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Antimicrobial Treatment for Surgical Intra-abdominal Infections, Duration of2019

Type: New Practice Management Guideline (PMG)
Category: Emergency General Surgery
Committee Liaison: Nikolay Bugaev, MD

Team leader(s)

There is great interest in the surgical community in the topic of management of intra-abdominal infections. Intra-abdominal infections is a common disease are common problems seen and managed by surgeons and are a major cause of morbidity and mortality worldwide. Many disease processes contribute to intra-abdominal infections, such as acute appendicitis, diverticulitis, perforated peptic ulcers, perforated colon cancer, and infectious colitis making it a challenge to provide recommendations based solely on the presence of intra-abdominal infections alone. 

Previous Efforts: Although a few guidelines have been written by national and international societies, none have applied the GRADE Methodology. One Two such guidelines were published in 2017 - the Surgical Infection Society Revised Guidelines on the Management of Intra-abdominal Infection by Mazuki and colleagues and the Management of Intra-abdominal Infections from the Global Perspective: 2017 WSES Guidelines for the Management of Intra-abdominal Infections by Sartelli et al. 

Methods: The Emergency General Surgery writing group from the Guidelines of the Eastern Association for the Surgery of Trauma (EAST) will perform a systematic review and meta-analysis of the current literature regarding the duration of antimicrobial treatment for intra-abdominal infections. The Grading of Recommendations Assessment, Development and Evaluation methodology will be applied to create recommendations addressing various aspects of management of surgical abdominal infections with antibiotics. 

Recommendations needed: Recommendations are needed for the type, duration and route of antimicrobials for specific disease states (appendicitis, cholecystitis, colitis, bowel perforations, solid organ abscesses, etc.) either with or without surgical source control, for those patients who are immunocompromised and/or frail, hemodynamically unstable or stable and whose surgical abdominal infections are caused by multidrug resistant organisms.

Work Group Members
Jin Ra, MD - Work Group Leader
Sofya Asfaw, MD - Work Group Leader
Bishwajit Bhattacharya, MD
Nikolay Bugaev, MD
Christopher Butts, PhD, DO
John Como, MD, MPH
Shailvi Gupta, MD, MPH
Caleb Mentzer, DO
Nimitt Patel, MD
Rishi Rattan, MD
Sheryl Sahr, MD, MS

Mazuski JE, Tessier JM, May AK et al. The Surgical Infection Society on the Management of Intra-Abdominal
Infection. Surgical Infections (Larchmt) 2017 Jan; 18(1):1-76. PMID: 28085573. 

Sartelli M, Chichom-Mefire A, Labricciosa FM et al. The Management of Intra-abdominal Infections from a Global Perspective: 2017 WSES Guidelines for Management of Intra-abdominal Infections. World Journal of Emergency Surgery 2017 Aug 2; 21:36. PMID: 28702076.

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