Browsing by Subject "Antibiotics"

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  • Pisano, Michele; Allievi, Niccolo; Gurusamy, Kurinchi; Borzellino, Giuseppe; Cimbanassi, Stefania; Boerna, Djamila; Coccolini, Federico; Tufo, Andrea; Di Martino, Marcello; Leung, Jeffrey; Sartelli, Massimo; Ceresoli, Marco; Maier, Ronald; Poiasina, Elia; De Angelis, Nicola; Magnone, Stefano; Fugazzola, Paola; Paolillo, Ciro; Coimbra, Raul; Di Saverio, Salomone; De Simone, Belinda; Weber, Dieter G.; Sakakushev, Boris E.; Lucianetti, Alessandro; Kirkpatrick, Andrew W.; Fraga, Gustavo P.; Wani, Imitaz; Biffl, Walter L.; Chiara, Osvaldo; Abu-Zidan, Fikri; Moore, Ernest E.; Leppäniemi, Ari; Kluger, Yoram; Catena, Fausto; Ansaloni, Luca (2020)
    Background: Acute calculus cholecystitis (ACC) has a high incidence in the general population. The presence of several areas of uncertainty, along with the availability of new evidence, prompted the current update of the 2016 WSES (World Society of Emergency Surgery) Guidelines on ACC. Materials and methods: The WSES president appointed four members as a scientific secretariat, four members as an organization committee and four members as a scientific committee, choosing them from the expert affiliates of WSES. Relevant key questions were constructed, and the task force produced drafts of each section based on the best scientific evidence from PubMed and EMBASE Library; recommendations were developed in order to answer these key questions. The quality of evidence and strength of recommendations were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria (see ). All the statements were presented, discussed and voted upon during the Consensus Conference at the 6th World Congress of the World Society of Emergency Surgery held in Nijmegen (NL) in May 2019. A revised version of the statements was voted upon via an online questionnaire until consensus was reached. Results: The pivotal role of surgery is confirmed, including in high-risk patients. When compared with the WSES 2016 guidelines, the role of gallbladder drainage is reduced, despite the considerable technical improvements available. Early laparoscopic cholecystectomy (ELC) should be the standard of care whenever possible, even in subgroups of patients who are considered fragile, such as the elderly; those with cardiac disease, renal disease and cirrhosis; or those who are generally at high risk for surgery. Subtotal cholecystectomy is safe and represents a valuable option in cases of difficult gallbladder removal. Conclusions, knowledge gaps and research recommendations: ELC has a central role in the management of patients with ACC. The value of surgical treatment for high-risk patients should lead to a distinction between high-risk patients and patients who are not suitable for surgery. Further evidence on the role of clinical judgement and the use of clinical scores as adjunctive tools to guide treatment of high-risk patients and patients who are not suitable for surgery is required. The development of local policies for safe laparoscopic cholecystectomy is recommended.
  • the Global NEO-ASP Study Group; Kekomäki, Satu; Monsalve, Juan Gonzalo Mesa (2021)
    Background: Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. Methods: We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. Findings: On July 1, 2019, 26% of infants (580/2,265; range, 0-100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received >= 1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were "rule-out" sepsis (32%) and "culture-negative" sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and "culture-negative" infections was 12 days (median; IQR, 8-14) and 7 days (median; IQR, 5-10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0.02). Interpretation: Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide. (C) 2021 The Authors. Published by Elsevier Ltd.
  • Tarasconi, Antonio; Perrone, Gennaro; Davies, Justin; Coimbra, Raul; Moore, Ernest; Azzaroli, Francesco; Abongwa, Hariscine; De Simone, Belinda; Gallo, Gaetano; Rossi, Giorgio; Abu-Zidan, Fikri; Agnoletti, Vanni; De'Angelis, Gianluigi; De'Angelis, Nicola; Ansaloni, Luca; Baiocchi, Gian Luca; Carcoforo, Paolo; Ceresoli, Marco; Chichom-Mefire, Alain; Di Saverio, Salomone; Gaiani, Federica; Giuffrida, Mario; Hecker, Andreas; Inaba, Kenji; Kelly, Michael; Kirkpatrick, Andrew; Kluger, Yoram; Leppäniemi, Ari; Litvin, Andrey; Ordonez, Carlos; Pattonieri, Vittoria; Peitzman, Andrew; Pikoulis, Manos; Sakakushev, Boris; Sartelli, Massimo; Shelat, Vishal; Tan, Edward; Testini, Mario; Velmahos, George; Wani, Imtiaz; Weber, Dieter; Biffl, Walter; Coccolini, Federico; Catena, Fausto (2021)
    Anorectal emergencies comprise a wide variety of diseases that share common symptoms, i.e., anorectal pain or bleeding and might require immediate management. While most of the underlying conditions do not need inpatient management, some of them could be life-threatening and need prompt recognition and treatment. It is well known that an incorrect diagnosis is frequent for anorectal diseases and that a delayed diagnosis is related to an impaired outcome. This paper aims to improve the knowledge and the awareness on this specific topic and to provide a useful tool for every physician dealing with anorectal emergencies. The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the boards of the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the WSES-AAST-WJES Consensus Conference on Anorectal Emergencies, and for each statement, a consensus among the WSES-AAST panel of experts was reached. We structured our work into seven main topics to cover the entire management of patients with anorectal emergencies and to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.
