Author: infectionsinsurgery

The mission of the Global Alliance for Infections in Surgery is to educate health care providers promoting the standards of care in managing infections in surgery worldwide.

Intra-abdominal Infections Survival Guide: a Position Statement by the Global Alliance for Infections in Surgery

Francesco M. Labricciosa, MD, Specialist in Hygiene and Preventive Medicine

An interesting article has been recently published in the World Journal of Emergency Surgery. An evidence-based position statement signed by a multidisciplinary working group of experts, whose main objective was to describe the best practices for complicated intra-abdominal infections (IAIs) management.

The working group, representing the Global Alliance for Infections in Surgery, included physicians from several different disciplines: general and emergency surgeons, intensive care specialists, and infectious diseases specialists.

A comprehensive literature search of pertinent scientific evidence was performed using PubMed and Google Scholar, and articles published in English between January 2010 and December 2023 were identified to formulate 28 statements. Evidence quality has been graded high, moderate, low, or very low according to the GRADE methodology. For each statement, consensus among the experts was reached using a Delphi approach. Statements were endorsed as a strong recommendation with agreement by ≥ 80% of participating experts. The final document was approved by each working group member to ensure consensus.

Several factors of importance in the management of complicated IAIs were listed.

First of all, the origin of the infection must be taken into account. Indeed, the term “intra-abdominal infections” includes several different pathologic conditions ranging in severity from uncomplicated appendicitis to diffuse faecal peritonitis. The origin of the infection should be always investigated for treatment planning. Achievement of source control is of utmost importance in the management of complicated IAIs.

Assessing the anatomic extent of infection is equally important to define the treatment approach. In uncomplicated IAIs, the infectious process only involves a single organ, while in complicated IAIs, it extends beyond, into the peritoneal cavity, leading to abscess formation or diffuse peritonitis. This classification does not describe patients’ complexity, but in its simplicity, defining the extension of the infectious process identifies those patients who need both source control and antimicrobial therapy.

Moreover, taking into account presumed pathogens involved and risk factors for antimicrobial resistance is crucial. Initial antimicrobial therapy for complicated IAIs is typically empiric in nature because standard microbiologic data and susceptibility results generally require 24-72 hours after peritoneal fluid specimen collection. For these reasons, an accurate patient stratification is crucial to optimize empiric antimicrobial therapy.

Finally, clinical conditions and host immune status have to be carefully considered when managing a patient with a complicated IAI.

The authors concluded that complicated IAIs are conditions sometimes difficult to manage, and available treatment options should be always assessed to optimize the management of patients with complicated IAIs.

Reference

  1. Sartelli M, Barie P, Agnoletti V, Al-Hasan MN, Ansaloni L, Biffl W, et al. Intra-abdominal infections survival guide: a position statement by the Global Alliance For Infections In Surgery. World J Emerg Surg. 2024 Jun 8;19(1):22.

Antimicrobial management of intra-abdominal infections: an Italian multidisciplinary Consensus Conference

Francesco M. Labricciosa, MD, Specialist in Hygiene and Preventive Medicine

In a paper recently published in the World Journal of Emergency Surgery, an Italian multidisciplinary group of healthcare professionals promoted a Consensus Conference on the antimicrobial management of intra-abdominal infections (IAIs).

IAIs are common surgical emergencies, representing an important cause of morbidity and mortality across global hospital settings. The cornerstones of IAIs management include timely diagnosis, adequate source control, early and appropriate antimicrobial therapy, and quick physiological stabilization through intravenous fluid therapy and vasopressor agents, especially in critically ill patients.

Optimizing antimicrobial therapy is of utmost importance to improve treatment effectiveness, increase patient safety, minimize the risk of selecting antimicrobial resistant microorganisms, and reduce the risk of opportunistic infections, such as Clostridioides difficile.

The Consensus Conference was promoted by the Multidisciplinary and Intersociety Italian Council for the Optimization of Antimicrobial Use which included diverse healthcare professionals: not only surgeons, but also infectious disease specialists, microbiologists, clinical pharmacologists, hospital pharmacists, emergency medicine specialists, intensivists, radiologists, and public health specialists.

