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Antibiotic De-Escalation in Emergency General Surgery

Background. Antibiotic treatment in emergency general surgery (EGS) is a major challenge for surgeons, and a multidisciplinary approach is necessary in order to improve outcomes. Intra-abdominal infections are at high risk of increased morbidity and mortality, and prolonged hospitalization. An incre...

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Autores principales: Vallicelli, Carlo, Minghetti, Margherita, Sartelli, Massimo, Coccolini, Federico, Ansaloni, Luca, Agnoletti, Vanni, Bravi, Francesca, Catena, Fausto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9495047/
https://www.ncbi.nlm.nih.gov/pubmed/36139928
http://dx.doi.org/10.3390/antibiotics11091148
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author Vallicelli, Carlo
Minghetti, Margherita
Sartelli, Massimo
Coccolini, Federico
Ansaloni, Luca
Agnoletti, Vanni
Bravi, Francesca
Catena, Fausto
author_facet Vallicelli, Carlo
Minghetti, Margherita
Sartelli, Massimo
Coccolini, Federico
Ansaloni, Luca
Agnoletti, Vanni
Bravi, Francesca
Catena, Fausto
author_sort Vallicelli, Carlo
collection PubMed
description Background. Antibiotic treatment in emergency general surgery (EGS) is a major challenge for surgeons, and a multidisciplinary approach is necessary in order to improve outcomes. Intra-abdominal infections are at high risk of increased morbidity and mortality, and prolonged hospitalization. An increase in multi-drug resistance bacterial infections and a tendency to an antibiotic overuse has been described in surgical settings. In this clinical scenario, antibiotic de-escalation (ADE) is emerging as a strategy to improve the management of antibiotic therapy. The objective of this article is to summarize the available evidence, current strategies and unsolved problems for the optimization of ADE in EGS. Methods. A literature search was performed on PubMed and Cochrane using “de-escalation”, “antibiotic therapy” and “antibiotic treatment” as research terms. Results. There is no universally accepted definition for ADE. Current evidence shows that ADE is a feasible strategy in the EGS setting, with the ability to optimize antibiotic use, to reduce hospitalization and health care costs, without compromising clinical outcome. Many studies focus on Intensive Care Unit patients, and a call for further studies is required in the EGS community. Current guidelines already recommend ADE when surgery for uncomplicated appendicitis and cholecystitis reaches a complete source control. Conclusions. ADE in an effective and feasible strategy in EGS patients, in order to optimize antibiotic management without compromising clinical outcomes. A collaborative effort between surgeons, intensivists and infectious disease specialists is mandatory. There is a strong need for further studies selectively focusing in the EGS ward setting.
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spelling pubmed-94950472022-09-23 Antibiotic De-Escalation in Emergency General Surgery Vallicelli, Carlo Minghetti, Margherita Sartelli, Massimo Coccolini, Federico Ansaloni, Luca Agnoletti, Vanni Bravi, Francesca Catena, Fausto Antibiotics (Basel) Perspective Background. Antibiotic treatment in emergency general surgery (EGS) is a major challenge for surgeons, and a multidisciplinary approach is necessary in order to improve outcomes. Intra-abdominal infections are at high risk of increased morbidity and mortality, and prolonged hospitalization. An increase in multi-drug resistance bacterial infections and a tendency to an antibiotic overuse has been described in surgical settings. In this clinical scenario, antibiotic de-escalation (ADE) is emerging as a strategy to improve the management of antibiotic therapy. The objective of this article is to summarize the available evidence, current strategies and unsolved problems for the optimization of ADE in EGS. Methods. A literature search was performed on PubMed and Cochrane using “de-escalation”, “antibiotic therapy” and “antibiotic treatment” as research terms. Results. There is no universally accepted definition for ADE. Current evidence shows that ADE is a feasible strategy in the EGS setting, with the ability to optimize antibiotic use, to reduce hospitalization and health care costs, without compromising clinical outcome. Many studies focus on Intensive Care Unit patients, and a call for further studies is required in the EGS community. Current guidelines already recommend ADE when surgery for uncomplicated appendicitis and cholecystitis reaches a complete source control. Conclusions. ADE in an effective and feasible strategy in EGS patients, in order to optimize antibiotic management without compromising clinical outcomes. A collaborative effort between surgeons, intensivists and infectious disease specialists is mandatory. There is a strong need for further studies selectively focusing in the EGS ward setting. MDPI 2022-08-24 /pmc/articles/PMC9495047/ /pubmed/36139928 http://dx.doi.org/10.3390/antibiotics11091148 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Perspective
Vallicelli, Carlo
Minghetti, Margherita
Sartelli, Massimo
Coccolini, Federico
Ansaloni, Luca
Agnoletti, Vanni
Bravi, Francesca
Catena, Fausto
Antibiotic De-Escalation in Emergency General Surgery
title Antibiotic De-Escalation in Emergency General Surgery
title_full Antibiotic De-Escalation in Emergency General Surgery
title_fullStr Antibiotic De-Escalation in Emergency General Surgery
title_full_unstemmed Antibiotic De-Escalation in Emergency General Surgery
title_short Antibiotic De-Escalation in Emergency General Surgery
title_sort antibiotic de-escalation in emergency general surgery
topic Perspective
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9495047/
https://www.ncbi.nlm.nih.gov/pubmed/36139928
http://dx.doi.org/10.3390/antibiotics11091148
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