  • Raju, Sajan C.; Viljakainen, Heli; Figueiredo, Rejane A. O.; Neuvonen, Pertti J.; Eriksson, Johan G.; Weiderpass, Elisabete; Rounge, Trine B. (2020)
    Background: The human microbiota contributes to health and well-being. Antimicrobials (AM) have an immediate effect on microbial diversity and composition in the gut, but next to nothing is known about their long-term contribution to saliva microbiota. Our objectives were to investigate the long-term impact of AM use on saliva microbiota diversity and composition in preadolescents. We compared the lifetime effects by gender and AMs. We used data from 808 randomly selected children in the Finnish Health In Teens (Fin-HIT) cohort with register-based data on AM purchases from the Social Insurance Institution of Finland. Saliva microbiota was assessed with 16S rRNA (V3-V4) sequencing. The sequences were aligned to the SILVA ribosomal RNA database and classified and counted using the mothur pipeline. Associations between AM use and alpha-diversity (Shannon index) were identified with linear regression, while associations between beta-diversity (Bray-Curtis dissimilarity) and low, medium or high AM use were identified with PERMANOVA. Results: Of the children, 53.6% were girls and their mean age was 11.7 (0.4) years. On average, the children had 7.4 (ranging from 0 to 41) AM prescriptions during their lifespan. The four most commonly used AMs were amoxicillin (n= 2622, 43.7%), azithromycin (n= 1495, 24.9%), amoxicillin-clavulanate (n= 1123, 18.7%) and phenoxymethylpenicillin (n= 408, 6.8%). A linear inverse association was observed between the use of azithromycin and Shannon index (b- 0.015,pvalue = 0.002) in all children, the effect was driven by girls (b- 0.032,pvalue = 0.001), while not present in boys. Dissimilarities were marked between high, medium and low users of all AMs combined, in azithromycin users specifically, and in boys with amoxicillin use. Amoxicillin and amoxicillin-clavulanate use was associated with the largest decrease in abundance ofRikenellaceae. AM use in general and phenoxymethylpenicillin specifically were associated with a decrease ofPaludibacterand pathways related to amino acid degradations differed in proportion between high and low AM users. Conclusions: A systematic approach utilising reliable registry data on lifetime use of AMs demonstrated long-term effects on saliva microbiota diversity and composition. These effects are gender- and AM-dependent. We found that frequent lifelong use of AMs shifts bacterial profiles years later, which might have unforeseen health impacts in the future. Our findings emphasise a concern for high azithromycin use, which substantially decreases bacterial diversity and affects composition as well. Further studies are needed to determine the clinical implications of our findings.
  • Raju, Sajan C; Viljakainen, Heli; Figueiredo, Rejane A O; Neuvonen, Pertti J; Eriksson, Johan G; Weiderpass, Elisabete; Rounge, Trine B (BioMed Central, 2020)
    Abstract Background The human microbiota contributes to health and well-being. Antimicrobials (AM) have an immediate effect on microbial diversity and composition in the gut, but next to nothing is known about their long-term contribution to saliva microbiota. Our objectives were to investigate the long-term impact of AM use on saliva microbiota diversity and composition in preadolescents. We compared the lifetime effects by gender and AMs. We used data from 808 randomly selected children in the Finnish Health In Teens (Fin-HIT) cohort with register-based data on AM purchases from the Social Insurance Institution of Finland. Saliva microbiota was assessed with 16S rRNA (V3-V4) sequencing. The sequences were aligned to the SILVA ribosomal RNA database and classified and counted using the mothur pipeline. Associations between AM use and alpha-diversity (Shannon index) were identified with linear regression, while associations between beta-diversity (Bray-Curtis dissimilarity) and low, medium or high AM use were identified with PERMANOVA. Results Of the children, 53.6% were girls and their mean age was 11.7 (0.4) years. On average, the children had 7.4 (ranging from 0 to 41) AM prescriptions during their lifespan. The four most commonly used AMs were amoxicillin (n = 2622, 43.7%), azithromycin (n = 1495, 24.9%), amoxicillin-clavulanate (n = 1123, 18.7%) and phenoxymethylpenicillin (n = 408, 6.8%). A linear inverse association was observed between the use of azithromycin and Shannon index (b − 0.015, p value = 0.002) in all children, the effect was driven by girls (b − 0.032, p value = 0.001), while not present in boys. Dissimilarities were marked between high, medium and low users of all AMs combined, in azithromycin users specifically, and in boys with amoxicillin use. Amoxicillin and amoxicillin-clavulanate use was associated with the largest decrease in abundance of Rikenellaceae. AM use in general and phenoxymethylpenicillin specifically were associated with a decrease of Paludibacter and pathways related to amino acid degradations differed in proportion between high and low AM users. Conclusions A systematic approach utilising reliable registry data on lifetime use of AMs demonstrated long-term effects on saliva microbiota diversity and composition. These effects are gender- and AM-dependent. We found that frequent lifelong use of AMs shifts bacterial profiles years later, which might have unforeseen health impacts in the future. Our findings emphasise a concern for high azithromycin use, which substantially decreases bacterial diversity and affects composition as well. Further studies are needed to determine the clinical implications of our findings. Video Abstract
