Clinical Challenges in Abdominal Infections Management: Dynamic Source Control and Adaptive Antibiotic Therapy

Dear Colleagues,

Abdominal infections remain a leading cause of sepsis, prolonged hospitalization, and mortality in both surgical and intensive care units across the world. Despite advances in source control techniques and broad-spectrum antibiotics, two critical challenges persist: failure of initial source control, which drives re-intervention rates of 10–30%, and inappropriate antibiotic duration, which fuels antimicrobial resistance. Current guidelines still recommend 4–7 days of therapy, but emerging evidence from trials such as STOP-IT and DURAPOP suggests that shorter courses (3–5 days) are safe—provided that source control is adequate. However, the intersection of these two pillars remains dangerously underexplored. What happens when source control is incomplete, delayed, or fails? How should antibiotic duration and de-escalation be adapted in real time based on re-intervention needs? This knowledge gap lies at the heart of persistent sepsis, recurrent intra-abdominal abscesses, and the emergence of multidrug-resistant organisms (MDROs) in the post-operative peritoneum.

This Special Issue aims to explore the most recent advances in abdominal infection management, with a particular focus on dynamic source control and adaptive antibiotic therapy. We welcome contributions addressing the clinical prediction of source control failure, the optimal timing and techniques for re-intervention (surgical, percutaneous, or endoscopic), antibiotic stewardship in re-operated patients, and novel strategies to prevent resistance while avoiding undertreatment. We particularly seek studies that integrate real-time biomarkers (such as procalcitonin and presepsin), peritoneal microbiome analysis, and risk scoring systems (e.g., Van Rijn, D-FAS, WSES scores) to guide adaptive decision-making in abdominal infections.

Topics of interest for publication include, but are not limited to, the following:

• Prediction and early recognition of source control failure
  Prediction models, early warning scores (Van Rijn, D-FAS, WSES), and dynamic risk assessment in abdominal infections.
• Timing and techniques for re-intervention
  Optimal timing of surgical vs. percutaneous vs. endoscopic re-intervention after failed initial source control.
• Short-course and biomarker-guided antibiotic therapy
  Short-course antibiotic therapy (≤5 days) in patients with confirmed adequate source control; procalcitonin-guided antibiotic discontinuation in post-operative peritonitis.
• Adaptive antibiotic strategies in re-operated patients
  Antibiotic de-escalation strategies in patients requiring re-operation; real-time adaptation based on re-intervention needs.
• Empirical therapy in previously colonized patients with MDROs
  Tailoring empirical regimens in patients with known colonization by carbapenem-resistant Enterobacterales (CRE), vancomycin-resistant Enterococci (VRE), or other MDROs.
• The role of Enterococci and Candida revisited
  Rethinking the pathogenicity, indications for treatment, and overgrowth prevention of Enterococci and Candida in recurrent abdominal sepsis.
• Peritoneal microbiome and molecular diagnostics
  The role of peritoneal fluid cultures, metagenomic sequencing, and rapid resistance gene detection in guiding adaptive therapy.
• Adjunctive surgical strategies for infection control
  Open abdomen management, negative pressure therapy, and peritoneal lavage strategies as infection control adjuncts.
• Long-term outcomes and resistance prevention
  Long-term outcomes (recurrent abscess, adhesive disease, chronic pain) after failed source control; prevention of CRE and Candida

Dr. Τaxiarchis Κonstantinos Nikolouzakis
Guest Editor

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• abdominal infections
• source control failure
• re-operation
• antibiotic de-escalation
• short-course antibiotic therapy
• procalcitonin
• multidrug-resistant organisms
• enterococci
• candida
• empirical therapy