PDF(Pubmed)
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.
摘要：
腹腔内感染（IAIs）是常见的外科急症，是医院环境中发病率和死亡率的重要原因。特别是如果管理不善。有效的IAIs管理的基石包括早期诊断，充分的源代码控制，适当的抗菌治疗，危重病人使用静脉输液和血管加压药进行早期生理稳定。在IAIs患者中，适当的经验性抗菌治疗至关重要，因为不适当的抗菌治疗与不良预后相关。优化抗菌药物处方可提高治疗效果,增加患者的安全，并将机会性感染（如艰难梭菌）和抗菌素耐药性选择的风险降至最低。耐多药生物的日益出现引起了迫在眉睫的危机，具有令人震惊的影响，特别是关于革兰氏阴性细菌。多学科和跨社会意大利抗菌药物使用优化委员会促进了关于IAIs抗菌药物管理的共识会议，包括急诊医学专家，放射科医生,外科医生,密集主义者，传染病专家,临床药理学家,医院药剂师,微生物学家和公共卫生专家。组织委员会构建了相关的临床问题，以调查该主题。专家小组根据PubMed和EMBASE图书馆的最佳科学证据以及专家的意见提出了建议声明。报表是根据建议评估的分级计划和分级的，证据的开发和评估(等级)层次结构。2023年11月10日，专家们在梅斯特（意大利）举行会议，对声明进行辩论。声明批准后，专家小组通过电子邮件和虚拟会议开会，以准备和修改最终文件。本文件是协商一致会议的执行摘要，包括三个部分。第一部分主要介绍了诊断和治疗IAIs的一般原则。第二部分为IAIs的抗菌治疗提供了23项循证建议。第三部分介绍了最常见的IAI的八种临床诊断-治疗途径。该文件已得到意大利外科学会的认可。