  • Kortela, Elisa; Kanerva, Mari J.; Kurkela, Satu; Oksi, Jarmo; Koivisto, Mari; Järvinen, Asko (2022)
    Our objective was to study the consumption of healthcare services and antibiotics in patients with suspicion of disseminated Lyme borreliosis (LB) before and after consultation of an infectious disease specialist. We evaluated retrospectively all presumed disseminated LB patients (n = 256) with a referral to the Department of Infectious Diseases (DID) in Helsinki University Hospital in 2013. Medical records from all healthcare providers in the area were reviewed and the number of physician contacts because of symptoms leading to LB suspicion and antimicrobial purchases were calculated 1 year before and after consultation or treatment at the DID. Patients were divided into three groups according to certainty of LB: unlikely, possible or probable/definite LB. The number of healthcare contacts 1 year before referral was higher among 121 patients with unlikely LB (6; interquartile range [IQR] 3–10), than 65 possible (4; IQR 2.5–7; p = 0.018) or 66 probable/definite LB patients (4; IQR 2.8–7; p = 0.010). The median number of contacts to healthcare during one year after consultation or treatment was 3 (IQR 0.5–7), 1 (IQR 0–3) and 0.5 (IQR 0–2.3), respectively, with a statistically significant difference between the groups (p<0.001). Antibiotics were purchased by 151 (60%) patients one year before referral and by 127 (50%) patients year after consultation or treatment at DID without statistically significant difference between groups with different LB certainty. These antibiotic purchases do not include the treatments prescribed by infectious disease specialists. In the case of 27 patients, an antimicrobial treatment was recommended in the consultation reply. In conclusion, patients with unlikely LB used more healthcare services than patients with possible or probable/definite LB. Antimicrobial consumption was similar between groups of different LB certainty.
  • Lankelma, Jacqueline M.; van Vught, Lonneke A.; Belzer, Clara; Schultz, Marcus J.; van der Poll, Tom; de Vos, Willem M.; Wiersinga, W. Joost (2017)
    The intestinal microbiota has emerged as a virtual organ with essential functions in human physiology. Antibiotic-induced disruption of the microbiota in critically ill patients may have a negative influence on key energy resources and immunity. We set out to characterize the fecal microbiota composition in critically ill patients both with and without sepsis and to explore the use of microbiota-derived markers for clinical outcome measurements in this setting. In this prospective observational cohort study we analyzed the fecal microbiota of 34 patients admitted to the intensive care unit. Fifteen healthy subjects served as controls. The fecal microbiota was phylogenetically characterized by 16S rRNA gene sequencing, and associations with clinical outcome parameters were evaluated. A marked shift in fecal bacterial composition was seen in all septic and non-septic critically ill patients compared with controls, with extreme interindividual differences. In 13 of the 34 patients, a single bacterial genus made up > 50% of the gut microbiota; in 4 patients this was even > 75%. A significant decrease in bacterial diversity was observed in half of the patients. No associations were found between microbiota diversity, Firmicutes/Bacteroidetes ratio, or Gram-positive/Gram-negative ratio and outcome measurements such as complications and survival. We observed highly heterogeneous patterns of intestinal microbiota in both septic and non-septic critically ill patients. Nevertheless, some general patterns were observed, including disappearance of bacterial genera with important functions in host metabolism. More detailed knowledge of the short- and long-term health consequences of these major shifts in intestinal bacterial communities is needed.
  • Lamut, Andraž; Cruz, Cristina D.; Skok, Žiga; Barančoková, Michaela; Zidar, Nace; Zega, Anamarija; Peterlin Mašič, Lucija; Ilaš, Janez; Tammela, Päivi; Kikelj, Danijel; Tomašič, Tihomir (2020)
    Bacterial DNA gyrase is an important target for the development of novel antibacterial drugs, which are urgently needed because of high level of antibiotic resistance worldwide. We designed and synthesized new 4,5,6,7-tetrahydrobenzo[d]thiazole-based DNA gyrase B inhibitors and their conjugates with siderophore mimics, which were introduced to increase the uptake of inhibitors into the bacterial cytoplasm. The most potent conjugate 34 had an IC50 of 58 nM against Escherichia coli DNA gyrase and displayed MIC of 14 mu g/mL against E. coli.tolC strain. Only minor improvements in the antibacterial activities against wild-type E. coli in low-iron conditions were seen for DNA gyrase inhibitor - siderophore mimic conjugates.
