Intra-abdominal infections (IAIs) are common surgical emergencies and are an important cause of morbidity and mortality in hospital settings, particularly if poorly managed. The cornerstones of effective IAIs management include early diagnosis, adequate source control, appropriate antimicrobial therapy, and early physiologic stabilization using intravenous fluids and vasopressor agents in critically ill patients. Adequate empiric antimicrobial therapy in patients with IAIs is of paramount importance because inappropriate antimicrobial therapy is associated with poor outcomes. Optimizing antimicrobial prescriptions improves treatment effectiveness, increases patients’ safety, and minimizes the risk of opportunistic infections (such as Clostridioides difficile) and antimicrobial resistance selection. The growing emergence of multi-drug resistant organisms has caused an impending crisis with alarming implications, especially regarding Gram-negative bacteria. The Multidisciplinary and Intersociety Italian Council for the Optimization of Antimicrobial Use promoted a consensus conference on the antimicrobial management of IAIs, including emergency medicine specialists, radiologists, surgeons, intensivists, infectious disease specialists, clinical pharmacologists, hospital pharmacists, microbiologists and public health specialists. Relevant clinical questions were constructed by the Organizational Committee in order to investigate the topic. The expert panel produced recommendation statements based on the best scientific evidence from PubMed and EMBASE Library and experts’ opinions. The statements were planned and graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence. On November 10, 2023, the experts met in Mestre (Italy) to debate the statements. After the approval of the statements, the expert panel met via email and virtual meetings to prepare and revise the definitive document. This document represents the executive summary of the consensus conference and comprises three sections. The first section focuses on the general principles of diagnosis and treatment of IAIs. The second section provides twenty-three evidence-based recommendations for the antimicrobial therapy of IAIs. The third section presents eight clinical diagnostic-therapeutic pathways for the most common IAIs. The document has been endorsed by the Italian Society of Surgery.

中文翻译：

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腹腔内感染的管理：意大利委员会关于优化抗菌药物使用的建议


腹腔内感染 (IAI) 是常见的外科急症，也是医院环境中发病率和死亡率的重要原因，特别是在管理不善的情况下。有效 IAI 管理的基石包括早期诊断、充分的感染源控制、适当的抗菌治疗以及对危重患者使用静脉输液和血管加压药物进行早期生理稳定。 IAI 患者充分的经验性抗菌治疗至关重要，因为不适当的抗菌治疗会导致不良预后。优化抗菌药物处方可以提高治疗效果，提高患者的安全性，并最大限度地降低机会性感染（如艰难梭菌）和抗菌药物耐药性选择的风险。多重耐药微生物的不断出现已经引发了一场迫在眉睫的危机，带来了令人震惊的影响，特别是对于革兰氏阴性细菌。意大利抗菌药物使用优化多学科和跨社会委员会推动召开了关于 IAI 抗菌管理的共识会议，与会者包括急诊医学专家、放射科医生、外科医生、重症医生、传染病专家、临床药理学家、医院药剂师、微生物学家和公共卫生专家。组织委员会构建了相关的临床问题来研究该主题。专家小组根据 PubMed 和 EMBASE 图书馆的最佳科学证据以及专家的意见提出了推荐声明。这些陈述是根据建议评估、制定和评估 (GRADE) 证据等级进行规划和分级的。 2023 年 11 月 10 日，专家们在意大利梅斯特雷举行会议，对这些声明进行辩论。声明获得批准后，专家小组通过电子邮件和虚拟会议召开会议，准备和修订最终文件。本文件是共识会议的执行摘要，由三个部分组成。第一部分重点介绍 IAI 诊断和治疗的一般原则。第二部分为 IAI 的抗菌治疗提供了 23 条基于证据的建议。第三部分介绍了最常见 IAI 的八种临床诊断治疗途径。该文件已得到意大利外科学会的认可。