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Perioperative Antibiotic Prophylaxis and Antimicrobial Therapy of Intra-Abdominal Infections
Stefan Hagel1, Hubert Scheuerlein2
1Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany, ; Department of Internal Medicine IV, Gastroenterology, Hepatology and Infectious Diseases, Jena University Hospital, Jena, Germany, ; Center for Sepsis Control & Care (CSCC), Jena University Hospital, Jena, Germany.
Background:
The increase of antimicrobial resistances to first- and second-line antibiotics, especially of Gram-negative bacteria, and the lack of novel antimicrobial substances are a challenge in the treatment of intra-abdominal infections.
Methods:
Review article.
Results:
The efficacy and safety of perioperative antibiotic prophylaxis in visceral surgery has been demonstrated by several meta-analyses. Perioperative antibiotic prophylaxis is defined as a single administration of antibiotics shortly before a surgical intervention. A so-called prolonged prophylaxis including the postoperative period (e.g. 1-3 days postoperatively) should be avoided as it does not reduce the number of wound infections and is associated with an increased risk of antimicrobial resistance and side effects. Antimicrobial management of severe intra-abdominal infections involves a delicate balance of optimizing empirical therapy which has been shown to improve outcomes while simultaneously reducing unnecessary use of antimicrobials.
Conclusion:
Antimicrobial resistance poses a serious threat to human health and requires a rational use of antibiotics to curb further spreading. This applies for perioperative prophylaxis as well as for the treatment of intra-abdominal infections.
Insights
Rational antibiotic use is crucial for treating intra-abdominal infections and preventing antimicrobial resistance. Avoid prolonged antibiotic prophylaxis in visceral surgery to minimize resistance and side effects.
Area of Science:
- Infectious Diseases
- Surgical Infections
- Pharmacology
Background:
- Rising antimicrobial resistance in Gram-negative bacteria complicates intra-abdominal infection treatment.
- Limited development of new antimicrobial agents exacerbates treatment challenges.
Purpose of the Study:
- To review the role of antibiotic prophylaxis in visceral surgery.
- To discuss antimicrobial management strategies for intra-abdominal infections.
- To emphasize rational antibiotic use in combating resistance.
Main Methods:
- Literature review.
- Analysis of meta-analyses on perioperative antibiotic prophylaxis.
- Synthesis of evidence on antimicrobial management.
Main Results:
- Perioperative antibiotic prophylaxis is effective and safe when administered as a single dose before surgery.
- Prolonged antibiotic prophylaxis (1-3 days postoperatively) offers no benefit for wound infections and increases resistance and side effects.
- Optimizing empirical therapy improves outcomes in severe intra-abdominal infections while reducing unnecessary antibiotic exposure.
Conclusions:
- Antimicrobial resistance is a significant global health threat.
- Rational antibiotic use is essential for both prophylaxis and treatment of intra-abdominal infections to curb resistance spread.
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