  • Mali, Juha; Mentula, Panu; Leppäniemi, Ari; Sallinen, Ville (2019)
    BackgroundDiverticular abscess diameter of 3-6cm is generally accepted as a cutoff determining whether percutaneous drainage is recommended in addition to antibiotics, but this is not based on high-quality evidence. The aim of this study was to analyze the treatment choices and outcomes of patients with diverticular abscesses.MethodsThis was a retrospective cohort study conducted in an academic teaching hospital functioning as a secondary and tertiary referral center. Altogether, 241 patients with computer tomography-verified acute left-sided colonic diverticulitis with intra-abdominal abscess were collected from a database containing all patients treated for colonic diverticulitis in our institution during 2006-2013. The main measured outcomes were need of emergency surgery and 30-day mortality, and these were compared between antibiotics only and percutaneous drainage groups. Treatment choices, including surgery, were also analyzed for all patients.ResultsAbscesses under 40mm were mostly treated with antibiotics alone with a high success rate (93 out of 107, 87%). In abscesses over 40mm, the use of emergency surgery increased and the use of antibiotics alone decreased with increasing abscess size, but the proportion of successful drainage remained at 13-18% regardless of the abscess size. There were no differences in failure rate, 30-day mortality, the need of emergency surgery, permanent stoma, recurrence, or length of stay in patients treated with percutaneous drainage vs. antibiotics alone, even when groups were adjusted for potential confounders.ConclusionsPercutaneous drainage as a treatment for large abscess does not seem to be superior to the treatment with only antibiotics.
  • Mali, Juha; Mentula, Panu; Leppäniemi, Ari; Sallinen, Ville (BioMed Central, 2019)
    Abstract Background Diverticular abscess diameter of 3–6 cm is generally accepted as a cutoff determining whether percutaneous drainage is recommended in addition to antibiotics, but this is not based on high-quality evidence. The aim of this study was to analyze the treatment choices and outcomes of patients with diverticular abscesses. Methods This was a retrospective cohort study conducted in an academic teaching hospital functioning as a secondary and tertiary referral center. Altogether, 241 patients with computer tomography-verified acute left-sided colonic diverticulitis with intra-abdominal abscess were collected from a database containing all patients treated for colonic diverticulitis in our institution during 2006–2013. The main measured outcomes were need of emergency surgery and 30-day mortality, and these were compared between antibiotics only and percutaneous drainage groups. Treatment choices, including surgery, were also analyzed for all patients. Results Abscesses under 40 mm were mostly treated with antibiotics alone with a high success rate (93 out of 107, 87%). In abscesses over 40 mm, the use of emergency surgery increased and the use of antibiotics alone decreased with increasing abscess size, but the proportion of successful drainage remained at 13–18% regardless of the abscess size. There were no differences in failure rate, 30-day mortality, the need of emergency surgery, permanent stoma, recurrence, or length of stay in patients treated with percutaneous drainage vs. antibiotics alone, even when groups were adjusted for potential confounders. Conclusions Percutaneous drainage as a treatment for large abscess does not seem to be superior to the treatment with only antibiotics.
  • Di Saverio, Salomone; Podda, Mauro; De Simone, Belinda; Ceresoli, Marco; Augustin, Goran; Gori, Alice; Boermeester, Marja; Sartelli, Massimo; Coccolini, Federico; Tarasconi, Antonio; Angelis, Nicola de'; Weber, Dieter G.; Tolonen, Matti; Birindelli, Arianna; Biffl, Walter; Moore, Ernest E.; Kelly, Michael; Soreide, Kjetil; Kashuk, Jeffry; Ten Broek, Richard; Gomes, Carlos Augusto; Sugrue, Michael; Davies, Richard Justin; Damaskos, Dimitrios; Leppäniemi, Ari; Kirkpatrick, Andrew; Peitzman, Andrew B.; Fraga, Gustavo P.; Maier, Ronald V.; Coimbra, Raul; Chiarugi, Massimo; Sganga, Gabriele; Pisanu, Adolfo; Angelis, Gian Luigi de'; Tan, Edward; Van Goor, Harry; Pata, Francesco; Di Carlo, Isidoro; Chiara, Osvaldo; Litvin, Andrey; Campanile, Fabio C.; Sakakushev, Boris; Tomadze, Gia; Demetrashvili, Zaza; Latifi, Rifat; Abu-Zidan, Fakri; Romeo, Oreste; Segovia-Lohse, Helmut; Baiocchi, Gianluca; Costa, David; Rizoli, Sandro; Balogh, Zsolt J.; Bendinelli, Cino; Scalea, Thomas; Ivatury, Rao; Velmahos, George; Andersson, Roland; Kluger, Yoram; Ansaloni, Luca; Catena, Fausto (2020)
    Background and aims Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of non-operative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and peri-operative antibiotic therapy. Methods This executive manuscript summarizes the WSES guidelines for the diagnosis and treatment of AA. Literature search has been updated up to 2019 and statements and recommendations have been developed according to the GRADE methodology. The statements were voted, eventually modified, and finally approved by the participants to the consensus conference and by the board of co-authors, using a Delphi methodology for voting whenever there was controversy on a statement or a recommendation. Several tables highlighting the research topics and questions, search syntaxes, and the statements and the WSES evidence-based recommendations are provided. Finally, two different practical clinical algorithms are provided in the form of a flow chart for both adults and pediatric (<16 years old) patients. Conclusions The 2020 WSES guidelines on AA aim to provide updated evidence-based statements and recommendations on each of the following topics: (1) diagnosis, (2) non-operative management for uncomplicated AA, (3) timing of appendectomy and in-hospital delay, (4) surgical treatment, (5) intra-operative grading of AA, (6) ,management of perforated AA with phlegmon or abscess, and (7) peri-operative antibiotic therapy.
