2013 WSES guidelines for management of intra-abdominal infections

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Abstract

Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high.

The 2013 update of the World Society of Emergency Surgery (WSES) guidelines for the management of intra-abdominal infections contains evidence-based recommendations for management of patients with intra-abdominal infections.

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Most cited references 246

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Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study

Mark S. Pearce, Jane Salotti, Mark Little … (2012)

Summary Background Although CT scans are very useful clinically, potential cancer risks exist from associated ionising radiation, in particular for children who are more radiosensitive than adults. We aimed to assess the excess risk of leukaemia and brain tumours after CT scans in a cohort of children and young adults. Methods In our retrospective cohort study, we included patients without previous cancer diagnoses who were first examined with CT in National Health Service (NHS) centres in England, Wales, or Scotland (Great Britain) between 1985 and 2002, when they were younger than 22 years of age. We obtained data for cancer incidence, mortality, and loss to follow-up from the NHS Central Registry from Jan 1, 1985, to Dec 31, 2008. We estimated absorbed brain and red bone marrow doses per CT scan in mGy and assessed excess incidence of leukaemia and brain tumours cancer with Poisson relative risk models. To avoid inclusion of CT scans related to cancer diagnosis, follow-up for leukaemia began 2 years after the first CT and for brain tumours 5 years after the first CT. Findings During follow-up, 74 of 178 604 patients were diagnosed with leukaemia and 135 of 176 587 patients were diagnosed with brain tumours. We noted a positive association between radiation dose from CT scans and leukaemia (excess relative risk [ERR] per mGy 0·036, 95% CI 0·005–0·120; p=0·0097) and brain tumours (0·023, 0·010–0·049; p<0·0001). Compared with patients who received a dose of less than 5 mGy, the relative risk of leukaemia for patients who received a cumulative dose of at least 30 mGy (mean dose 51·13 mGy) was 3·18 (95% CI 1·46–6·94) and the relative risk of brain cancer for patients who received a cumulative dose of 50–74 mGy (mean dose 60·42 mGy) was 2·82 (1·33–6·03). Interpretation Use of CT scans in children to deliver cumulative doses of about 50 mGy might almost triple the risk of leukaemia and doses of about 60 mGy might triple the risk of brain cancer. Because these cancers are relatively rare, the cumulative absolute risks are small: in the 10 years after the first scan for patients younger than 10 years, one excess case of leukaemia and one excess case of brain tumour per 10 000 head CT scans is estimated to occur. Nevertheless, although clinical benefits should outweigh the small absolute risks, radiation doses from CT scans ought to be kept as low as possible and alternative procedures, which do not involve ionising radiation, should be considered if appropriate. Funding US National Cancer Institute and UK Department of Health.

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The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria.

Patrice Nordmann, Gaelle Cuzon, Thierry Naas (2009)

From early this decade, Enterobacteriaceae that produce Klebsiella pneumoniae carbapenemases (KPC) were reported in the USA and subsequently worldwide. These KPC-producing bacteria are predominantly involved in nosocomial and systemic infections; although they are mostly Enterobacteriaceae, they can also be, rarely, Pseudomonas aeruginosa isolates. KPC beta lactamases (KPC-1 to KPC-7) confer decreased susceptibility or resistance to virtually all beta lactams. Carbapenems (imipenem, meropenem, and ertapenem) may thus become inefficient for treating enterobacterial infections with KPC-producing bacteria, which are, in addition, resistant to many other non-beta-lactam molecules, leaving few available therapeutic options. Detection of KPC-producing bacteria may be difficult based on routine antibiotic susceptibility testing. It is therefore crucial to implement efficient infection control measures to limit the spread of these pathogens.

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Grading strength of recommendations and quality of evidence in clinical guidelines: report from an american college of chest physicians task force.

