Infection in Acute Care Surgery

A special issue of Antibiotics (ISSN 2079-6382).

Deadline for manuscript submissions: closed (31 January 2023) | Viewed by 5337

Special Issue Editors


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Guest Editor
Department of Emergency Surgery and Trauma, Bufalini Hospital, AUSL Romagna, 47521 Cesena, Italy
Interests: acute care surgery; infections; trauma; emergency general surgery; intra-abdominal infections
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL Romagna, 47521 Cesena, Italy
Interests: dynamics of infection; evolution; anesthesia; airway management; intensive care; healthcare management
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Ospedale M. Bufalini, Cesena, Italy
Interests: surgical oncology; surgery; gastrointestinal diseases
Talent Recruitment and Career Support (TRACS) Office and Bibliometrics Analysis, Nanyang Technological University, Singapore 639798, Singapore
Interests: scientometrics; human microbiome; essential nutrition; COVID-19; Luigi Cornaro diet; restrictive eating; starvation-induced autophagy; metabolic syndromes; diabetes mellitus; obesity; anorexia nervosa

Special Issue Information

Dear Colleagues,

Antibiotic resistance is a world health issue. An acute care surgeon has to decide the appropriate antibiotic therapy every day without compromising the world antibiotic armamentarium available. Moreover, postoperative and acute care surgery patients are a further challenge because of SIRS that has to be differentiated from infection. The type of empirical treatment has to be tailored to the single patient according to guidelines, considering also local ecology and resistance data. Obviously, de-escalation according to patient risk, pursuing target therapy, is fundamental. Additionally, in the acute care surgery setting, antibiotic stewardship is mandatory.

Dr. Fausto Catena
Dr. Vanni Agnoletti
Prof. Dr. Luca Ansaloni
Dr. Ligen Yu
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

  • acute care surgery
  • infections
  • antibiotics
  • resistance
  • intensive care

Published Papers (3 papers)

