Antibiotic De-Escalation in Emergency General Surgery
<i>Background.</i> 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 hospit...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-08-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/11/9/1148 |
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| author | Carlo Vallicelli Margherita Minghetti Massimo Sartelli Federico Coccolini Luca Ansaloni Vanni Agnoletti Francesca Bravi Fausto Catena |
| author_facet | Carlo Vallicelli Margherita Minghetti Massimo Sartelli Federico Coccolini Luca Ansaloni Vanni Agnoletti Francesca Bravi Fausto Catena |
| author_sort | Carlo Vallicelli |
| collection | DOAJ |
| description | <i>Background.</i> 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. <i>Methods.</i> A literature search was performed on PubMed and Cochrane using “de-escalation”, “antibiotic therapy” and “antibiotic treatment” as research terms. <i>Results.</i> 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. <i>Conclusions.</i> 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. |
| first_indexed | 2024-03-10T00:56:07Z |
| format | Article |
| id | doaj.art-c95a2035ad554875be143b36bb4b1074 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-10T00:56:07Z |
| publishDate | 2022-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-c95a2035ad554875be143b36bb4b10742023-11-23T14:43:50ZengMDPI AGAntibiotics2079-63822022-08-01119114810.3390/antibiotics11091148Antibiotic De-Escalation in Emergency General SurgeryCarlo Vallicelli0Margherita Minghetti1Massimo Sartelli2Federico Coccolini3Luca Ansaloni4Vanni Agnoletti5Francesca Bravi6Fausto Catena7General, Emergency and Trauma Surgery Department, Bufalini Hospital, 47521 Cesena, ItalyGeneral, Emergency and Trauma Surgery Department, Bufalini Hospital, 47521 Cesena, ItalyDepartment of Surgery, Macerata Hospital, 62100 Macerata, ItalyGeneral, Emergency and Trauma Surgery Department, Pisa University Hospital, 56124 Pisa, ItalyDepartment of General and Emergency Surgery, Policlinico San Matteo, 27100 Pavia, ItalyAnesthesia, Intensive Care and Trauma Department, Bufalini Hospital, 47521 Cesena, ItalyHealthcare Administration, Santa Maria delle Croci Hospital, 48121 Ravenna, ItalyGeneral, Emergency and Trauma Surgery Department, Bufalini Hospital, 47521 Cesena, Italy<i>Background.</i> 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. <i>Methods.</i> A literature search was performed on PubMed and Cochrane using “de-escalation”, “antibiotic therapy” and “antibiotic treatment” as research terms. <i>Results.</i> 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. <i>Conclusions.</i> 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.https://www.mdpi.com/2079-6382/11/9/1148antibioticsde-escalationemergency general surgery |
| spellingShingle | Carlo Vallicelli Margherita Minghetti Massimo Sartelli Federico Coccolini Luca Ansaloni Vanni Agnoletti Francesca Bravi Fausto Catena Antibiotic De-Escalation in Emergency General Surgery Antibiotics antibiotics de-escalation 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 | antibiotics de-escalation emergency general surgery |
| url | https://www.mdpi.com/2079-6382/11/9/1148 |
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