Complicated Intra-Abdominal Infections: The Old Antimicrobials and the New Players

Area of Science:

• Infectious Diseases
• Pharmacology
• Critical Care Medicine

Background:

• Complicated intra-abdominal infections (cIAIs) are a significant global health concern, leading to substantial morbidity and mortality.
• Effective management hinges on timely source control and appropriate empiric antimicrobial therapy, with deviations impacting patient outcomes and healthcare costs.
• Rising antimicrobial resistance, particularly from extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae and carbapenemase-producing Klebsiella pneumoniae, complicates treatment strategies.

Purpose of the Study:

• To review current guidelines for antimicrobial therapy in cIAIs.
• To discuss the properties and clinical utility of novel antimicrobial agents.
• To explore optimal treatment durations and recent clinical trial findings for cIAIs.

Main Methods:

• Literature review of current guidelines and recent clinical trials.
• Analysis of antimicrobial properties, focusing on agents effective against resistant pathogens.
• Discussion of treatment duration and the role of newly approved antimicrobials.

Main Results:

• Increasing resistance necessitates updated therapeutic approaches beyond traditional regimens.
• Novel agents like ceftazidime-avibactam and ceftolozane-tazobactam demonstrate efficacy against resistant organisms, including ESBL producers.
• Optimal antimicrobial therapy duration for cIAIs remains an area requiring further investigation.

Conclusions:

• The evolving landscape of antimicrobial resistance in cIAIs demands careful selection of empiric therapy.
• Newer antimicrobial agents offer valuable options for treating infections caused by resistant bacteria.
• Further research is crucial to establish evidence-based optimal durations for antimicrobial therapy in cIAIs.