TY - JOUR
T1 - Management of intra-abdominal-infections
T2 - 2017 World Society of Emergency Surgery guidelines summary focused on remote areas and low-income nations
AU - Perrone, Gennaro
AU - Sartelli, Massimo
AU - Mario, Giuffrida
AU - Chichom-Mefire, Alain
AU - Labricciosa, Francesco Maria
AU - Abu-Zidan, Fikri M.
AU - Ansaloni, Luca
AU - Biffl, Walter L.
AU - Ceresoli, Marco
AU - Coccolini, Federico
AU - Coimbra, Raul
AU - Demetrashvili, Zaza
AU - Di Saverio, Salomone
AU - Fraga, Gustavo Pereira
AU - Khokha, Vladimir
AU - Kirkpatrick, Andrew W.
AU - Kluger, Yoram
AU - Leppaniemi, Ari
AU - Maier, Ronald V.
AU - Moore, Ernest Eugene
AU - Negoi, Ionut
AU - Ordonez, Carlos A.
AU - Sakakushev, Boris
AU - Lohse, Helmut A.Segovia
AU - Velmahos, George C.
AU - Wani, Imtaz
AU - Weber, Dieter G.
AU - Bonati, Elena
AU - Catena, Fausto
PY - 2020/10
Y1 - 2020/10
N2 - BACKGROUND: Most remote areas have restricted access to healthcare services and are too small and remote to sustain specialist services. In 2017, the World Society of Emergency Surgery (WSES) published guidelines for the management of intra-abdominal infections. Many hospitals, especially those in remote areas, continue to face logistical barriers, leading to an overall poorer adherence to international guidelines.METHODS: The aim of this paper is to report and amend the 2017 WSES guidelines for the management of intra-abdominal infections, extending these recommendations for remote areas and low-income countries. A literature search of the PubMed/MEDLINE databases was conducted covering the period up until June 2020.RESULTS: The critical shortages of healthcare workers and material resources in remote areas require the use of a robust triage system. A combination of abdominal signs and symptoms with early warning signs may be used to screen patients needing immediate acute care surgery. A tailored diagnostic step-up approach based on the hospital's resources is recommended. Ultrasound and plain X-ray may be useful diagnostic tools in remote areas. The source of infection should be totally controlled as soon as possible.CONCLUSIONS: The cornerstones of effective treatment for intra-abdominal infections in remote areas include early diagnosis, prompt resuscitation, early source control, and appropriate antimicrobial therapy. Standardization in applying the guidelines is mandatory to adequately manage intra-abdominal infections.
AB - BACKGROUND: Most remote areas have restricted access to healthcare services and are too small and remote to sustain specialist services. In 2017, the World Society of Emergency Surgery (WSES) published guidelines for the management of intra-abdominal infections. Many hospitals, especially those in remote areas, continue to face logistical barriers, leading to an overall poorer adherence to international guidelines.METHODS: The aim of this paper is to report and amend the 2017 WSES guidelines for the management of intra-abdominal infections, extending these recommendations for remote areas and low-income countries. A literature search of the PubMed/MEDLINE databases was conducted covering the period up until June 2020.RESULTS: The critical shortages of healthcare workers and material resources in remote areas require the use of a robust triage system. A combination of abdominal signs and symptoms with early warning signs may be used to screen patients needing immediate acute care surgery. A tailored diagnostic step-up approach based on the hospital's resources is recommended. Ultrasound and plain X-ray may be useful diagnostic tools in remote areas. The source of infection should be totally controlled as soon as possible.CONCLUSIONS: The cornerstones of effective treatment for intra-abdominal infections in remote areas include early diagnosis, prompt resuscitation, early source control, and appropriate antimicrobial therapy. Standardization in applying the guidelines is mandatory to adequately manage intra-abdominal infections.
KW - Acute appendicitis
KW - Acute cholecystitis
KW - Acute diverticulitis
KW - Antimicrobial resistance
KW - Intra-abdominal infections
KW - Remote areas
UR - http://www.scopus.com/inward/record.url?scp=85089506696&partnerID=8YFLogxK
U2 - 10.1016/j.ijid.2020.07.046
DO - 10.1016/j.ijid.2020.07.046
M3 - Article
C2 - 32739433
SN - 1201-9712
VL - 99
SP - 140
EP - 148
JO - International Journal of Infectious Diseases
JF - International Journal of Infectious Diseases
ER -