  • Di Saverio, Salomone; Podda, Mauro; De Simone, Belinda; Ceresoli, Marco; Augustin, Goran; Gori, Alice; Boermeester, Marja; Sartelli, Massimo; Coccolini, Federico; Tarasconi, Antonio; de’ Angelis, Nicola; Weber, Dieter G; Tolonen, Matti; Birindelli, Arianna; Biffl, Walter; Moore, Ernest E; Kelly, Michael; Soreide, Kjetil; Kashuk, Jeffry; Ten Broek, Richard; Gomes, Carlos A; Sugrue, Michael; Davies, Richard J; Damaskos, Dimitrios; Leppäniemi, Ari; Kirkpatrick, Andrew; Peitzman, Andrew B; Fraga, Gustavo P; Maier, Ronald V; Coimbra, Raul; Chiarugi, Massimo; Sganga, Gabriele; Pisanu, Adolfo; de’ Angelis, Gian L; Tan, Edward; Van Goor, Harry; Pata, Francesco; Di Carlo, Isidoro; Chiara, Osvaldo; Litvin, Andrey; Campanile, Fabio C; Sakakushev, Boris; Tomadze, Gia; Demetrashvili, Zaza; Latifi, Rifat; Abu-Zidan, Fakri; Romeo, Oreste; Segovia-Lohse, Helmut; Baiocchi, Gianluca; Costa, David; Rizoli, Sandro; Balogh, Zsolt J; Bendinelli, Cino; Scalea, Thomas; Ivatury, Rao; Velmahos, George; Andersson, Roland; Kluger, Yoram; Ansaloni, Luca; Catena, Fausto (BioMed Central, 2020)
    Abstract Background and aims Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of non-operative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and peri-operative antibiotic therapy. Methods This executive manuscript summarizes the WSES guidelines for the diagnosis and treatment of AA. Literature search has been updated up to 2019 and statements and recommendations have been developed according to the GRADE methodology. The statements were voted, eventually modified, and finally approved by the participants to the consensus conference and by the board of co-authors, using a Delphi methodology for voting whenever there was controversy on a statement or a recommendation. Several tables highlighting the research topics and questions, search syntaxes, and the statements and the WSES evidence-based recommendations are provided. Finally, two different practical clinical algorithms are provided in the form of a flow chart for both adults and pediatric (< 16 years old) patients. Conclusions The 2020 WSES guidelines on AA aim to provide updated evidence-based statements and recommendations on each of the following topics: (1) diagnosis, (2) non-operative management for uncomplicated AA, (3) timing of appendectomy and in-hospital delay, (4) surgical treatment, (5) intra-operative grading of AA, (6) ,management of perforated AA with phlegmon or abscess, and (7) peri-operative antibiotic therapy.
  • the DIABIMMUNE Study Group; Mustonen, Neea; Siljander, Heli; Peet, Aleksandr; Tillmann, Vallo; Härkönen, Taina; Ilonen, Jorma; Hyöty, Heikki; Knip, Mikael (2019)
    Aim Infections in early childhood are common reasons to seek medical attention. This study compares the prevalence of infections, and the use of antibiotics and antipyretic-analgesics, in children from Finland, Estonia and Russian Karelia. Methods Children with a genetically increased risk for type 1 diabetes (N = 797) were observed from birth up to 3 years of age. Illnesses and medications were reported by parents continuously. All reported infections, antibiotics and antipyretic-analgesics were compared between Finland and Estonia, and to a lesser extent with Russian Karelia, due to poor study compliance. Results Compared with Estonians, Finns reported more infections during the first and second years of life. During the follow-up, Finnish children had 10 infections while Estonians only had 8 (p <0.001). Finns also used more antibiotics and antipyretic-analgesics in each year during the follow-up. Russian Karelians reported the lowest frequency of infections and the most infrequent use of antibiotics and antipyretic-analgesics in the first two years of life. Conclusion Infections and the use of antibiotics and antipyretic-analgesics in early childhood were most frequent in Finland, where socio-economic conditions are the most developed and microbial encounters are sparse. This may reflect on the hygiene hypothesis, a less effective immune system that allows normally harmless microbes to attack and cause clinical infections.
