Untargeted antifungal therapy in adult patients with complicated intra-abdominal infection: a systematic review

The Surgical Infection Society Guidelines on the Management of Intra-Abdominal Infection: 2024 Update

Background: The Surgical Infection Society (SIS) published evidence-based guidelines for the management of intra-abdominal infection (IAI) in 1992, 2002, 2010, and 2017. Here, we present the most recent guideline update based on a systematic review of current literature. Methods: The writing group, including current and former members of the SIS Therapeutics and Guidelines Committee and other individuals with content or guideline expertise within the SIS, working with a professional librarian, performed a systematic review using PubMed/Medline, the Cochrane Library, Embase, and Web of Science from 2016 until February 2024. Keyword descriptors combined "surgical site infections" or "intra-abdominal infections" in adults limited to randomized controlled trials, systematic reviews, and meta-analyses. Additional relevant publications not in the initial search but identified during literature review were included. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system was utilized to evaluate the evidence. The strength of each recommendation was rated strong (1) or weak (2). The quality of the evidence was rated high (A), moderate (B), or weak (C). The guideline contains new recommendations and updates to recommendations from previous IAI guideline versions. Final recommendations were developed by an iterative process. All writing group members voted to accept or reject each recommendation. Results: This updated evidence-based guideline contains recommendations from the SIS for the treatment of adult patients with IAI. Evidence-based recommendations were developed for antimicrobial agent selection, timing, route of administration, duration, and de-escalation; timing of source control; treatment of specific pathogens; treatment of specific intra-abdominal disease processes; and implementation of hospital-based antimicrobial agent stewardship programs. Summary: This document contains the most up-to-date recommendations from the SIS on the prevention and management of IAI in adult patients.

Antifungal prophylaxis against invasive Candida and Aspergillus infection in adult heart transplant recipients: protocol for a systematic review and meta-analysis

INTRODUCTION

Invasive fungal infections (IFI) can contribute to increased mortality and morbidity rates after heart transplant in adults. The most common causes are Aspergillus and Candida species. There is uncertainty on how effective antifungal prophylaxis is against Candida spp infections and limited guidance on the prevention of Aspergillus spp infections. This systematic review and meta-analysis will assess the literature to see if antifungal prophylaxis reduces the incidence of IFI after heart transplant in adults.

METHODS AND ANALYSIS

This systematic review protocol follows the Preferred Reporting Items for Systematic reviews and Meta Analysis guidelines. A systematic search of the Cochrane Library, Web of Science, Scopus, Embase, MEDLINE, and Proquest databases will be undertaken. Reference lists of retrieved publications and conference abstracts will also be searched. Title, abstract and full-text screening will be undertaken by two reviewers. Discrepancies will be resolved by a third reviewer. Studies with paediatric patients, multi-organ transplants, or patients with a second heart transplant will be excluded, along with those who do not have clear definitions and diagnostic criteria for IFI. Risk of bias will be assessed using the Cochrane Risk of Bias 2 tool and the Risk of Bias in Non-randomised Studies of Interventions tool. A meta-analysis will be carried out, but if studies are not deemed to be sufficiently similar, only a narrative synthesis will be undertaken.

ETHICS AND DISSEMINATION

Ethical approval is not required for this systematic review as primary data will not be collected. The results of the review will be disseminated through publication in an academic journal and scientific conferences.

PROSPERO REGISTRATION NUMBER

CRD42024516588.

Pathogenic bacteria in abdominal cavity drainage of patients with intraabdominal infection and their drug resistance

AIM

To identify the pathogenic bacteria in abdominal cavity drainage of patients with intraabdominal infection and to analyze their drug resistance.

METHODS

From January 2015 to November 2017, 92 patients with intraperitoneal infection were treated by celiac drainage at our hospital. The bacterial culture and drug susceptibility results of peritoneal drainage fluid were statistically analyzed, and the differences in different bacterial populations and drug resistance were analyzed. Cox regression model was used to explore the independent risk factors affecting the prognosis of patients.

RESULTS

A total of 145 bacterial strains were cultured, including 46 Gram-positive and 97 Gram-negative strains. The top five pathogens were Escherichia coli (31.72%), Klebsiellosis pneumoniae (24.14%), Staphylococcus aureus (15.86%), Enterococcus (11.72%), and Pseudomonas aeruginosa (7.59%). Staphylococcus aureus and Enterococcus were two Gram-positive strains that had high resistance rates but were highly sensitive to vancomycin. Enterococci had high resistance rates to erythromycin, chloramphenicol, and levofloxacin than Staphylococcus aureus, which had a high resistance rate to ampicillin. Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and other three kinds of G-bacteria had high resistance rates, but all of them had a high sensitivity to β-lactams/β-lactamase inhibitors, imipenem/Cistadine and amikacin; among them, extended spectrum beta lactamase (ESBL) producing strains and Pseudomonas aeruginosa had high resistance rates to ceftriaxone, ceftazidime, cefepime, and levofloxacin. Univariate Cox regression analysis showed that age, multidrug resistant organism (MDRO), nosocomial infection, ESBL positivity, and time from fever to culture were related to death in patients with intraabdominal infection. Multivariate Cox regression analysis showed that MDRO, ESBL positivity, and time from fever to culture were independent risk factors for death in patients with intraabdominal infection.

CONCLUSION

Main pathogens in peritoneal drainage fluid of patients with intraabdominal infection are Gram-negative bacteria, and the pathogens are highly resistant to commonly used antibiotics. MDRO, ESBL positivity, and time from fever to culture are independent risk factors for death from intraabdominal infection.