Tag: AMR

A healthier world for all: is it possible?

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

Today the world is facing a crisis that threatens the fundamental pillars of public health, scientific integrity and social stability. These challenges can exacerbate global inequalities, jeopardise health security and undermine the progress achieved through years of international collaboration. It is crucial that health scientists are aware of these interconnected challenges and respond united and determined.

For these reasons, in a paper recently published in the World Journal of Emergency Surgery, a viewpoint declaration was signed by the Global Consortium for Solidarity to Overcome Challenges, Restore Trust and Advance Science for a Sustainable Future. This group included 366 healthcare workers and scientists from 119 countries from across all continents and belonging to numerous disciplines.

The paper aims to highlight the urgent need for global solidarity and collective action to address several global health challenges.

The authors begin their dissertation by focusing on the importance of investing in resilient healthcare systems, considering the vulnerability and fragility of global public health systems revealed by the COVID-19 pandemic. Moreover, the rapid process of globalisation has challenged traditional border-based control mechanisms, calling for new approaches to governing the globalization of public health.

Then, considering climate change as a public health emergency is essential, as well as evaluating the challenges of infectious diseases and antimicrobial resistance (AMR). In particular, AMR is considered by the authors as a global scientific, human, and economic challenge. They wish for a new research model on AMR that promotes collaboration and integrates knowledge across disciplines, ensuring a holistic approach and universal impact. Therefore, these objectives can be achieved adopting a One Health approach to combat infectious diseases and AMR.

Moreover, wars must be considered as public health emergencies. They have devastating effects on health, requiring immediate and coordinated global response. The healthcare community must play a leading role in preventing wars and promoting peace.

Among the challenges to be faced today, the authors included also combating false and misleading information. False narratives regarding health can damage public trust in science. Scientists must actively involve the public and communicate their findings in transparent and accessible ways. Furthermore, rethinking the quality and integrity of scientific research is essential as well.

Regulating artificial intelligence use in healthcare should be a priority, wisely considering its opportunities and challenges in a balance between innovation and ethical oversight. Finally, the importance of strengthening the global health governance is clearly underlined.

The authors conclude that scientists, clinicians, and healers can be stronger and better in restoring global trust and confidence only if they are united by a single but shared goal: a healthier world for all.

Reference

Sartelli M, Mossialos E, Coccolini F, et al. Global health at crossroads: uniting together to overcome challenges, restore trust and advance priorities for a sustainable future. World J Emerg Surg. 2025;20:84.

Antibiotics for Intra-Abdominal Infections: When, Which, How and How Long?

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

Intra-abdominal infections (IAIs) are among the most challenging problems in surgical practice, ranging from uncomplicated appendicitis to life-threatening peritonitis. IAIs require prompt diagnosis, timely surgical intervention, and appropriate antimicrobial therapy.

Antibiotics are essential in IAIs management. For years, an empirical broad-spectrum approach, often with prolonged courses of multiple agents, has been the default response to IAIs. This approach certainly saved lives. However, it has promoted the selection of multidrug-resistant organisms.

Prescribing antibiotics in IAIs is challenging: it requires a balance between urgency and precision, between lifesaving therapy and the long-term threat of antimicrobial resistance (AMR). Antibiotic therapy should be individualised and tailored on the patient’s clinical conditions and the local epidemiology.

In community-acquired IAIs, narrow-spectrum coverage is often sufficient, avoiding unnecessary exposure to carbapenems or anti-pseudomonal agents. In contrast, healthcare-associated infections, especially in patients with previous antibiotic exposure or serious illness, may need a broader empiric approach, followed by de-escalation once cultures clarify the microbiologic picture.

For these reasons, in a narrative review recently published in Antibiotics, Massimo Sartelli and his collaborators tried to answer four questions.

When should antibiotics be used in patients with IAIs? Which antibiotics should be selected? How should they be managed? How long should they be administered in patients with IAIs?

The authors concluded that advances in antibiotic agents, optimised pharmacokinetics and pharmacodynamics strategies, and stewardship-driven de-escalation provide opportunities to improve efficacy while preserving future antibiotic utility in an era of increasing AMR.

Reference

Sartelli M, Palmieri M, Labricciosa FM. Antibiotics for Intra-Abdominal Infections: When, Which, How and How Long? Antibiotics. 2025;14(11):1127. 

Prevention and control of healthcare-associated infections: the first principle of every antimicrobial stewardship program

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

The misuse and overuse of antimicrobials are among the main drivers in the development of drug-resistant pathogens, and the appropriate use of these precious medications is paramount to preserve them for future generations to come. However, healthcare professionals should always keep in mind that also an inadequate infection prevention and control contributes considerably to the emergence and spread of antimicrobial resistance (AMR).

AMR is closely related to healthcare-associated infections (HAIs): 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. For this reason, even before using antimicrobials correctly, preventing the occurrence and controlling the spread of HAIs in healthcare facilities is essential. It should be considered the first principle of an appropriate antimicrobial stewardship program in every hospital worldwide.

In a paper recently published in Antibiotics, an international working group of physicians defined the most important measures to prevent and control HAIs in hospital settings.

In this narrative review, the authors presented seven measures that all healthcare workers must know and support. They focused their attention not only on the pivotal role of hand hygiene and the prevention of HAIs, but also on the importance of an effective environmental hospital hygiene, the implementation of surveillance systems, and patients’ screening, decolonization, isolation and cohorting. Finally, they did not forget to discuss about adapting evidence-based practices to the local context, and promoting safety culture.

The authors hope that this document can contribute to raise awareness among healthcare professionals about all issues associated with HAIs, and the need to embrace a personal involvement in the strategies that can help reduce their occurrence.

Fewer microorganisms there will be in our hospitals, fewer antimicrobials we will use. Fewer HAIs will develop in our hospitals, fewer broad-spectrum antibiotics we will have to use to combat multidrug-resistant organisms.

Reference

  1. Sartelli M, Marini CP, McNelis J, Coccolini F, Rizzo C, Labricciosa FM, Petrone P. Preventing and Controlling Healthcare-Associated Infections: The First Principle of Every Antimicrobial Stewardship Program in Hospital Settings. Antibiotics. 2024;13(9):896.

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.

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.

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