Gordon Guyatt, David Gutterman, Michael H Baumann … (2006)

While grading the strength of recommendations and the quality of underlying evidence enhances the usefulness of clinical guidelines, the profusion of guideline grading systems undermines the value of the grading exercise. An American College of Chest Physicians (ACCP) task force formulated the criteria for a grading system to be utilized in all ACCP guidelines that included simplicity and transparency, explicitness of methodology, and consistency with current methodological approaches to the grading process. The working group examined currently available systems, and ultimately modified an approach formulated by the international GRADE group. The grading scheme classifies recommendations as strong (grade 1) or weak (grade 2), according to the balance among benefits, risks, burdens, and possibly cost, and the degree of confidence in estimates of benefits, risks, and burdens. The system classifies quality of evidence as high (grade A), moderate (grade B), or low (grade C) according to factors that include the study design, the consistency of the results, and the directness of the evidence. For all future ACCP guidelines, The College has adopted a simple, transparent approach to grading recommendations that is consistent with current developments in the field. The trend toward uniformity of approaches to grading will enhance the usefulness of practice guidelines for clinicians.

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Author and article information

Contributors

Massimo Sartelli

Pierluigi Viale

Fausto Catena

Luca Ansaloni

Ernest Moore

Mark Malangoni

Frederick A Moore

George Velmahos

Raul Coimbra

Rao Ivatury

Andrew Peitzman

Kaoru Koike

Ari Leppaniemi

Walter Biffl

Clay Cothren Burlew

Zsolt J Balogh

Ken Boffard

Cino Bendinelli

Sanjay Gupta

Yoram Kluger

Ferdinando Agresta

Salomone Di Saverio

Imtiaz Wani

Alex Escalona

Carlos Ordonez

Gustavo P Fraga

Gerson Alves Pereira Junior

Miklosh Bala

Yunfeng Cui

Sanjay Marwah

Boris Sakakushev

Victor Kong

Noel Naidoo

Adamu Ahmed

Ashraf Abbas

Gianluca Guercioni

Nereo Vettoretto

Rafael Díaz-Nieto

Ihor Gerych

Cristian Tranà

Mario Paulo Faro

Kuo-Ching Yuan

Kenneth Yuh Yen Kok

Alain Chichom Mefire

Jae Gil Lee

Suk-Kyung Hong

Wagih Ghnnam

Boonying Siribumrungwong

Norio Sato

Kiyoshi Murata

Takayuki Irahara

Federico Coccolini

Helmut A Segovia Lohse

Alfredo Verni

Tomohisa Shoko

Journal

Journal ID (nlm-ta): World J Emerg Surg

Journal ID (iso-abbrev): World J Emerg Surg

Title: World Journal of Emergency Surgery : WJES

Publisher: BioMed Central

ISSN (Electronic): 1749-7922

Publication date Collection: 2013

Publication date (Electronic): 8 January 2013

Volume: 8

Page: 3

Affiliations

[1 ]Department of Surgery, Macerata Hospital, Macerata, Italy

[2 ]Clinic of Infectious Diseases, Department of Internal Medicine Geriatrics and Nephrologic Diseases, St Orsola-Malpighi University Hospital, Bologna, Italy

[3 ]Emergency Surgery, Maggiore Parma Hospital, Parma, Italy

[4 ]Department of General Surgery, Ospedali Riuniti, Bergamo, Italy

[5 ]Department of Surgery, Denver Health Medical Center, Denver, CO, USA

[6 ]American Board of Surgery, Philadelphia, PA, USA

[7 ]University of Texas Health Science Center, Houston, TX, USA

[8 ]Harvard Medical School, Division of Trauma, Emergency Surgery and Surgical Critical Care Massachusetts General Hospital, Boston, MA, USA

[9 ]Department of Surgery, UC San Diego Health System, San Diego, CA, USA

[10 ]Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA

[11 ]Division of General Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

[12 ]Department of Primary Care & Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan

[13 ]Department of Abdominal Surgery, University Hospital Meilahti, Helsinki, Finland

[14 ]Department of Surgery, University of Newcastle, Newcastle, NSW, Australia

[15 ]Department of Surgery, Charlotte Maxeke Johannesburg Hospital University of the Witwatersrand, Johannesburg, South Africa

