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Cost-effectiveness of ceftolozane/tazobactam plus metronidazole versus piperacillin/tazobactam as initial empiric therapy for the treatment of complicated intra-abdominal infections based on pathogen distributions drawn from national surveillance data in the United States

The prevalence of antimicrobial resistance among gram-negative pathogens in complicated intra-abdominal infections (cIAIs) has increased. In the absence of timely information on the infecting pathogens and their susceptibilities, local or regional epidemiology may guide initial empirical therapy and reduce treatment failure, length of stay and mortality. The objective of this...

Vancomycin for Surgical Prophylaxis?

The increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) has resulted in a reevaluation of the role of vancomycin for surgical prophylaxis. Two systematic reviews of randomized control studies have concluded that cephalosporins are as effective as vancomycin for the prevention of surgical site infections (SSIs). However, most of these studies were conducted...

Clinical Efficacy and Correlation of Clinical Outcomes With In Vitro Susceptibility for Anaerobic Bacteria in Patients With Complicated Intra-abdominal Infections Treated With Moxifloxacin

Background. Appropriate antimicrobial therapy results in improved clinical outcomes in complicated intra-abdominal infections (cIAIs). Recent in vitro studies have reported increasing moxifloxacin resistance of Bacteroides species, thereby cautioning empiric use in infections with these organisms. Methods. This pooled analysis of 4 randomized clinical trials (2000–2010) evaluated...

Source Control Review in Clinical Trials of Anti-Infective Agents in Complicated Intra-Abdominal Infections

In clinical trials of complicated intra-abdominal infections, assessment of adequacy of the initial surgical approach to the management of the infection is of considerable importance in determining outcome. Antibiotic therapy would not be expected to adequately treat the infection if the surgical procedure was inadequate with respect to source control. Inclusion of such cases in...

Meta-Analysis of Trials Evaluating Parenteral Antimicrobial Therapy for Skin and Soft Tissue Infections

Background. Many trials have been carried out to determine the effectiveness of antimicrobial agents in treating skin and soft tissue infections. The results of these studies are often utilized to make determinations about the use of these antimicrobials against other types of infections. Despite the importance of these trials in determining clinical care, we hypothesized that...

TG13 antimicrobial therapy for acute cholangitis and cholecystitis

Therapy with appropriate antimicrobial agents is an important component in the management of patients with acute cholangitis and/or acute cholecystitis. In the updated Tokyo Guidelines (TG13), we recommend antimicrobial agents that are suitable from a global perspective for management of these infections. These recommendations focus primarily on empirical therapy (presumptive...

TG13 management bundles for acute cholangitis and cholecystitis

Bundles that define mandatory items or procedures to be performed in clinical practice have been increasingly used in guidelines in recent years. Observance of bundles enables improvement of the prognosis of target diseases as well as guideline preparation. There were no bundles adopted in the Tokyo Guidelines 2007, but the updated Tokyo Guidelines 2013 (TG13) have adopted this...

Divergent adaptive and innate immunological responses are observed in humans following blunt trauma

Background The immune response to trauma has traditionally been modeled to consist of the systemic inflammatory response syndrome (SIRS) followed by the compensatory anti-inflammatory response syndrome (CARS). We investigated these responses in a homogenous cohort of male, severe blunt trauma patients admitted to a University Hospital surgical intensive care unit (SICU). After...

TG13 flowchart for the management of acute cholangitis and cholecystitis

We propose a management strategy for acute cholangitis and cholecystitis according to the severity assessment. For Grade I (mild) acute cholangitis, initial medical treatment including the use of antimicrobial agents may be sufficient for most cases. For non-responders to initial medical treatment, biliary drainage should be considered. For Grade II (moderate) acute cholangitis...

TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos)

Since its publication in 2007, the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) have been widely adopted. The validation of TG07 conducted in terms of clinical practice has shown that the diagnostic criteria for acute cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. Discussion by the Tokyo...

TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis

In 2007, the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) were first published in the Journal of Hepato-Biliary-Pancreatic Surgery. The fundamental policy of TG07 was to achieve the objectives of TG07 through the development of consensus among specialists in this field throughout the world. Considering such a situation, validation and feedback...

Health Care—Associated Infection (HAI): A Critical Appraisal of the Emerging Threat—Proceedings of the HAI Summit

Marin H. Kollef () 1 3 Lena M. Napolitano 0 Joseph S. Solomkin 7 Richard G. Wunderink 6 In-Gyu Bae 4 Vance G. Fowler 4 Robert A. Balk 5 Dennis L. Stevens 9 James J. Rahal 2 8 Andrew F. Shorr 11 12

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

Joseph S. Solomkin () 9 John E. Mazuski 8 John S. Bradley 7 Keith A. Rodvold 15 Ellie J. C. Goldstein 12 Ellen J. Baron 11 Patrick J. O'Neill 14 Anthony W. Chow 2 E. Patchen Dellinger 10 Soumitra R

New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo guidelines

Background The Tokyo Guidelines for the management of acute cholangitis and cholecystitis were published in 2007 (TG07) and have been widely cited in the world literature. Because of new information that has been published since 2007, we organized the Tokyo Guidelines Revision Committee to conduct a multicenter analysis to develop the updated Tokyo Guidelines (TG13). Methods...

New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo guidelines

Background The Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) were published in 2007 as the world’s first guidelines for acute cholangitis and cholecystitis. The diagnostic criteria and severity assessment of acute cholecystitis have since been widely used all over the world. A validation study of TG07 has shown that the diagnostic criteria for...

TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos)

Since the publication of the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07), diagnostic criteria and severity assessment criteria for acute cholangitis have been presented and extensively used as the primary standard all over the world. However, it has been found that there are crucial limitations in these criteria. The diagnostic criteria of...

Guidelines for the Selection of Anti-infective Agents for Complicated Intra-abdominal Infections

addition, duration of therapy for postoperative infections is an important variable that needs study. DISCLOSURE OF FINANCIAL INTERESTS OR RELATIONSHIPS Joseph S. Solomkin has received honoraria and travel

Antimicrobial therapy for acute cholecystitis: Tokyo Guidelines

Masahiro Yoshida 10 Tadahiro Takada 10 Yoshifumi Kawarada 9 Atsushi Tanaka 8 Yuji Nimura 15 Harumi Gomi 14 Masahiko Hirota 13 Fumihiko Miura 10 Keita Wada 10 Toshihiko Mayumi 12 Joseph S. Solomkin 17 ... the acute cholecystitis, if you do a cholecystectomy, that you can often get away with a very short course, especially if it is a mild case, which meant most of the cases. Joseph S. Solomkin (USA): The