Antimicrobial management in nosocomial peritonitis: microbiota, drug and time

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Pharmacology

Background:

• Complicated intra-abdominal infections (cIAI) necessitate early surgical intervention and broad-spectrum antibiotics.
• The rise of multidrug-resistant bacteria (MDRB), particularly carbapenemase-producing Enterobacteriaceae (CPE), poses a significant threat in critical care settings.
• High mortality rates associated with Candida peritonitis in critically ill patients underscore the need for timely diagnosis and treatment.

Purpose of the Study:

• To review current therapeutic strategies for complicated intra-abdominal infections and Candida peritonitis.
• To highlight the challenges posed by multidrug-resistant bacteria in critical care.
• To discuss the role of novel antimicrobial agents in managing resistant infections.

Main Methods:

• Literature review of studies on complicated intra-abdominal infections and Candida peritonitis.
• Analysis of the impact of multidrug-resistant bacteria on treatment outcomes.
• Evaluation of emerging therapeutic options, including new antibiotics and antifungals.

Main Results:

• Carbapenem resistance has limited treatment options, with tigecycline and colistin as last resorts.
• Ceftazidime-avibactam and ceftolozane-tazobactam represent promising advancements for treating multidrug-resistant Enterobacteriaceae.
• Echinocandins are the preferred treatment for Candida peritonitis, improving patient prognosis.

Conclusions:

• Effective management of cIAI and Candida peritonitis requires a multifaceted approach including surgery, appropriate antibiotics, and antifungals.
• The emergence of MDRB necessitates the adoption of newer agents like ceftazidime-avibactam and ceftolozane-tazobactam.
• Early diagnosis and targeted therapy, particularly with echinocandins for fungal infections, are crucial for improving outcomes in critically ill patients.