[16 ]Department of Surgery, Govt Medical College and Hospital, Chandigarh, India

[17 ]Department of General Surgery, Rambam Health Care Campus, Haifa, Israel

[18 ]Department of Surgery, Adria Hospital, Adria, Italy

[19 ]Department of Surgery, Maggiore Hospital, Bologna, Italy

[20 ]Department of Digestive Surgery Faculty of Medicine Pontificia Universidad Católica de Chile, Santiago, Chile

[21 ]Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India

[22 ]Department of Surgery, Universidad del Valle, Fundacion Valle del Lili, Cali, Colombia

[23 ]Division of Trauma Surgery, Hospital de Clinicas - University of Campinas, Campinas, Brazil

[24 ]Emergency Unit, Department of Surgery, Ribeirão Preto, Brazil

[25 ]Department of General Surgery, Hadassah Medical Center, Jerusalem, Israel

[26 ]Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China

[27 ]Department of Surgery, Pt BDS Post-graduate Institute of Medical Sciences, Rohtak, India

[28 ]First Clinic of General Surgery, University Hospital /UMBAL/ St George Plovdiv, Plovdiv, Bulgaria

[29 ]Department of Surgery, Edendale Hospital, Pietermaritzburg, Republic of South Africa

[30 ]Department of Surgery, Port Shepstone Hospital, Kwazulu Natal, South Africa

[31 ]Department of Surgery, Ahmadu Bello University Teaching Hospital Zaria, Kaduna, Nigeria

[32 ]Department of Surgery, Mansoura University Hospital, Mansoura, Egypt

[33 ]Department of Surgery, Mazzoni Hospital, Ascoli Piceno, Italy

[34 ]Department of Surgery, Mellini Hospital, Chiari (BS), Italy

[35 ]Department of General and Digestive Surgery, University Hospital, Malaga, Spain

[36 ]Department of General Surgery, Lviv Emergency Hospital, Lviv, Ukraine

[37 ]Department of Surgery, Ancona University, Ancona, Italy

[38 ]Division of General and Emergency Surgery, Faculdade de Medicina da Fundação do ABC, São Paulo, Santo André, Brazil

[39 ]Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan

[40 ]Department of Surgery, Ripas Hospital, Bandar Seri Begawan, Brunei

[41 ]Clinical Sciences, Regional Hospitals Limbe and Buea, Limbe, Cameroon

[42 ]Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

[43 ]Division of Trauma and Surgical Critical Care, Department of Surgery, University of Ulsan, Seoul, Republic of Korea

[44 ]Wagih Ghnnam, Department of Surgery, Khamis Mushayt General Hospital, Khamis Mushayt, Saudi Arabia

[45 ]Boonying Siribumrungwong, Department of Surgery, Thammasat University Hospital, Pathumthani, Thailand

[46 ]Department of Acute and Critical Care Medicine, Tokyo Medical and Dental University, Tokyo, Japan

[47 ]Department of Emergency and Critical Care Medicine, Nippon Medical School, Emergency and Critical Care Center of Nippon Medical School, Tama-Nagayama Hospital, Tokyo, Japan

[48 ]II Catedra de Clinica Quirúrgica, Hospital de Clínicas, San Lorenzo, Paraguay

[49 ]Department of Surgery, Cutral Co Clinic, Neuquen, Argentina

[50 ]The Shock Trauma and Emergency Medical Center, Matsudo City Hospital, Chiba, Japan

Article

Publisher ID: 1749-7922-8-3

DOI: 10.1186/1749-7922-8-3

PMC ID: 3545734

PubMed ID: 23294512

SO-VID: 42157115-5f06-4367-9b12-9d4793a79ae7

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

2013 WSES guidelines for management of intra-abdominal infections

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Research from Ukraine

Most cited references 246

Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study

The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria.

Grading strength of recommendations and quality of evidence in clinical guidelines: report from an american college of chest physicians task force.

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