After focusing on the general principles of diagnosis and treatment of IAIs, a list of relevant clinical questions was constructed to investigate the topic. Concerning the antimicrobial management of IAIs, basic subjects were faced, such as the optimal timing to start an antibiotic therapy, its reassessment based on the results of microbiological culture and susceptibility testing, its optimal duration, daily doses and modality of administration, without forgetting to discuss antifungal treatment, as well.

Following the best scientific evidence from PubMed, EMBASE Library and experts’ opinions, the panel produced 23 recommendation statements for the antimicrobial therapy of IAIs. They were planned and graded according to the GRADE hierarchy of evidence. Using a Delphi approach, a consensus was reached for each statement.

In the last section of the paper, 8 clinical diagnostic-therapeutic pathways for the most common IAIs were presented. The document was endorsed by the Italian Society of Surgery.

The authors concluded that an effective antimicrobial strategy for managing IAIs requires a correct balance between two elements: optimizing empiric therapy to improve clinical outcomes, and curbing excessive antimicrobial use to mitigate the emergence of multidrug-resistant strains.  

Reference

  1. Sartelli M, Tascini C, Coccolini F, Dellai F, Ansaloni L, Antonelli M, et al. Management of intra-abdominal infections: recommendations by the Italian council for the optimization of antimicrobial use. World J Emerg Surg. 2024 Jun 8;19(1):23.

A global evidence-based bundle for surgical antibiotic prophylaxis

Francesco M. Labricciosa, MD, Specialist in Hygiene and Preventive Medicine

Recommending a bundle with evidence-based measures for surgical antibiotic prophylaxis (SAP), easily applicable and helpful to improve antibiotic prescribing practices among surgeons worldwide. This is the aim of a narrative review just published in Antibiotics by Massimo Sartelli and colleagues.

Surgical site infections (SSIs) represent the most common healthcare-associated infections occurring in surgical patients. Therefore, all procedures aiming to prevent SSIs should be integrated before, during, and after surgery.

SAP is one of the most important measures to prevent SSIs. Nevertheless, many surgeons erroneously believe that SAP is peripheral to their clinical practice. But actually, surgeons play a central role in prevention SSIs.

Indeed, approximately 15% of all antibiotics in hospitals are prescribed for SAP. Using antibiotics appropriately, both for therapy and prophylaxis, is essential to improve treatment effectiveness and patient safety, reduce the risk of antibiotic-associated infections (e.g., Clostridioides difficile infection), and the selection and spread of antibiotic-resistant bacteria.

Several guidelines have been published regarding SSIs prevention, but measures stated in these guidelines are not self-implementing. Bundles are among the most used methods to adapt guidelines in local contexts, and improve acceptance and adherence to best practices.

As observed by the authors, bundles implemented as stand-alone interventions or as part of multimodal strategies were associated with decreased SSI rates.

For these reasons, an international working group of 30 physicians has been established by the Global Alliance for Infections in Surgery. The authors aimed to define a global evidence-based bundle for the appropriate SAP administration, and evaluated the evidence supporting it.

This bundle includes five different actions that may affect adequate SAP administration.

A global evidence-based bundle for surgical antibiotic prophylaxis [Adapted from Figure 1 in Ref. 1]

In administering antibiotics for any indication, including for SAP, surgeons should always be responsible for handling antibiotics with care. Indeed, inappropriate prescriptions of these precious medications, as well as poor implementation of infection prevention and control measures, are contributing to the development and spread of bacterial antimicrobial-resistance.

The authors hope this bundle can be easily applied everywhere, and help to improve antibiotic prescribing practices among surgeons worldwide.

Reference

  1. Sartelli M, Coccolini F, Labricciosa FM, Al Omari AH, Bains L, Baraket O, et al. Surgical Antibiotic Prophylaxis: A Proposal for a Global Evidence-Based Bundle. Antibiotics. 2024; 13(1):100.

Infection prevention and management in surgery: a global declaration

Francesco M. Labricciosa, MD, Specialist in Hygiene and Preventive Medicine

In a paper recently published in the World Journal of Emergency Surgery, seven surgical societies around the world shared an important declaration.

