Microbiology in intraabdominal infections: what is the message for clinical studies? (Opinion paper)

Bacterial flora participating in intraabdominal infections are well known. Data are reviewed here documenting the constant antibiotic susceptibility of this flora despite many years of widespread use of antibiotics. The flaws inherent in the concept of "microbiologic efficacy" in evaluating antibiotic efficacy are examined. Among the possible results of a clinical trial, outcomes not in accord with antibiotic sensitivity data occur regularly. Factors such as host defense responses, source control and inoculum density also influence the outcome in a clinical trial but are not currently being measured. Recommendations for improved conduct of trails are made.