Antibiotic De-Escalation in Emergency General Surgery

Area of Science:

• Surgical Infectious Diseases
• Pharmacology
• Critical Care Medicine

Background:

• Antibiotic treatment in emergency general surgery (EGS) presents challenges due to high rates of intra-abdominal infections, multi-drug resistance, and antibiotic overuse.
• Antibiotic de-escalation (ADE) is an emerging strategy to improve antibiotic therapy management in surgical settings.
• Optimizing antibiotic use is crucial to reduce morbidity, mortality, and prolonged hospitalizations.

Purpose of the Study:

• To summarize existing evidence, current strategies, and identify challenges for optimizing antibiotic de-escalation (ADE) in EGS.
• To review the feasibility and impact of ADE on clinical outcomes and healthcare costs.
• To highlight the need for further research focused on ADE in the EGS population.

Main Methods:

• A comprehensive literature search was conducted using PubMed and Cochrane databases.
• Keywords included "de-escalation", "antibiotic therapy", and "antibiotic treatment".
• The review focused on evidence, strategies, and unsolved problems related to ADE in EGS.

Main Results:

• There is no universally accepted definition for antibiotic de-escalation (ADE).
• Current evidence suggests ADE is feasible in EGS, optimizing antibiotic use, reducing hospitalization, and healthcare costs without compromising clinical outcomes.
• Existing guidelines recommend ADE for specific conditions like uncomplicated appendicitis and cholecystitis post-source control.

Conclusions:

• Antibiotic de-escalation (ADE) is an effective and feasible strategy for optimizing antibiotic management in EGS patients without negatively impacting clinical outcomes.
• A multidisciplinary approach involving surgeons, intensivists, and infectious disease specialists is essential for successful ADE implementation.
• There is a significant need for further studies specifically investigating ADE within the EGS ward setting.