79 research outputs found
A Proposal for a Classification Guiding the Selection of Appropriate Antibiotic Therapy for Intra-Abdominal Infections
No full textAdequately 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
The “Torment” of Surgical Antibiotic Prophylaxis among Surgeons
No full textSurgical antibiotic prophylaxis (SAP) is one of the peri-operative measures for preventing surgical site infections (SSIs). Its goal is to counteract the proliferation of bacteria in the surgical site during intervention in order to reduce the risk of SSIs. SAP should be administered for surgical interventions where the benefit expected (prevention of SSIs) is higher compared to the risk (serious side effects, such as acute kidney injury, Clostridioides difficile infection, and the spread of antimicrobial resistance). In prescribing SAP, surgeons should have both the awareness necessary “to handle antibiotics with care”, and the knowledge required to use them appropriately
Preventing and Controlling Healthcare-Associated Infections: The First Principle of Every Antimicrobial Stewardship Program in Hospital Settings
No full textAntimicrobial resistance (AMR) is one of the main public health global burdens of the 21st century, responsible for over a million deaths every year. Hospital programs aimed at improving antibiotic use, referred to as antimicrobial stewardship programs (ASPs), can both optimize the treatment of infections and minimize adverse antibiotics events including the development and spread of AMR. The challenge of AMR is closely linked to the development and spread of healthcare-associated infection (HAIs). In fact, the management of patients with HAIs frequently requires the administration of broader-spectrum antibiotic regimens due to the higher risk of acquiring multidrug-resistant organisms, which, in turn, promotes resistance. For this reason, even before using antibiotics correctly, it is necessary to prevent and control the spread of HAIs in our hospitals. In this narrative review, we present seven measures that healthcare workers, even if not directly involved in the tasks of infection prevention and control, must know, support, and embrace. We hope that this review may raise awareness among all healthcare professionals about the issues with the increasing rate of AMR and the ongoing efforts towards minimizing its rise
Epidemiology and Risk Factors for Superficial Surgical Site Infections after Appendectomy for Acute Appendicitis: A Secondary Data Analysis
No full textBackground:
The identification of risk factors for superficial surgical site infections (SSSIs) associated with appendectomy is paramount in the management of patients with acute appendicitis (AA).
Methods:
This study was a secondary data analysis from a prospective multi-center observational study. It included all consecutive hospitalized patients with AA who underwent appendectomy and were monitored for complications at 30 days after the intervention. A case-control approach was used to evaluate risk factors associated with the occurrence of SSSI.
Results:
Among 2,667 patients, 156 (5.8%) developed an SSSI. The series included 1,449 males (54.3%) and 1,218 females with a median age of 29 years (interquartile range [IQR] 20-45 years). Antimicrobial therapy within the previous 30 days was reported by 170 patients (6.4%), and a C-reactive protein concentration (CRP) >50 mg/L was observed in 609 (22.8%). A total of 960 patients (36.0%) underwent open surgery, 1,699 (63.7%) laparoscopic surgery, and 8 (0.3%) another surgical intervention. In 2,575 patients (95.6%), a pathological appendix was detected during the operation. In 776 patients (29.1%), an intra-operative abdominal drain (IAD) was placed; 125 patients (4.7%) were admitted to the intensive care unit. The median hospital length of stay was 3 days (IQR 2-5 days). The overall mortality rate was 0.11%. Multinomial logistic regression analysis of risk factors demonstrated that statistically significant risk factors independently associated with the occurrence of SSSIs were antimicrobial therapy within the previous 30 days, CRP >50 mg/L, open surgical procedures, presence of IAD, and intra-operative findings of complex appendicitis.
Conclusions:
Knowledge of five easily recognizable variables, assessable at hospital admission or as soon as the surgical intervention is concluded, might identify patients with a greater risk of developing an SSSI
Optimizing Surgical Antibiotic Prophylaxis in the Era of Antimicrobial Resistance: A Position Paper from the Italian Multidisciplinary Society for the Prevention of Healthcare-Associated Infections (SIMPIOS)
No full textBackground: Although surgical antibiotic prophylaxis (SAP) is considered a standard of care for preventing surgical site infections, the rising incidence of antimicrobial resistance (AMR) increases the likelihood of infections caused by multidrug-resistant organisms (MDROs), which may be associated with worse surgical outcomes. Methods: A multidisciplinary working group was convened by the Italian Multidisciplinary Society for the Prevention of Healthcare-Associated Infections (SIMPIOS) to define key measures for optimizing SAP in the era of AMR. Selecting the most appropriate SAP in patients colonized with MDROs is a complex decision that cannot be generalized, as it depends on both host factors and the specific surgical procedure. At present, there is limited evidence of SAP in these patients. Results: This position paper aims to provide practical guidance for optimizing SAP in the context of an AMR era. It is structured in three sections: (1) core principles of surgical antibiotic prophylaxis; (2) the role of screening, decolonization, and targeted prophylaxis for MDROs; and (3) barriers to changing surgeons’ prescribing behaviours. Conclusions: The working group developed 15 recommendation statements based on scientific evidence
Epidemiology and risk factors for isolation of multi-drug-resistant organisms in patients with complicated intra-abdominal infections
No full textBACKGROUND: Patients with complicated intra-abdominal infections
(cIAIs) caused by multi-drug-resistant organisms (MDROs) have
been identified as being at increased risk for adverse outcomes.
