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Current Infectious Disease Reports

Erschienen in:

01.08.2015 | Sepsis and ICU (L Napolitano, Section Editor)

Advances in Intra-abdominal Sepsis: What Is New?

verfasst von: Zachary C. Dietch, Puja M. Shah, Robert G. Sawyer

Erschienen in: Current Infectious Disease Reports | Ausgabe 8/2015

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Abstract

We have reviewed the literature regarding recent advances in the management of intra-abdominal sepsis, with a focus on antimicrobial agents, duration of therapy, and source control. Several important developments in these areas are discussed in this review. The introduction of a new antimicrobial agent—ceftolozane/tazobactam—marks the first novel agent for treating intra-abdominal infections in a number of years, and its indications for use and supporting evidence are reviewed here. In addition, we discuss recent evidence that clarifies the importance of early source control for intra-abdominal infection and new data that suggests that an abbreviated course of antimicrobial therapy for intra-abdominal infection is equally effective as prolonged therapy.

1.••

Shirah GR, O’Neill PJ. Intra-abdominal infections. Surg Clin N Am. 2014;94:1319–33. This important multicenter, double-blind, randomized controlled trial describes the results of administering a novel antibiotic, ceftolozane/tazobactom, to cIAI patients, when compared to the current gold standard.PubMedCrossRef

2.••

Solomkin JS et al. Diagnosis and management of complicated intra-abdominal infections in adults and children. guidelines by the surgical infection society and the infectious diseases society of America. Clin Infect Dis Off Publ Infect Dis Soc Am. 2009;50. This is a multicenter, retrospective study evaluating different levels of procalcitonin and the role of procalcitonin in driving duration of antibiotic therapy. There is increasing evidence that procalcitonin correlates with disease severity.

Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Surg Infect. 2010;11:79–109.CrossRef

Sartelli M et al. Complicated intra-abdominal infections worldwide: the definitive data of the CIAOW Study. World J Emerg Surg. 2014;9:37.PubMedCentralPubMedCrossRef

5.••

Solomkin J et al. Ceftolozane/tazobactum plus metronidazole for complicated intra-abdominal infections in an era of multidrug resistance: results from a randomized, double-blind, phase 3 trial (ASPECT-cIAI). Clin Infect Dis. 2015;60:1462–71. An important prospective, double-blind non-inferiority trial randomizing patients to ceftolozane/tazobactam plus metronidazole versus meropenem. The outcomes demonstrate that ceftolozame/tazobactam is non-inferior, even in patients with multi-drug resistant organisms.

Hong M-C, Hsu DI, Bounthavong M. Ceftolozane/tazobactam: a novel antipseudomonal cephalosporin and β-lactamase-inhibitor combination. Infect Drug Resist. 2013;6:215–23.PubMedCentralPubMed

Lucasti C et al. Multicenter, double-blind, randomized, phase II trial to assess the safety and efficacy of ceftolozane-tazobactam plus metronidazole compared with meropenem in adult patients with complicated intra-abdominal infections. Antimicrob Agents Chemother. 2014;58:5350–7.PubMedCentralPubMedCrossRef

Temkin E, Adler A, Lerner A, Carmeli Y. Carbapenem-resistant Enterobacteriaceae: biology, epidemiology, and management. Ann N Y Acad Sci. 2014;1323:22–42.PubMedCrossRef

Farrell DJ, Sader HS, Flamm RK, Jones RN. Ceftolozane/tazobactam activity tested against Gram-negative bacterial isolates from hospitalised patients with pneumonia in US and European medical centres (2012). Int J Antimicrob Agents. 2014;43:533–9.PubMedCrossRef

10.

Stone HH, Bourneuf AA, Stinson LD. Reliability of criteria for predicting persistent or recurrent sepsis. Arch Surg. 1985;120:17–20.PubMedCrossRef

11.

Sawyer RG, Claridge JA, Nathens AB, et al. Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection. N Engl J Med. 2015;372(21):1996–2005. doi:10.1056/NEJMoa1411162.

12.

Maseda E et al. Procalcitonin-guided therapy may reduce length of antibiotic treatment in intensive care unit patients with secondary peritonitis: a multicenter retrospective study. J Crit Care. 2014;30:10–5. doi:10.1016/j.jcrc.2014.12.014.

13.

Nobre V, Harbarth S, Graf JD, Rohner P, Pugin J. Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial. Am J Respir Crit Care Med. 2008;177:498–505.PubMedCrossRef

14.••

Bouadma L et al. Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet. 2010;375:463–74. PRORATA is an interesting clinical trial that randomized patients to varying durations of antibiotic treatment in control and experimental populations. The experimental group received antibiotic therapy based on procalcitonin levels with predetermined cutoff values, whereas the control group was treated based on current guidelines. Patients in the procalcitonin group had fewer antibiotic days and non-inferior rates of mortality when compared to control patients.

15.

Schroeder S et al. Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: results of a prospective randomized study. Langenbeck's Arch Surg. 2009;394:221–6.CrossRef

16.

Hochreiter M et al. Procalcitonin to guide duration of antibiotic therapy in intensive care patients: a randomized prospective controlled trial. Crit Care. 2009;13:R83.PubMedCentralPubMedCrossRef

17.

Jensen JU et al. Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: a randomized trial*. Crit Care Med. 2011;39:2048–58.PubMedCrossRef

18.

Schein M, Marshall J. Source control for surgical infections. World J Surg. 2004;28:638–45.PubMed

19.

Hecker A, Uhle F, Schwandner T, Padberg W, Weigand MA. Diagnostics, therapy and outcome prediction in abdominal sepsis: current standards and future perspectives. Langenbeck's Arch Surg. 2014;399:11–22.CrossRef

20.

Dellinger RP et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39:165–228.PubMedCrossRef

21.

De Waele JJ. Early source control in sepsis. Langenbeck's Arch Surg. 2010;395:489–94.CrossRef

22.

Azuhata T et al. Time from admission to initiation of surgery for source control is a critical determinant of survival in patients with gastrointestinal perforation with associated septic shock. Crit Care. 2014;18:R87.PubMedCentralPubMedCrossRef

23.

Rivers E, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345.

Titel: Advances in Intra-abdominal Sepsis: What Is New?
verfasst von: Zachary C. Dietch
Puja M. Shah
Robert G. Sawyer
Publikationsdatum: 01.08.2015
Verlag: Springer US
Erschienen in: Current Infectious Disease Reports / Ausgabe 8/2015
Print ISSN: 1523-3847
Elektronische ISSN: 1534-3146
DOI: https://doi.org/10.1007/s11908-015-0497-2

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