Tag: Intra-abdominal Infections

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.

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.