Intra-abdominal infections (IAIs) are an important cause of morbidity and mortality in hospital settings worldwide. The cornerstones of IAI management include rapid, accurate diagnostics; timely, adequate source control; appropriate, short-duration antimicrobial therapy administered according to the principles of pharmacokinetics/pharmacodynamics and antimicrobial stewardship; and hemodynamic and organ functional support with intravenous fluid and adjunctive vasopressor agents for critical illness (sepsis/organ dysfunction or septic shock after correction of hypovolemia). In patients with IAIs, a personalized approach is crucial to optimize outcomes and should be based on multiple aspects that require careful clinical assessment. The anatomic extent of infection, the presumed pathogens involved and risk factors for antimicrobial resistance, the origin and extent of the infection, the patient's clinical condition, and the host's immune status should be assessed continuously to optimize the management of patients with complicated IAIs.

• Keywords
• Antimicrobial resistance, Antimicrobial therapy, Intra-abdominal infections, Source control,
• MeSH
• Anti-Bacterial Agents therapeutic use   MeSH
• Humans MeSH
• Intraabdominal Infections * drug therapy   MeSH
• Risk Factors MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Names of Substances
• Anti-Bacterial Agents MeSH

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in hospitals worldwide. The cornerstones of effective treatment of IAIs include early recognition, adequate source control, appropriate antimicrobial therapy, and prompt physiologic stabilization using a critical care environment, combined with an optimal surgical approach. Together, the World Society of Emergency Surgery (WSES), the Global Alliance for Infections in Surgery (GAIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), and the American Association for the Surgery of Trauma (AAST) have jointly completed an international multi-society document in order to facilitate clinical management of patients with IAIs worldwide building evidence-based clinical pathways for the most common IAIs. An extensive non-systematic review was conducted using the PubMed and MEDLINE databases, limited to the English language. The resulting information was shared by an international task force from 46 countries with different clinical backgrounds. The aim of the document is to promote global standards of care in IAIs providing guidance to clinicians by describing reasonable approaches to the management of IAIs.

• Keywords
• Intra-abdominal infections, Peritonitis, Sepsis,
• MeSH
• Anti-Bacterial Agents therapeutic use   MeSH
• Anti-Infective Agents * therapeutic use   MeSH
• Critical Pathways MeSH
• Humans MeSH
• Intraabdominal Infections * drug therapy   surgery   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Names of Substances
• Anti-Bacterial Agents MeSH
• Anti-Infective Agents * MeSH

Despite evidence supporting the effectiveness of best practices of infection prevention and management, many surgeons worldwide fail to implement them. Evidence-based practices tend to be underused in routine practice. Surgeons with knowledge in surgical infections should provide feedback to prescribers and integrate best practices among surgeons and implement changes within their team. Identifying a local opinion leader to serve as a champion within the surgical department may be important. The "surgeon champion" can integrate best clinical practices of infection prevention and management, drive behavior change in their colleagues, and interact with both infection control teams in promoting antimicrobial stewardship.

• Keywords
• Antibiotic therapy, Infection, Prevention, Surgeon,
• MeSH
• Surgeons psychology   standards   MeSH
• Adult MeSH
• Surgical Wound Infection prevention & control   MeSH
• Infection Control methods   standards   MeSH
• Middle Aged MeSH
• Humans MeSH
• Health Knowledge, Attitudes, Practice * MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• United States MeSH

[This corrects the article DOI: 10.1186/s13017-016-0089-y.].

• Publication type
• Journal Article MeSH
• Published Erratum MeSH

BACKGROUND: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. METHODS: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. RESULTS: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). CONCLUSION: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.

• Keywords
• Antibiotics, Antimicrobial stewardship, Infections, Surgery,
• MeSH
• Antimicrobial Stewardship methods   MeSH
• Anti-Infective Agents therapeutic use   MeSH
• Global Health trends   MeSH
• Humans MeSH
• Intraabdominal Infections drug therapy   MeSH
• Postoperative Complications drug therapy   MeSH
• Cross-Sectional Studies MeSH
• Surveys and Questionnaires MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• Anti-Infective Agents MeSH

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.

• Keywords
• Antibiotics, Intra-abdominal infections, Peritonitis, Sepsis,
• MeSH
• Anti-Bacterial Agents therapeutic use   MeSH
• Surgeons organization & administration   trends   MeSH
• Humans MeSH
• Disease Management MeSH
• Intraabdominal Infections drug therapy   surgery   MeSH
• Peritonitis drug therapy   MeSH
• Abdominal Injuries drug therapy   surgery   MeSH
• Sepsis drug therapy   surgery   MeSH
• Guidelines as Topic * MeSH
• Societies, Medical organization & administration   trends   MeSH
• Organ Dysfunction Scores MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Names of Substances
• Anti-Bacterial Agents MeSH

This paper reports on the consensus conference on the management of intra-abdominal infections (IAIs) which was held on July 23, 2016, in Dublin, Ireland, as a part of the annual World Society of Emergency Surgery (WSES) meeting. This document covers all aspects of the management of IAIs. The Grading of Recommendations Assessment, Development and Evaluation recommendation is used, and this document represents the executive summary of the consensus conference findings.

• Keywords
• Antibiotics, Intra-abdominal infections, Peritonitis, Sepsis,
• MeSH
• Anti-Bacterial Agents therapeutic use   MeSH
• Appendectomy methods   MeSH
• Abdominal Pain etiology   MeSH
• Cholecystectomy, Laparoscopic methods   MeSH
• Diverticulitis surgery   MeSH
• Laparoscopy methods   statistics & numerical data   MeSH
• Humans MeSH
• Decision Support Techniques MeSH
• Intra-Abdominal Hypertension etiology   prevention & control   MeSH
• Intraabdominal Infections complications   surgery   MeSH
• Tomography, X-Ray Computed methods   MeSH
• Guidelines as Topic * MeSH
• Ultrasonography methods   MeSH
• Organ Dysfunction Scores MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Consensus Development Conference MeSH
• Review MeSH
• Names of Substances
• Anti-Bacterial Agents MeSH