  • Kantele, Anu; Mero, Sointu; Kirveskari, Juha; Laaveri, Tinja (2017)
    Background: One third of travellers to the poor regions of the (sub) tropics become colonized by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). Co-resistance to non-betalactam antibiotics complicates the treatment of potential ESBL-PE infections. Methods: We analysed co-resistance to non-beta-lactams among travel-acquired ESBL-PE isolates of 90 visitors to the (sub) tropics with respect to major risk factors of colonization: destination, age, travellers' diarrhoea (TD) and antibiotic (AB) use. Results: Of the ESBL-PE isolates, 53%, 52%, 73%, and 2% proved co-resistant to ciprofloxacin, tobramycin, co-trimoxazole, and nitrofurantoin, respectively. The rates were similar among those with (TD+) or without (TD-) travellers' diarrhoea. Among fluoroquinolone-users vs. AB non-users, the co-resistance rates for ciprofloxacin were 95% versus 37% (p = 0.001), for tobramycin 85% versus 43% (p = 0.005), co-trimoxazole 85% versus 68% (p = 0.146), and nitrofurantoin 5% versus 2% (p = 0.147). In multivariable analysis co-resistance to ciprofloxacin was associated with increasing age, fluoroquinolone use, and tobramycin resistance. Conlusions: While TD predisposes to ESBL-PE non-selectively, antimicrobial use favours strains resistant to drug taken and, simultaneously, any drug with resistance genetically linked to the drug used. Antibiotics taken during travel predispose to ESBL-PE with a high co-resistance rate. (C) 2017 The Author(s). Published by Elsevier Ltd.
  • Sartelli, Massimo; Catena, Fausto; Abu-Zidan, Fikri M.; Ansaloni, Luca; Biffl, Walter L.; Boermeester, Marja A.; Ceresoli, Marco; Chiara, Osvaldo; Coccolini, Federico; De Waele, Jan J.; Di Saverio, Salomone; Eckmann, Christian; Fraga, Gustavo P.; Giannella, Maddalena; Girardis, Massimo; Griffiths, Ewen A.; Kashuk, Jeffry; Kirkpatrick, Andrew W.; Khokha, Vladimir; Kluger, Yoram; Labricciosa, Francesco M.; Leppäniemi, Ari; Maier, Ronald V.; May, Addison K.; Malangoni, Mark; Martin-Loeches, Ignacio; Mazuski, John; Montravers, Philippe; Peitzman, Andrew; Pereira, Bruno M.; Reis, Tarcisio; Sakakushev, Boris; Sganga, Gabriele; Soreide, Kjetil; Sugrue, Michael; Ulrych, Jan; Vincent, Jean-Louis; Viale, Pierluigi; Moore, Ernest E. (2017)
    This paper reports on the consensus conference on the management of intra-abdominal infections (IAIs) which was held on July 23, 2016, in Dublin, Ireland, as a part of the annual World Society of Emergency Surgery (WSES) meeting. This document covers all aspects of the management of IAIs. The Grading of Recommendations Assessment, Development and Evaluation recommendation is used, and this document represents the executive summary of the consensus conference findings.
  • Tarasconi, Antonio; Coccolini, Federico; Biffl, Walter L.; Tomasoni, Matteo; Ansaloni, Luca; Picetti, Edoardo; Molfino, Sarah; Shelat, Vishal; Cimbanassi, Stefania; Weber, Dieter G.; Abu-Zidan, Fikri M.; Campanile, Fabio C.; Di Saverio, Salomone; Baiocchi, Gian Luca; Casella, Claudio; Kelly, Michael D.; Kirkpatrick, Andrew W.; Leppäniemi, Ari; Moore, Ernest E.; Peitzman, Andrew; Fraga, Gustavo Pereira; Ceresoli, Marco; Maier, Ronald V.; Wani, Imtaz; Pattonieri, Vittoria; Perrone, Gennaro; Velmahos, George; Sugrue, Michael; Sartelli, Massimo; Kluger, Yoram; Catena, Fausto (2020)
    Background Peptic ulcer disease is common with a lifetime prevalence in the general population of 5-10% and an incidence of 0.1-0.3% per year. Despite a sharp reduction in incidence and rates of hospital admission and mortality over the past 30 years, complications are still encountered in 10-20% of these patients. Peptic ulcer disease remains a significant healthcare problem, which can consume considerable financial resources. Management may involve various subspecialties including surgeons, gastroenterologists, and radiologists. Successful management of patients with complicated peptic ulcer (CPU) involves prompt recognition, resuscitation when required, appropriate antibiotic therapy, and timely surgical/radiological treatment. Methods The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the board of the WSES to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the 5th WSES Congress, and for each statement, a consensus among the WSES panel of experts was reached. Conclusions The population considered in these guidelines is adult patients with suspected complicated peptic ulcer disease. These guidelines present evidence-based international consensus statements on the management of complicated peptic ulcer from a collaboration of a panel of experts and are intended to improve the knowledge and the awareness of physicians around the world on this specific topic. We divided our work into the two main topics, bleeding and perforated peptic ulcer, and structured it into six main topics that cover the entire management process of patients with complicated peptic ulcer, from diagnosis at ED arrival to post-discharge antimicrobial therapy, to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.