The authors – expert physicians representing the societies involved in this alliance – highlighted the threat posed by antimicrobial resistance (AMR), and the importance to prevent and manage infections appropriately across the surgical pathway.

The Global Alliance for Infections in Surgery (GAIS), the World Society of Emergency Surgery (WSES), the Surgical Infection Society (SIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), the American Association for the Surgery of Trauma (AAST), and the Panamerican Trauma Society (PTS) participated in the realization of this document.

The goal was to raise awareness among surgeons about AMR by focusing on the importance of actively participating in this challenge.

Surgeons really play a pivotal role in prevention and management of infections in their daily practice. Indeed, they are primarily responsible for preventing hospital-acquired infections, particularly surgical site infections. Moreover, they are prescribers of antibiotics, both for prophylaxis and therapy.

Nevertheless, among them adequate infection prevention and control (IPC) measures, and appropriate antibiotic prescribing practices are often disregarded. Why?

In healthcare facilities around the world, cultural, contextual, and behavioural determinants can influence surgeons’ clinical practice. Furthermore, other factors – such as the fear of clinical failure, time pressure, or organizational contexts – can limit their adherence to IPC procedures and antibiotic prescribing practices.

According to the authors, surgeons in hospital settings should be aware of their role and responsibility, and follow the fundamental principles for correct infection prevention and management across the surgical pathway.

Fundamental principles for correct infection prevention and management across the surgical pathway
[Adapted from Figure 1 in Ref. 1].

Changing clinical behaviour is extremely challenging.

A collaborative and multidisciplinary approach is paramount to optimize individual patients’ outcomes and overall healthcare delivery. Each healthcare provider of the team has to participate, and be responsible for its own contribution to patient care.

The authors concluded calling all surgeons around the world to take part in this global cause, by pledging support for this declaration, and accepting responsibility for maintaining the effectiveness of current and future antibiotics.

Reference

  1. Sartelli M, Coccolini F, Ansaloni L, Biffl WL, Blake DP, Boermeester MA, Coimbra R, Evans HL, Ferrada P, Gkiokas G, et al. Declaration on infection prevention and management in global surgery. World J Emerg Surg. 2023 Dec 6;18(1):56.

Happy Holiday Season

The year 2023 is coming to an end. At the end of the year, we would like to look back at the successes but also the challenges we were confronted with and will be confronted with. Global issues have increased in intensity and speed. At this time, our thoughts are with those most affected and we hope for more peaceful times ahead. However, the year 2023 has also shown that crises are also an opportunity for change and that many people are committed to a better world. This gives hope that we can continue to act together to hand over a healthy world. The proverb “If you want to go fast, go alone; if you want to go far, go together” reminds us that there is a need for global solidarity not only as a means of reducing health inequalities but also as a way of putting up a united force against global health challenges.

Wishing you a Happy Holiday Season, we would like to remind you that at this moment many people in the world are experiencing war. As an alliance that deals with health, the Global Alliance for Infections in Surgery does not aim to discuss responsibilities, because there are too complex reasons behind war, but we aim to remember the effects that war has on people’s health.
War has a catastrophic effect on the health and well-being of nations. War and armed conflict cause a significant loss of human life and are a major cause of disability worldwide. In addition to those hurt and killed as a direct result of violent conflict, a vast amount of people are also negatively impacted by the wider effect of war on health.
War diverts essential and often scarce resources from those who need it to survive the war effort. It also damages the infrastructure put in place to support healthcare. War forces people to flee their homes in search of safety, with the latest figures from the UN estimating that around 70 million people are currently displaced due to war. This displacement can be incredibly detrimental to health, with no safe and consistent place to sleep, wash, and shelter from the elements. It also removes a regular source of food and proper nutrition. 
War inevitably reduces access to clean water, food, and sanitation. This further increases the risk of contracting communicable diseases. It elevates the risk of malnutrition and diseases linked with malnutrition. Lack of access to clean water can also enhance the prevalence of cholera and other water-borne illnesses.
The impacts of war on health are strongly gendered. While men are traditionally more likely to die or become injured in battle, women are more likely to be left to face the lasting consequences of conflict on health.
Children’s health is strongly linked with maternal health. Children born during conflict are at a higher risk of being of a low birth weight, which is associated with an increased risk of infant mortality, poorer health in later life, and childhood developmental problems. Additionally, vaccination programs are limited during times of armed conflict. This can significantly increase a child’s chances of contracting what are now largely preventable diseases.
Finally, many studies have shown that war harms the mental health of both those involved in the conflict and civilians. People who live through war face psychologically challenging situations, often being uprooted from their homes, facing food insecurity, and constant fear of death and injury to name a few. This inevitably causes damage to a person’s psychological well-being and can exacerbate existing problems.
Our mission and values as a global alliance are to bring people together to advance health and well-being beyond borders, to inspire each other and to progress together. It is for these reasons that we firmly believe in unity and dialogue.