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Research

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14 pages, 846 KiB  
Article
A Six-Year Retrospective Study of Microbiological Characteristics and Antimicrobial Resistance in Specimens from a Tertiary Hospital’s Surgical Ward
by Petros Ioannou, Sofia Maraki, Dimitra Koumaki, Georgios A. Manios, Vasiliki Koumaki, Dimitrios Kassotakis, Georgios V. Zacharopoulos, Diamantis P. Kofteridis, Andreas Manios and Eelco de Bree
Antibiotics 2023, 12(3), 490; https://doi.org/10.3390/antibiotics12030490 - 01 Mar 2023
Cited by 2 | Viewed by 1447
Abstract
Surgery has revolutionized the practice of medicine by allowing the treatment of conditions amenable to conservative medical management with some of them pathophysiologically involving the prevalence of pathogenic microorganisms. On the other hand, infections such as surgical site infections or urinary tract infections [...] Read more.
Surgery has revolutionized the practice of medicine by allowing the treatment of conditions amenable to conservative medical management with some of them pathophysiologically involving the prevalence of pathogenic microorganisms. On the other hand, infections such as surgical site infections or urinary tract infections may complicate patients hospitalized in surgical wards leading to considerable morbidity, mortality, and increased healthcare-associated costs. The aim of this study was to present the microbiological characteristics and antimicrobial resistance of all isolates identified in microbiological specimens from a surgical ward of a tertiary hospital in Greece during a six-year period. Only specimens that yielded at least one microorganism were included in the analysis. In total, 1459 strains in 789 positive cultures were isolated. The most common sample sent to the microbiology department was pus from surgical wounds. The most common pathogens among all 1459 strains isolated were Enterobacterales at 33% (n = 482), however, the most common genus was Enterococcus at 22.3% (n = 326). Antimicrobial resistance against third-generation cephalosporins was 23% (n = 111/482) among Enterobacterales, while, the rate of vancomycin-resistant enterococci (VRE) was 18.5% (n = 60/324) among Enterococcus species and was increasing in the last years of the study. Antimicrobial resistance of Acinetobacter baumannii to carbapenems was 68.8% (n = 11/16), which was lower than the corresponding rate in other wards in Greece. The antimicrobial resistance rates noted herein raise questions regarding the appropriateness of currently suggested antimicrobials in guidelines and imply that a revision could be required. Practicing clinicians should always be aware of local microbiological data that allow the selection of appropriate antimicrobials for the management of infections. Finally, the increasing rates of VRE noted herein mandate further actions from the point of infection control and antimicrobial stewardship. Full article
(This article belongs to the Special Issue Infection in Acute Care Surgery)
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10 pages, 260 KiB  
Article
Retrospective Study of Indications and Outcomes of Open Abdomen with Negative Pressure Wound Therapy Technique for Abdominal Sepsis in a Tertiary Referral Centre
by Francesco Prete, Giuseppe Massimiliano De Luca, Alessandro Pasculli, Giovanna Di Meo, Elisabetta Poli, Lucia Ilaria Sgaramella, Piercarmine Panzera, Francesco Vittore, Antonella Filoia, Fausto Catena, Mario Testini and Angela Gurrado
Antibiotics 2022, 11(11), 1498; https://doi.org/10.3390/antibiotics11111498 - 28 Oct 2022
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Abstract
In patients with advanced sepsis from abdominal disease, the open abdomen (OA) technique as part of a damage control surgery (DCS) approach enables relook surgery to control infection, defer intestinal anastomosis, and prevent intra-abdominal hypertension. Limited evidence is available on key outcomes, such [...] Read more.
In patients with advanced sepsis from abdominal disease, the open abdomen (OA) technique as part of a damage control surgery (DCS) approach enables relook surgery to control infection, defer intestinal anastomosis, and prevent intra-abdominal hypertension. Limited evidence is available on key outcomes, such as mortality and rate of definitive fascial closure (DFC), which are needed for surgeons to select patients and adequate therapeutic strategies. Abdominal closure with negative pressure wound therapy (NPWT) has shown rates of DFC around 90%. We conducted a retrospective study to evaluate in-hospital survival and factors associated with mortality in acute, non-trauma patients treated using the OA technique and NPWT for sepsis from abdominal disease. Fifty consecutive patients treated using the OA technique and NPWT between February 2015 and July 2022 were included. Overall mortality was 32%. Among surviving patients, 97.7% of cases reached DFC, and the overall complication rate was 58.8%, with one case of entero-atmospheric fistula. At univariable analysis, age (p = 0.009), ASA IV status (<0.001), Mannheim Peritonitis Index > 30 (p = 0.001) and APACHE II score (p < 0.001) were associated with increased mortality. At multivariable analysis, higher APACHE II was a predictor of in-hospital mortality (OR 2.136, 95% CI 1.08–4.22; p = 0.029). Although very resource-intensive, DCS and the OA technique are valuable tools to manage patients with advanced abdominal sepsis, allowing reduced mortality and high DFC rates. Full article
(This article belongs to the Special Issue Infection in Acute Care Surgery)

Review

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22 pages, 586 KiB  
Review
Antimicrobial Challenge in Acute Care Surgery
by Carlo Alberto Schena, Gian Luigi de’Angelis, Maria Clotilde Carra, Giorgio Bianchi and Nicola de’Angelis
Antibiotics 2022, 11(10), 1315; https://doi.org/10.3390/antibiotics11101315 - 27 Sep 2022
Cited by 2 | Viewed by 1827
Abstract
The burden of infections in acute care surgery (ACS) is huge. Surgical emergencies alone account for three million admissions per year in the United States (US) with estimated financial costs of USD 28 billion per year. Acute care facilities and ACS patients represent [...] Read more.
The burden of infections in acute care surgery (ACS) is huge. Surgical emergencies alone account for three million admissions per year in the United States (US) with estimated financial costs of USD 28 billion per year. Acute care facilities and ACS patients represent boost sanctuaries for the emergence, development and transmission of infections and multi-resistant organisms. According to the World Health Organization, healthcare-associated infections affected around 4 million cases in Europe and 1.7 million in the US alone in 2011 with 39,000 and 99,000 directly attributable deaths, respectively. In this scenario, antimicrobial resistance arose as a public-health emergency that worsens patients’ morbidity and mortality and increases healthcare costs. The optimal patient care requires the application of comprehensive evidence-based policies and strategies aiming at minimizing the impact of healthcare associated infections and antimicrobial resistance, while optimizing the treatment of intra-abdominal infections. The present review provides a snapshot of two hot topics, such as antimicrobial resistance and systemic inflammatory response, and three milestones of infection management, such as source control, infection prevention, and control and antimicrobial stewardship. Full article
(This article belongs to the Special Issue Infection in Acute Care Surgery)
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