, Maier RV, Marinis A, Marmorale C, Marwah S, Mesina C, Moore EE, Moore FA, Negoi I, Olaoye I, Ordoñez CA, Ouadii M, Peitzman AB, Perrone G, Pikoulis M, Pintar T, Pipitone G, Podda M, Raşa K, Ribeiro J, Rodrigues G, Rubio-Perez I, Sall I, Sato N, Sawyer RG, Segovia Lohse H, Sganga G, Shelat VG, Stephens I, Sugrue M, Tarasconi A, Tochie JN, Tolonen M, Tomadze G, Ulrych J, Vereczkei A, Viaggi B, Gurioli C, Casella C, Pagan… See abstract for full author list ➔ Sartelli M, et al. World J Emerg Surg. 2021 Sep 25;16(1):49. doi: 10.1186/s13017-021-00387-8. World J Emerg Surg. 2021. PMID: 34563232 Free PMC article. Review.
  • Antimicrobial management of intra-abdominal infections: literature's guidelines.
    Sartelli M, Catena F, Coccolini F, Pinna AD. Sartelli M, et al. World J Gastroenterol. 2012 Mar 7;18(9):865-71. doi: 10.3748/wjg.v18.i9.865. World J Gastroenterol. 2012. PMID: 22408344 Free PMC article.
  • [Expert consensus on multidisciplinary management of intra-abdominal infections].
    Chinese Society of Surgery of Chinese Medical Association; Infectious Diseases Society for Evidence-based and Translational Medicine of Chinese Research Hospital Association; Editorial Board of Chinese Journal of Surgery. Chinese Society of Surgery of Chinese Medical Association, et al. Zhonghua Wai Ke Za Zhi. 2021 Mar 1;59(3):161-178. doi: 10.3760/cma.j.cn112139-20201223-00874. Zhonghua Wai Ke Za Zhi. 2021. PMID: 33685050 Chinese.
  • Intra-abdominal infections survival guide: a position statement by the Global Alliance For Infections In Surgery.
    Sartelli M, Barie P, Agnoletti V, Al-Hasan MN, Ansaloni L, Biffl W, Buonomo L, Blot S, Cheadle WG, Coimbra R, De Simone B, Duane TM, Fugazzola P, Giamarellou H, Hardcastle TC, Hecker A, Inaba K, Kirkpatrick AW, Labricciosa FM, Leone M, Martin-Loeches I, Maier RV, Marwah S, Maves RC, Mingoli A, Montravers P, Ordóñez CA, Palmieri M, Podda M, Rello J, Sawyer RG, Sganga G, Tattevin P, Thapaliya D, Tessier J, Tolonen M, Ulrych J, Vallicelli C, Watkins RR, Catena F, Coccolini F. Sartelli M, et al. World J Emerg Surg. 2024 Jun 8;19(1):22. doi: 10.1186/s13017-024-00552-9. World J Emerg Surg. 2024. PMID: 38851700 Free PMC article. Review.
See all similar articles

Cited by

References

    1. Sartelli M, Abu-Zidan FM, Catena F, Griffiths EA, Di Saverio S, Coimbra R, et al. Global validation of the WSES Sepsis Severity Score for patients with complicated intraabdominal infections: a prospective multicenter study (WISS Study) World J Emerg Surg. 2015;10:61. doi: 10.1186/s13017-015-0055-0. - DOI - PMC - PubMed
    1. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA. 2014;311:1308–1316. doi: 10.1001/jama.2014.2637. - DOI - PubMed
    1. Prescott HC, Kepreos KM, Wiitala WL, Iwashyna TJ. Temporal changes in the influence of hospitals and regional healthcare networks on severe sepsis mortality. Crit Care Med. 2015;43:1368–1374. doi: 10.1097/CCM.0000000000000970. - DOI - PMC - PubMed
    1. Iwashyna TJ, Speelmon EC. Advancing a third revolution in critical care. Am J Respir Crit Care Med. 2016;194:782–783. doi: 10.1164/rccm.201603-0619ED. - DOI - PubMed
    1. Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010;304:1787–1794. doi: 10.1001/jama.2010.1553. - DOI - PMC - PubMed

MeSH terms

Substances

LinkOut - more resources