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Considerations for therapy of mixed infections: focus on intraabdominal infection
1University of Georgia College of Pharmacy, Augusta, USA.
Abstract:
Intraabdominal infections are a wide range of diseases that include penetrating abdominal trauma, appendicitis, peritonitis, and abscess. Most are polymicrobic, involving aerobic and anaerobic bacteria. The primary treatment is surgery, but important issues regarding administration of antimicrobials may affect patient outcome. Evaluation of an antimicrobial regimen must include consideration of outcomes--survival, organ failure, adverse drug effects, and superinfection. Single-agent regimens have demonstrated benefit in patients with acute intraabdominal contamination and established infections. Guidelines for selecting antimicrobial agents are available from the Surgical Infection Society. Regimens are effective when active against most bacteria isolated from the focus of abdominal infection. The patient's clinical response, not culture results independent of clinical findings, is the primary guide for directing changes in therapy.
Insights
Intraabdominal infections, often caused by multiple bacteria, require surgery and appropriate antimicrobial therapy. Single-agent regimens can be effective, with clinical response guiding treatment adjustments for better patient outcomes.
Area of Science:
- Infectious Diseases
- Surgical Infections
- Microbiology
Background:
- Intraabdominal infections encompass diverse conditions like appendicitis and peritonitis, frequently involving both aerobic and anaerobic bacteria.
- While surgery is the primary treatment, antimicrobial administration significantly impacts patient outcomes, including survival and organ function.
- Evaluating antimicrobial regimens necessitates assessing survival rates, organ failure, drug toxicity, and the risk of superinfections.
Purpose of the Study:
- To review the principles of antimicrobial therapy for intraabdominal infections.
- To highlight the importance of selecting effective antimicrobial agents against common pathogens.
- To emphasize the role of clinical response in guiding antimicrobial treatment adjustments.
Main Methods:
- Review of existing literature and guidelines on antimicrobial therapy for intraabdominal infections.
- Analysis of factors influencing patient outcomes in intraabdominal infections.
- Discussion of evidence supporting single-agent versus combination therapy.
Main Results:
- Single-agent antimicrobial regimens have shown efficacy in patients with acute intraabdominal contamination and established infections.
- Antimicrobial effectiveness is determined by activity against the predominant bacteria isolated from the infection site.
- Guidelines from the Surgical Infection Society provide a framework for selecting appropriate antimicrobial agents.
Conclusions:
- Effective antimicrobial therapy for intraabdominal infections requires agents active against polymicrobial flora.
- Patient's clinical response is the most critical factor in directing changes to antimicrobial therapy.
- Careful consideration of antimicrobial regimens is essential for optimizing outcomes in intraabdominal infections.