Journal Article

The 2018 Lebanese Society of Infectious Diseases and Clinical Microbiology Guidelines for the use of antimicrobial therapy in complicated intra-abdominal infections in the era of antimicrobial resistance

Kanj, Souha S., Haddad, Nicholas, Moghnieh, Rima A., Awad, Lyn S., Abdallah, Dania I.

2019

Overview

Background The Lebanese Society of Infectious Diseases and Clinical Microbiology (LSIDCM) is involved in antimicrobial stewardship. In an attempt at guiding clinicians across Lebanon in regards to the proper use of antimicrobial agents, members of this society are in the process of preparing national guidelines for common infectious diseases, among which are the guidelines for empiric and targeted antimicrobial therapy of complicated intra-abdominal infections (cIAI). The aims of these guidelines are optimizing patient care based on evidence-based literature and local antimicrobial susceptibility data, together with limiting the inappropriate use of antimicrobials thus decreasing the emergence of antimicrobial resistance (AMR) and curtailing on other adverse outcomes. Methods Recommendations in these guidelines are adapted from other international guidelines but modeled based on locally derived susceptibility data and on the availability of pharmaceutical and other resources. Results These guidelines propose antimicrobial therapy of cIAI in adults based on risk factors, site of acquisition of infection, and clinical severity of illness. We recommend using antibiotic therapy targeting third-generation cephalosporin (3GC)-resistant gram negative organisms, with carbapenem sparing as much as possible, for community-acquired infections when the following risk factors exist: prior (within 90 days) exposure to antibiotics, immunocompromised state, recent history of hospitalization or of surgery and invasive procedure all within the preceding 90 days. We also recommend antimicrobial de-escalation strategy after culture results. Prompt and adequate antimicrobial therapy for cIAI reduces morbidity and mortality; however, the duration of therapy should be limited to no more than 4 days when adequate source control is achieved and the patient is clinically stable. The management of acute pancreatitis is conservative, with a role for antibiotic therapy only in specific situations and after microbiological diagnosis. The use of broad-spectrum antimicrobial agents including systemic antifungals and newly approved antibiotics is preferably restricted to infectious diseases specialists. Conclusion These guidelines represent a major step towards initiating a Lebanese national antimicrobial stewardship program. The LSIDCM emphasizes on development of a national AMR surveillance network, in addition to a national antibiogram for cIAI stratified based on the setting (community, hospital, unit-based) that should be frequently updated.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Abdomen / Abdominal abscess / Adult / Adults / Anti-infective agents / Anti-Infective Agents - therapeutic use / Antibiotics / Antiinfectives and antibacterials / Antimicrobial agents / Antimicrobial Resistance / Antimicrobial stewardship / Antimicrobial therapy / Associations / Bacterial and fungal diseases / Bacterial infections / Cephalosporins / Clinical medicine / Clinical microbiology / Communicable diseases / Communities / Community-acquired infections / Community-Acquired Infections - prevention & control / Complicated intra-abdominal infections / Dosage and administration / Drug resistance / Drug Resistance, Microbial / Drug therapy / Evaluation / Evidence-based medicine / Forecasts and trends / Guidelines / Humans / Immunocompromised Host / Infection / Infectious Diseases / Intensive care / Internal Medicine / Intervention / Intraabdominal Infections - drug therapy / Intraabdominal Infections - microbiology / Lebanon / Medical Microbiology / Medicine / Medicine & Public Health / Microbial drug resistance / Microbial Sensitivity Tests / Microbiology / Morbidity / Mortality / Neutropenia / Pancreatitis / Pancreatitis - drug therapy / Pancreatitis - microbiology / Parasitology / Patients / Practice guidelines (Medicine) / Professional associations / Research Article / Risk analysis / Risk factors / Studies / Surgery / Therapy / Time Factors / Trends / Tropical Medicine / Urinary tract diseases / Urinary tract infections / Urogenital system