Optimal antibiotic use in hospital settings: ten golden rules

Francesco M. Labricciosa, MD, Specialist in Hygiene and Preventive Medicine

An important article has been recently published in the World Journal of Emergency Surgery.

A position paper, developed by an international multidisciplinary task force of experts, the WARNING collaborators, whose objective is to raise awareness of antimicrobial resistance (AMR), and improve antibiotic prescribing practices worldwide.

This document outlines ten axioms, or “golden rules”, that healthcare professionals should follow in their clinical practice for the appropriate use of these medications in hospital settings.

Antibiotics are life-saving medications, and therefore ensuring their correct prescription is an essential aspect of good clinical practice. The excessive and inappropriate antibiotic use is a main driver of AMR. However, in many regions of the world, there is not only overuse and misuse of antibiotics but also underuse. It is paramount to narrow the gap between excess and access.

As a matter of fact, optimising antibiotic prescribing implies improved treatment effectiveness and patient safety, minimises the risk of antibiotic-associated infections (e.g., Clostridioides difficile infection), and the selection and spread of antibiotic-resistant bacteria in patients within and across hospitals, countries, and globally.

In January 2023, the Global Alliance for Infections in Surgery established an international multidisciplinary task force to write and share a document on the need for appropriate use of antibiotics in hospitals to curb the spread of AMR.

Overall, 295 healthcare professionals with different backgrounds from 115 countries joined the WARNING (Worldwide Antimicrobial Resistance National/International Network Group) project.

In the final document, the ten golden rules for optimal antibiotic use in hospital settings have been described. They focus not only on the appropriate prescription of antibiotics, but also on the importance of Infection Prevention and Control, source control, monitoring and surveillance tools, education and awareness, and Antimicrobial Stewardship Programs.

The 10 golden rules for optimal antibiotic use in hospital settings [Adapted from Figure 1 in Ref. 1].

This document confirms the mission of the Global Alliance for Infections in Surgery, promoting standards of care in managing infections in surgery through a multidisciplinary and cohesive approach.

As the authors conclude, the appropriate use of antibiotics should be integral to good clinical practice, and these precious medications should be considered as a public good on the verge of scarcity.

Therefore, it is a global collective responsibility to preserve antibiotics, and avoid future deaths caused by multidrug resistant infections.

Reference

  1. Worldwide Antimicrobial Resistance National/International Network Group (WARNING) Collaborators. Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action. World J Emerg Surg. 2023 Oct 16;18(1):50.

Francesco M. Labricciosa, MD, Specialist in Hygiene and Preventive Medicine

FREE GLOBAL WEBINAR MEETING

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Antimicrobial resistance (AMR) is one of the greatest threats to public health, sustainable development, and security worldwide. Its prevalence has increased alarmingly over the past decades. The term “One Health” is now used widely to recognize the interconnectedness of the health of people, animals, and the environment. Multisectoral collaborations and concerted global efforts across multiple health domains are needed to tackle AMR. Despite the complexity of AMR determinants, healthcare workers play a central role in preventing the emergence and spread of AMR, optimizing antimicrobial use, strengthening surveillance and infection prevention and control, and improving education and awareness regarding the appropriate use of antibiotics and the correct respect of infection prevention and control measures. The webinar is free of charge and completely online. To give people from all over the world the opportunity to connect, the webinar will last 15 hours, starting at 6.55 a.m. UTC and ending at 10.00 p.m. UTC. The webinar will be held during World Antimicrobial Resistance Awareness Week. It aims to increase awareness of AMR and to encourage a comprehensive approach to infections in hospital settings. Throughout the webinar meeting, speakers from all around the world will debate the main aspects of AMR and the prevention and management of infections in hospital settings.

