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The Need of Antimicrobial Stewardship in Post-Operative Infectious Complications of Abdominal Surgery
Wilfried Obst1, Torben Esser2, Achim Jens Kaasch2
1Department of Gastroenterology, Hepatology and Infectious Diseases Medical Faculty of the Otto von Guericke University Magdeburg, Magdeburg, Germany.
Background:
Post-operative infection is a common complication following abdominal surgery. The two most common infections are secondary peritonitis and surgical site infections, which lead to increased perioperative morbidity, prolonged hospitalization, higher mortality rates, and increased treatment costs. In addition to surgical procedures, treatment is based on effective antibiotic therapy. Due to increasing antimicrobial resistance, the correct use of antimicrobials is becoming more complex. Many initiatives call for the implementation of an antimicrobial stewardship (AMS) programme to optimize anti-infective therapy. The review article summarizes current recommendations in anti-infective therapy of post-operative peritonitis and surgical site infections and highlights the importance of an AMS programme in abdominal surgery.
Summary:
Larger studies evaluating the benefit of AMS in abdominal surgery are lacking. However, national and international guidelines have formulated appropriate recommendations for the rational use of antibiotics in post-operative peritonitis and surgical site infections. The rate of post-operative infections can be significantly reduced by perioperative antibiotic prophylaxis. The increase in multidrug-resistant bacteria complicates anti-infective therapy for post-operative infections. Analysis of local susceptibility patterns helps choose an adequate empiric therapy. A high rate of extended-spectrum beta-lactamase-producing bacteria may necessitate the use of other reserve antibiotics in addition to carbapenems, which are approved for the treatment of complicated intra-abdominal infections. A key role for the AMS team is the subsequent de-escalation of antibiotic therapy which limits the use of unnecessary broad-spectrum antibiotics.
Key Messages:
The increase in multidrug-resistant bacteria poses challenges for abdominal surgery. Post-operative infections should be treated by an interdisciplinary team of surgeons and specialists for AMS.
Insights
Optimizing antibiotic use through antimicrobial stewardship (AMS) programs is crucial for managing post-operative infections in abdominal surgery. AMS helps combat rising antimicrobial resistance and improve patient outcomes.
Area of Science:
- Surgical infections
- Antimicrobial resistance
- Public health
Background:
- Post-operative infections, including secondary peritonitis and surgical site infections, are frequent complications of abdominal surgery.
- These infections increase patient morbidity, hospital stays, mortality, and healthcare costs.
- Rising antimicrobial resistance complicates the effective treatment of these infections.
Purpose of the Study:
- To review current recommendations for anti-infective therapy in post-operative peritonitis and surgical site infections.
- To emphasize the critical role of antimicrobial stewardship (AMS) programs in optimizing antibiotic use within abdominal surgery.
Main Methods:
- Review of national and international guidelines on antibiotic use in post-operative abdominal infections.
- Analysis of strategies to reduce post-operative infection rates, including antibiotic prophylaxis.
- Discussion of challenges posed by multidrug-resistant bacteria and the importance of local susceptibility data.
Main Results:
- Perioperative antibiotic prophylaxis can significantly decrease post-operative infection rates.
- Multidrug-resistant bacteria complicate treatment, necessitating careful selection of empiric and reserve antibiotics.
- De-escalation of antibiotic therapy by AMS teams is vital to limit broad-spectrum antibiotic use.
Conclusions:
- Effective management of post-operative infections in abdominal surgery requires adherence to current guidelines and robust antimicrobial stewardship.
- Interdisciplinary collaboration between surgeons and AMS specialists is essential for optimal patient care.
- Addressing the challenge of multidrug-resistant bacteria is paramount for successful treatment outcomes.
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