2013 WSES guidelines for management of intra-abdominal infections

World Journal of Emergency Surgery, Sep 2018

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. - 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)


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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