Prompt identification and stratification of these patients is
essential in the clinical management, allowing the physician
timely optimization of empiric antimicrobial therapy while
awaiting results of intra-operative cultures to streamline
antibiotic treatment. METHODS: The study is a secondary analysis
from two prospective multi-center color surveillance studies. It
included all consecutively hospitalized adult patients undergoing
surgical procedures, interventional drainage, or conservative
treatment with cIAIs, with positive cultures performer on
intra-operative samples of peritoneal fluid or purulent
exudate/discrete abscesses. Patients with pancreatitis and
primary peritonitis were excluded. A case-control approach has
been used to evaluate the factors associated with the isolation
of a MDRO in enrolled patients. RESULTS: Among 1986 patients
included in the study, a total of 3534 micro-organisms were
isolated from intra-peritoneal fluid samples; in 46.5\% of
cultures, two or more pathogens were identified. The MDROs
represented 9.8\% of the total of isolated micro-organisms. The
overall incidence rate of MDROs was 13.9\%. The MDROs were more
frequently isolated in patients with health-care-associated cIAIs
(25.4\%). Multi-nomial logistic regression analysis of risk
factors demonstrated that statistically significant risk factors
independently associated with the occurrence of MDROs were
previous antimicrobial therapy administered within seven days
before operation, presence of severe cardiovascular disease,
white blood cell count 12,000/mL, cIAI acquired in a healthcare
setting, and inadequate source control. CONCLUSIONS: The study
showed that knowledge of five easily recognizable
variables-assessable on hospital admission or as soon as the
surgical intervention is concluded-might guide the surgeon to
identify patients with cIAIs caused by MDROs, and therefore to
choose the most adequate empiric antimicrobial therapy for them
Epidemiology and risk factors for superficial surgical site infections after appendectomy for acute appendicitis: A secondary data analysis
No full textBackground: The identification of risk factors for superficial
surgical site infections (SSSIs) associated with appendectomy is
paramount in the management of patients with acute appendicitis
(AA). Methods: This study was a secondary data analysis from a
prospective multi-center observational study. It included all
consecutive hospitalized patients with AA who underwent
appendectomy and were monitored for complications at 30 days
after the intervention. A case-control approach was used to
evaluate risk factors associated with the occurrence of SSSI.
Results: Among 2,667 patients, 156 (5.8\%) developed an SSSI.
The series included 1,449 males (54.3\%) and 1,218 females with
a median age of 29 years (interquartile range [IQR] 20-45
years). Antimicrobial therapy within the previous 30 days was
reported by 170 patients (6.4\%), and a C-reactive protein
concentration (CRP) >50 mg/L was observed in 609 (22.8\%). A
total of 960 patients (36.0\%) underwent open surgery, 1,699
(63.7\%) laparoscopic surgery, and 8 (0.3\%) another surgical
intervention. In 2,575 patients (95.6\%), a pathological
appendix was detected during the operation. In 776 patients
(29.1\%), an intra-operative abdominal drain (IAD) was placed;
125 patients (4.7\%) were admitted to the intensive care unit.
The median hospital length of stay was 3 days (IQR 2-5 days).
The overall mortality rate was 0.11\%. Multinomial logistic
regression analysis of risk factors demonstrated that
statistically significant risk factors independently associated
with the occurrence of SSSIs were antimicrobial therapy within
the previous 30 days, CRP >50 mg/L, open surgical procedures,
presence of IAD, and intra-operative findings of complex
appendicitis. Conclusions: Knowledge of five easily recognizable
variables, assessable at hospital admission or as soon as the
surgical intervention is concluded, might identify patients with
a greater risk of developing an SSSI
Personalized Approaches to Patients with Intra-Abdominal Infections
No full textIntra-abdominal infections (IAIs) continue to be an important cause of morbidity and mortality worldwide. The optimal management of patients with IAIs relies on early and accurate diagnosis, prompt and adequate source control, appropriate antimicrobial therapy based on the PK/PD principles, as well as hemodynamic support with intravenous fluids and vasopressors in critically ill patients. This narrative review aims to suggest five basic factors which should always be considered when assessing patients with IAIs to provide the most adequate treatment. These factors include the anatomical extent of the infection, the origin of the infection, the patient’s clinical status, the suspected pathogens and their resistance profiles, and immune competence. The continuous assessment of these elements is essential in managing complicated IAIs
Strategies to prevent {Healthcare-Associated} Infections: A narrative overview
No full textHealthcare-associated infections (HCAIs) are a major source of
morbidity and mortality and are the second most prevalent cause
of death. Furthermore, it has been reported that for every
one-hundred patients admitted to hospital, seven patients in
high-income economies and ten in emerging and low-income
economies acquire at least one type of HCAI. Currently, almost
all pathogenic microorganisms have developed antimicrobial
resistance, and few new antimicrobials are being developed and
brought to market. The literature search for this narrative
review was performed by searching bibliographic databases
(including Google Scholar and PubMed) using the search terms:
``Strategies,'' ``Prevention,'' and ``Healthcare-Associated
Infections,'' followed by snowballing references cited by
critical articles. We found that although hand hygiene is a
centuries-old concept, it is still the primary strategy used
around the world to prevent HCAIs. It forms one of a bundle of
approaches used to clean and maintain a safe hospital
environment and to stop the transmission of contagious and
infectious microorganisms, including multidrug-resistant
microbes. Finally, antibiotic stewardship also has a crucial
role in reducing the impact of HCAIs through conserving
currently available antimicrobials
Emergency surgeons' perceptions and attitudes towards antibiotic prescribing and resistance: a worldwide cross-sectional survey
No full textAntibiotic resistance (AMR) is a growing public health problem worldwide, in part related to inadequate antibiotic use. A better knowledge of physicians' motivations, attitudes and practice about AMR and prescribing should enable the design and implementation of effective antibiotic stewardship programs (ASPs). The objective of the study was to assess attitudes and perceptions concerning AMR and use of antibiotics among surgeons who regularly perform emergency or trauma surgery
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