  • Laaveri, Tinja; Sterne, Jesper; Rombo, Lars; Kantele, Anu (2016)
    Looking at the worldwide emergency of antimicrobial resistance, international travellers appear to have a central role in spreading the bacteria across the globe. Travellers' diarrhoea (TD) is the most common disease encountered by visitors to the (sub) tropics. Both TD and its treatment with antibiotics have proved significant independent risk factors of colonization by resistant intestinal bacteria while travelling. Travellers should therefore be given preventive advice regarding TD and cautioned about taking antibiotics: mild or moderate TD does not require antibiotics. Logical alternatives are medications with effects on gastrointestinal function, such as loperamide. The present review explores literature on loperamide in treating TD. Adhering to manufacturer's dosage recommendations, loperamide offers a safe and effective alternative for relieving mild and moderate symptoms. Moreover, loperamide taken singly does no predispose to contracting MDR bacteria. Most importantly, we found no proof that would show antibiotics to be significantly more effective than loperamide in treating mild/moderate TD. (C) 2016 The Authors. Published by Elsevier Ltd.
  • Sartelli, Massimo; Labricciosa, Francesco M.; Barbadoro, Pamela; Pagani, Leonardo; Ansaloni, Luca; Brink, Adrian J.; Carlet, Jean; Khanna, Ashish; Chichom-Mefire, Alain; Coccolini, Federico; Di Saverio, Salomone; May, Addison K.; Viale, Pierluigi; Watkins, Richard R.; Scudeller, Luigia; Abbo, Lilian M.; Abu-Zidan, FikriM.; Adesunkanmi, Abdulrashid K.; Al-Dahir, Sara; Al-Hasan, Majdi N.; Alis, Halil; Alves, Carlos; Araujo da Silva, Andre R.; Augustin, Goran; Bala, Miklosh; Barie, Philip S.; Beltran, Marcelo A.; Bhangu, Aneel; Bouchra, Belefquih; Brecher, Stephen M.; Cainzos, Miguel A.; Camacho-Ortiz, Adrian; Catani, Marco; Chandy, Sujith J.; Jusoh, Asri Che; Cherry-Bukowiec, Jill R.; Chiara, Osvaldo; Colak, Elif; Cornely, Oliver A.; Cui, Yunfeng; Demetrashvili, Zaza; De Simone, Belinda; De Waele, Jan J.; Dhingra, Sameer; Di Marzo, Francesco; Dogjani, Agron; Dorj, Gereltuya; Dortet, Laurent; Duane, ThereseM.; Elmangory, Mutasim M.; Enani, Mushira A.; Ferrada, Paula; Foianini, J. Esteban; Gachabayov, Mahir; Gandhi, Chinmay; Ghnnam, Wagih Mommtaz; Giamarellou, Helen; Gkiokas, Georgios; Gomi, Harumi; Goranovic, Tatjana; Griffiths, Ewen A.; Guerra Gronerth, Rosio I.; Haidamus Monteiro, Julio C.; Hardcastle, Timothy C.; Hecker, Andreas; Hodonou, Adrien M.; Ioannidis, Orestis; Isik, Arda; Iskandar, Katia A.; Kafil, Hossein S.; Kanj, Souha S.; Kaplan, Lewis J.; Kapoor, Garima; Karamarkovic, Aleksandar R.; Kenig, Jakub; Kerschaever, Ivan; Khamis, Faryal; Khokha, Vladimir; Kiguba, Ronald; Kim, Hong B.; Ko, Wen-Chien; Koike, Kaoru; Kozlovska, Iryna; Kumar, Anand; Lagunes, Leonel; Latifi, Rifat; Lee, Jae G.; Lee, Young R.; Leppaniemi, Ari; Li, Yousheng; Liang, Stephen Y.; Lowman, Warren; Machain, Gustavo M.; Maegele, Marc; Major, Piotr; Malama, Sydney; Manzano-Nunez, Ramiro; Marinis, Athanasios; Martinez Casas, Isidro; Marwah, Sanjay; Maseda, Emilio; McFarlane, Michael E.; Memish, Ziad; Mertz, Dominik; Mesina, Cristian; Mishra, ShyamK.; Moore, Ernest E.; Munyika, Akutu; Mylonakis, Eleftherios; Napolitano, Lena; Negoi, Ionut; Nestorovic, Milica D.; Nicolau, David P.; Omari, Abdelkarim H.; Ordonez, Carlos A.; Paiva, Jose-Artur; Pant, Narayan D.; Parreira, Jose