Tag: Antimicrobial Stewardship

Epidemiological analysis of intra-abdominal infections in Italy: the IRIS study

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

Intra-abdominal infections (IAIs) are common and serious surgical emergencies. Over the past few years, an increase in antimicrobial resistance (AMR) associated with IAIs has been observed worldwide, responsible for a significant increase in morbidity and mortality rates, and overall healthcare costs. In order to improve the quality of treatment, it is essential to recognize the underlying local epidemiology, clinical implications, and appropriate management of AMR.

In a paper recently published in the World Journal of Emergency Surgery, a prospective, observational, nationwide, multicentre study was conducted to investigate the epidemiology and initial management of complicated IAIs (cIAIs) in Italy.

The IRIS study (Italian Register of Complicated Intra-abdominal InfectionS) included 4,530 consecutively hospitalized patients – older than 16 years of age – from 23 different Italian hospitals, between May 1, 2021 and April 31, 2023, with diagnosis of cIAIs undergoing surgery, interventional drainage or conservative treatment.

Overall, 70.9% of the cases were community acquired infections, the predominant type of infection for all the diagnosis. The majority of healthcare-associated infections were represented by colonic perforation and diverticulitis (28.3%), small bowel occlusion (19%) and intestinal ischemia (18%). At presentation, 27.8% of patients had a septic shock. The overall mortality rate was 5.13%, and 16.5% of patients required admission to Intensive Care Unit.

Microbiological samples were collected from 3,208 (70.8%) patients; 48.8% of intrabdominal samples resulted positive. Not surprisingly, the major pathogen involved in IAIs was E. coli (45.6%). Remarkably, in 29% of the cases microbiological samples were not collected.

During hospital stay, an empiric antimicrobial therapy was administered in 78.4% of patients. Amoxicillin/clavulanate was the most common antibiotic used (e.g., in 30.1% appendicitis, 30.5% of cholecystitis, and 55% small bowel perforation), followed by piperacillin/tazobactam (e.g., in 13.3% colonic perforation and diverticulitis, 22.6% cholecystitis, 28.6% pancreatitis). Empiric antifungal therapy was administered in 2.6% of patients with no sign of sepsis, 3.1% of patients with clinical sign of sepsis and 4.1% of patients with septic shock. Azoles were the most used antifungals in patients that received empiric antifungal therapy.

The authors concluded that antibiotic stewardship programs and correct antimicrobial and antifungal prescription campaigns are needed to further improve the appropriateness of drug usage and reduce the burden of AMR. This will contribute to better care and treatment for the next generations.

Reference

  1. Coccolini F, Brogi E, Ceresoli M, et al. Epidemiological analysis of intra-abdominal infections in Italy from the Italian register of complicated intra-abdominal infections—the IRIS study: a prospective observational nationwide study. World J Emerg Surg. 2025;20:22.

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.