All participants will receive a certificate of participation.

Join us!

…

—–

Program

…

Speakers

—

Register now

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Time zone converter

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Antimicrobial resistance (AMR) poses a global challenge. No single country, however effective it is at containing resistance within its boundaries, can protect itself from the importation of multi-drug resistant organisms. The global nature of antimicrobial resistance calls for a global response, both in the geographic sense and across the whole range of sectors involved. Nobody is exempt from the problem. There is no single ‘silver bullet’ to address AMR. What we need to tackle the AMR problem is an adaptive, multipronged approach involving many stakeholders – working locally, nationally, and globally – to attain optimal health for people, animals, and the environment. What we need is a multidisciplinary approach, considering also the great diversity of social, economic, political, and cultural contexts in which AMR emerges or spreads. What we need are strategies to increase awareness about AMR in order to implement more effective interventions. Finally, what we need is a comprehensive and solidaristic model as the only solution for a problem that knows no borders. To tackle AMR, antimicrobial effectiveness needs to be recognized as a fundamentally important global public good and governed accordingly. AMR is a challenge to global development. Antimicrobial effectiveness must be looked upon as a limited global public good on the verge of becoming scarce, and the world has a collective responsibility to preserve it in order to avoid countless future victims of drug-resistant infections. The COVID-19 pandemic has shown that despite all of our medical advances, we remain incredibly vulnerable to infections for which we have no therapies. However, it has shown that if sufficiently motivated, we can make huge changes in short time frames. The COVID-19 pandemic has also created a renewed awareness of the importance of infectious diseases. It is a substantial entry point for reigniting the momentum toward containing the “silent pandemic” of AMR.

Join us!

Massimo Sartelli

Global Alliance for Infections in Surgery

World Antimicrobial Resistance Awareness Week 2023

FREE GLOBAL WEBINAR MEETING

—

……

…..

Antimicrobial resistance (AMR) is one of the greatest threats to public health, sustainable development, and security worldwide. Its prevalence has increased alarmingly over the past decades. The term “One Health” is now used widely to recognize the interconnectedness of the health of people, animals, and the environment. Multisectoral collaborations and concerted global efforts across multiple health domains are needed to tackle AMR. Despite the complexity of AMR determinants, healthcare workers play a central role in preventing the emergence and spread of AMR, optimizing antimicrobial use, strengthening surveillance and infection prevention and control, and improving education and awareness regarding the appropriate use of antibiotics and the correct respect of infection prevention and control measures. The webinar is free of charge and completely online. To give people from all over the world the opportunity to connect, the webinar will last 15 hours, starting at 6.55 a.m. UTC and ending at 10.00 p.m. UTC. The webinar will be held during World Antimicrobial Resistance Awareness Week. It aims to increase awareness of AMR and to encourage a comprehensive approach to infections in hospital settings. Throughout the webinar meeting, speakers from all around the world will debate the main aspects of AMR and the prevention and management of infections in hospital settings.

All participants will receive a certificate of participation.

Join us!

…

—–

Program

…

Speakers

—

Register now

—

Time zone converter

,,,,,

,

…….

….