G.; Pedziwiatr, Michal; Pereira, BrunoM.; Ponce-de-Leon, Alfredo; Poulakou, Garyphallia; Preller, Jacobus; Pulcini, Celine; Pupelis, Guntars; Quiodettis, Martha; Rawson, Timothy M.; Reis, Tarcisio; Rems, Miran; Rizoli, Sandro; Roberts, Jason; Pereira, Nuno Rocha; Rodriguez-Bano, Jesus; Sakakushev, Boris; Sanders, James; Santos, Natalia; Sato, Norio; Sawyer, Robert G.; Scarpelini, Sandro; Scoccia, Loredana; Shafiq, Nusrat; Shelat, Vishalkumar; Sifri, Costi D.; Siribumrungwong, Boonying; Soreide, Kjetil; Soto, Rodolfo; de Souza, Hamilton P.; Talving, Peep; Trung, Ngo Tat; Tessier, Jeffrey M.; Tumbarello, Mario; Ulrych, Jan; Uranues, Selman; Van Goor, Harry; Vereczkei, Andras; Wagenlehner, Floriann; Xiao, Yonghong; Yuan, Kuo-Ching; Wechsler-Foerdoes, Agnes; Zahar, Jean-Ralph; Zakrison, Tanya L.; Zuckerbraun, Brian; Zuidema, Wietse P.; Catena, Fausto (2017)
    Background: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. Methods: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. Results: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p <0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). Conclusion: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.
  • Sartelli, Massimo; Chichom-Mefire, Alain; Labricciosa, Francesco M.; Hardcastle, Timothy; Abu-Zidan, Fikri M.; Adesunkanmi, Abdulrashid K.; Ansaloni, Luca; Bala, Miklosh; Balogh, Zsolt J.; Beltran, Marcelo A.; Ben-Ishay, Offir; Biffl, Walter L.; Birindelli, Arianna; Cainzos, Miguel A.; Catalini, Gianbattista; Ceresoli, Marco; Jusoh, Asri Che; Chiara, Osvaldo; Coccolini, Federico; Coimbra, Raul; Cortese, Francesco; Demetrashvili, Zaza; Di Saverio, Salomone; Diaz, Jose J.; Egiev, Valery N.; Ferrada, Paula; Fraga, Gustavo P.; Ghnnam, Wagih M.; Lee, Jae Gil; Gomes, Carlos A.; Hecker, Andreas; Herzog, Torsten; Kim, Jae Il; Inaba, Kenji; Isik, Arda; Karamarkovic, Aleksandar; Kashuk, Jeffry; Khokha, Vladimir; Kirkpatrick, Andrew W.; Kluger, Yoram; Koike, Kaoru; Kong, Victor Y.; Leppäniemi, Ari; Machain, Gustavo M.; Maier, Ronald V.; Marwah, Sanjay; McFarlane, Michael E.; Montori, Giulia; Moore, Ernest E.; Negoi, Ionut; Olaoye, Iyiade; Omari, Abdelkarim H.; Ordonez, Carlos A.; Pereira, Bruno M.; Pereira Junior, Gerson A.; Pupelis, Guntars; Reis, Tarcisio; Sakakhushev, Boris; Sato, Norio; Lohse, Helmut A. Segovia; Shelat, Vishal G.; Soreide, Kjetil; Uhl, Waldemar; Ulrych, Jan; Van Goor, Harry; Velmahos, George C.; Yuan, Kuo-Ching; Wani, Imtiaz; Weber, Dieter G.; Zachariah, Sanoop K.; Catena, Fausto (2017)
    Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.
  • Di Saverio, Salomone; Birindelli, Arianna; Kelly, Micheal D.; Catena, Fausto; Weber, Dieter G.; Sartelli, Massimo; Sugrue, Michael; De Moya, Mark; Gomes, Carlos Augusto; Bhangu, Aneel; Agresta, Ferdinando; Moore, Ernest E.; Soreide, Kjetil; Griffiths, Ewen; De Castro, Steve; Kashuk, Jeffry; Kluger, Yoram; Leppaniemi, Ari; Ansaloni, Luca; Andersson, Manne; Coccolini, Federico; Coimbra, Raul; Gurusamy, Kurinchi S.; Campanile, Fabio Cesare; Biffl, Walter; Chiara, Osvaldo; Moore, Fred; Peitzman, Andrew B.; Fraga, Gustavo P.; Costa, David; Maier, Ronald V.; Rizoli, Sandro; Balogh, Zsolt J.; Bendinelli, Cino; Cirocchi, Roberto; Tonini, Valeria; Piccinini, Alice; Tugnoli, Gregorio; Jovine, Elio; Persiani, Roberto; Biondi, Antonio; Scalea, Thomas; Stahel, Philip; Ivatury, Rao; Velmahos, George; Andersson, Roland (2016)
    Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.