Essentials for selecting antimicrobial therapy for intra-abdominal infections

Area of Science:

• Infectious Diseases
• Surgical Infections
• Antimicrobial Stewardship

Background:

• Intra-abdominal infections (IAI) present complex challenges in antimicrobial therapy and duration.
• Current classifications of IAI, such as 'uncomplicated' vs. 'complicated' and 'tertiary peritonitis,' often cause confusion.
• Existing systems inadequately separate anatomical disruption, disease severity, and risk factors for resistant pathogens.

Purpose of the Study:

• To propose a novel classification system for intra-abdominal infections (IAI).
• To develop a grid-based approach that separates anatomical disruption, disease severity, and acquisition origin/risk factors.
• To enhance the precision of defining IAI cases for optimized antimicrobial therapy selection.

Main Methods:

• Critically reviewed existing IAI classification systems.
• Proposed a new classification grid incorporating anatomical disruption, disease severity, and origin/exposure.
• Defined risk factors for specific pathogens (e.g., Pseudomonas aeruginosa, enterococci, Candida) and resistant organisms.

Main Results:

• The proposed grid offers a more unequivocal method for defining intra-abdominal infection (IAI) index cases.
• It aids in selecting appropriate empirical antimicrobial regimens by considering key IAI components.
• The system guides decisions on covering nosocomial pathogens, including Gram-negatives, enterococci, and yeasts.

Conclusions:

• Abandoning terms like 'uncomplicated,' 'complicated,' and 'tertiary peritonitis' is recommended to reduce confusion.
• Separating anatomical disruption and disease severity into distinct phenotypes is crucial.
• The new classification grid facilitates more precise IAI management and antimicrobial selection.