2013 WSES guidelines for management of intra-abdominal infections
World Journal of Emergency Surgery ,
Sep 2018
Massimo Sartelli , Pierluigi Viale , Fausto Catena , Luca Ansaloni , Ernest Moore , Mark Malangoni , Frederick A Moore , George Velmahos , Raul Coimbra , Rao Ivatury , et al.
Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. The 2013 update of the World Society of Emergency Surgery (WSES) guidelines for the management of intra-abdominal infections contains evidence-based recommendations for management of patients with intra-abdominal infections.
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2013 WSES guidelines for management of intra-abdominal infections
World Journal of Emergency Surgery
2013 WSES guidelines for management of intra-abdominal infections
Massimo Sartelli 0
Pierluigi Viale
Fausto Catena
Luca Ansaloni
Ernest Moore
Mark Malangoni
Frederick A Moore
George Velmahos
Raul Coimbra
Rao Ivatury
Andrew Peitzman
Kaoru Koike
Ari Leppaniemi
Walter Biffl
Clay Cothren Burlew
Zsolt J Balogh
Ken Boffard
Cino Bendinelli
Sanjay Gupta
Yoram Kluger
Ferdinando Agresta
Salomone Di Saverio
Imtiaz Wani
Alex Escalona
Carlos Ordonez
Gustavo P Fraga
Gerson Alves Pereira Junior
Miklosh Bala
Yunfeng Cui
Sanjay Marwah
Boris Sakakushev
Victor Kong
Noel Naidoo
Adamu Ahmed
Ashraf Abbas
Gianluca Guercioni
Nereo Vettoretto
Rafael Daz-Nieto
Ihor Gerych
Cristian Tran
Mario Paulo Faro
Kuo-Ching Yuan
Kenneth Yuh Yen Kok
Alain Chichom Mefire
Jae Gil Lee
Suk-Kyung Hong
Wagih Ghnnam
Boonying Siribumrungwong
Norio Sato
Kiyoshi Murata
Takayuki Irahara
Federico Coccolini
Helmut A Segovia Lohse
Alfredo Verni
Tomohisa Shoko
0 Department of Surgery, Macerata Hospital , Macerata , Italy
Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. The 2013 update of the World Society of Emergency Surgery (WSES) guidelines for the management of intra-abdominal infections contains evidence-based recommendations for management of patients with intra-abdominal infections.
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Introduction
The clinical recommendations discussed in these
guidelines are based on research conducted by members of
the WSES Expert Panel. These updated guidelines
replace those previously published in 2010 [1]. The
guidelines outline clinical recommendations based on the
Grading of Recommendations Assessment, Development,
and Evaluation (GRADE) hierarchy criteria summarized
in Table 1 [2,3].
Principles of surgical management
Intra-abdominal infections (IAIs) encompass a variety of
pathological conditions, ranging from uncomplicated
appendicitis to fecal peritonitis [4].
As a general principle, every verified source of
infection should be controlled as soon as possible. The level
of urgency of treatment is determined by the affected
organ(s), the relative speed at which clinical symptoms
progress and worsen, and the underlying physiological
stability of the patient.
The procedure used to treat the infection depends on
the anatomical site of infection, the degree of peritoneal
inflammation, the generalized septic response, the
patients underlying condition, and the available resources
of the treatment center. IAIs are subcategorized in 2
groups: uncomplicated and complicated IAIs [5].
In the event of an uncomplicated case of IAI, the
infection involves a single organ and does not spread to
the peritoneum. Patients with such infections can be
treated with either surgical intervention or antibiotics.
When the infection is effectively resolved by means of
surgery, a 24-hour regimen of perioperative antibiotics is
typically sufficient. Patients with uncomplicated
intraabdominal infections, such as acute diverticulitis, acute
cholecystitis, and acute appendicitis, may be treated
nonoperatively by means of antimicrobial therapy.
In the event of complicated IAI, the infectious process
proceeds beyond a single organ, causing either
localized or diffuse peritonitis. The treatment of patients with
Table 1 Grading of recommendations from Guyatt and colleagues [1,2]
Benefits clearly outweigh risk
and burdens, or vice versa
Benefits clearly outweigh risk
and burdens, or vice versa
Benefits clearly outweigh risk
and burdens, or vice versa
Quality of supporting evidence
RCTs without important limitations or Strong recommendation, applies to most
overwhelming evidence from observational patients in most circumstances without
studies reservation
RCTs with important limitations (inconsistent Strong recommendation, applies to most
results, methodological flaws, indirect or patients in most circumstances without
imprecise) or exceptionally strong evidence reservation
from observational studies
Observational studies or case series
Strong recommendation based on limited
evidence; recommendations may change
when higher quality or more extensive
evidence becomes available
Benefits closely balanced with RCTs without important limitations or Weak recommendation, best action may
risks and burdens overwhelming evidence from observational differ depending on circumstances,
studies expertise of clinician, the patient in
question, or other social issues
Benefits closely balanced with RCTs with important limitations (inconsistent Weak recommendation, best action may
risks and burdens results, methodological flaws, indirect or differ depending on circumstances,
imprecise) or exceptionally strong evidence expertise of clinician, the patient in
from observational studies question, or other social issues
Uncertainty in the estimates
of benefits, risks, and burdens;
benefits, risks, and burdens
may be closely balanced
Observational studies or case (...truncated)
This is a preview of a remote PDF: http://www.wjes.org/content/pdf/1749-7922-8-3.pdf
Massimo Sartelli, Pierluigi Viale, Fausto Catena, Luca Ansaloni, Ernest Moore, Mark Malangoni, Frederick A Moore, George Velmahos, Raul Coimbra, Rao Ivatury, Andrew Peitzman, Kaoru Koike, Ari Leppaniemi, Walter Biffl, Clay Cothren Burlew, Zsolt J Balogh, Ken Boffard, Cino Bendinelli, Sanjay Gupta, Yoram Kluger, Ferdinando Agresta, Salomone Di Saverio, Imtiaz Wani, Alex Escalona, Carlos Ordonez, Gustavo P Fraga, Gerson Alves Pereira, Miklosh Bala, Yunfeng Cui, Sanjay Marwah, Boris Sakakushev, Victor Kong, Noel Naidoo, Adamu Ahmed, Ashraf Abbas, Gianluca Guercioni, Nereo Vettoretto, Rafael Díaz-Nieto, Ihor Gerych, Cristian Tranà, Mario Paulo Faro, Kuo-Ching Yuan, Kenneth Yuh Yen Kok, Alain Chichom Mefire, Jae Gil Lee, Suk-Kyung Hong, Wagih Ghnnam, Boonying Siribumrungwong, Norio Sato, Kiyoshi Murata, Takayuki Irahara, Federico Coccolini, Helmut A Segovia Lohse, Alfredo Verni, Tomohisa Shoko.
2013 WSES guidelines for management of intra-abdominal infections ,
World Journal of Emergency Surgery,
2013, pp. 3, 8, DOI: 10.1186/1749-7922-8-3