Antimicrobial resistance (AMR) poses a global challenge. No single country, however effective it is at containing resistance within its boundaries, can protect itself from the importation of multi-drug resistant organisms. The global nature of antimicrobial resistance calls for a global response, both in the geographic sense and across the whole range of sectors involved. Nobody is exempt from the problem. There is no single ‘silver bullet’ to address AMR. What we need to tackle the AMR problem is an adaptive, multipronged approach involving many stakeholders – working locally, nationally, and globally – to attain optimal health for people, animals, and the environment. What we need is a multidisciplinary approach, considering also the great diversity of social, economic, political, and cultural contexts in which AMR emerges or spreads. What we need are strategies to increase awareness about AMR in order to implement more effective interventions. Finally, what we need is a comprehensive and solidaristic model as the only solution for a problem that knows no borders. To tackle AMR, antimicrobial effectiveness needs to be recognized as a fundamentally important global public good and governed accordingly. AMR is a challenge to global development. Antimicrobial effectiveness must be looked upon as a limited global public good on the verge of becoming scarce, and the world has a collective responsibility to preserve it in order to avoid countless future victims of drug-resistant infections. The COVID-19 pandemic has shown that despite all of our medical advances, we remain incredibly vulnerable to infections for which we have no therapies. However, it has shown that if sufficiently motivated, we can make huge changes in short time frames. The COVID-19 pandemic has also created a renewed awareness of the importance of infectious diseases. It is a substantial entry point for reigniting the momentum toward containing the “silent pandemic” of AMR.

Join us!

Massimo Sartelli

Global Alliance for Infections in Surgery

World Antimicrobial Resistance Awareness Week 2023

Why to join World Antimicrobial Awareness Week

The World Antimicrobial Awareness Week is a good reminder that we must all work together to slow the spread of antimicrobial resistance (AMR).

AMR has emerged as one of the principal public health problems of the 21st century. This has resulted in a public health crisis of international concern, which threatens the practice of modern medicine, animal health and food security. Combating resistance has become a top priority for global policy makers and public health authorities. New mechanisms of resistance continue to emerge and spread globally, threatening our ability to treat common infections. Antibacterial and antifungal use in animal and agricultural industries aggravates selective pressure on microbes. A One Health approach is urgently required. The burden of AMR is difficult to quantify in some regions of the world because enhanced surveillance requires personnel, equipment and financial resources that are not always available. However, the worldwide impact of AMR is significant  in terms of economic and patient outcomes; due to untreatable infections or those requiring antibiotics of last resort (such as colistin) leading to increased length of hospital stay, morbidity, mortality and treatment cost. Antibiotics can be life-saving when treating bacterial infections but are often used inappropriately, specifically when unnecessary or when administered for excessive durations or without consideration of pharmacokinetic principles. Large variations in antibiotic consumption exist between countries and whilst excessive use remains a major problem in some areas of the world, elsewhere there is lack of access to many antimicrobial agents. AMR is a natural phenomenon that occurs as microbes evolve. However, human activities have accelerated the pace at which bacteria develop and disseminate resistance. Inappropriate use of antibiotics in humans and food-producing animals, as well as poor infection prevention and control practices, contribute to the development and spread of AMR.

Efforts must be aimed at the general public, healthcare professionals, food producing farmers, civil society organizations and policy makers. An effective and cost-effective strategy to reduce AMR should involve a multi-faceted approach aimed at optimizing antimicrobial use, strengthening surveillance and infection prevention and control, and improving patient and clinician education regarding the appropriate use of antibiotics.

AMR poses a global challenge. No single country, however effective it is at containing resistance within its boundaries, can protect itself from the importation of antibiotic resistance through travel and trade.

The global nature of AMR calls for a global response, both in the geographic sense and across the whole range of sectors involved. Nobody is exempt from the problem.

Although the current magnitude of the problem, healthcare workers play a central role in preventing the emergence and spread of resistance. Appropriate use of antibiotics should be integral to good clinical practice and standards of care. Healthcare workers should be aware of their role and responsibility for maintaining the effectiveness of current and future antibiotics specifically by:

•  Following locally-developed customized antibiotic guidelines and clinical pathways

•  Supporting and enhancing IPC including correct hand hygiene protocols

•  Supporting and enhancing surveillance of ABR and antibiotic consumption

•  Prescribing and dispensing antibiotics only when they are truly required

•  Identifying and controlling the source of infection

•  Prescribing and dispensing appropriate antibiotics(s) with adequate dosages i.e.   administration of antibiotics according to pharmacokinetic-pharmacodynamic   principles

•  Reassessing treatment when culture results are available

•  Using the shortest duration of antibiotics based on evidence

•  Educating healthcare workerss and staff how to use antibiotics wisely